Failure to Notify Primary POA of Resident’s New Skin Abrasions
Penalty
Summary
The deficiency involves the facility’s failure to notify the primary Power of Attorney for Healthcare (POAHC-M) of a change in condition for a resident with an activated healthcare power of attorney. The resident had multiple diagnoses, including traumatic brain injury, mild neurocognitive disorder with behavioral disturbance, delusional disorder, and muscle contractures, but had intact cognition with a BIMS score of 15/15. The POAHC document designated POAHC-M as the primary agent and POAHC-N as the alternate, to act only when POAHC-M was unavailable or unable, with POAHC-M resuming the role when again available. The resident’s facesheet instructed staff to call POAHC-M and, if there was no answer, to then call POAHC-N. On the date the new skin issues were identified, POAHC-M had emailed the facility stating they could not attend the care conference and had forwarded the invitation to POAHC-N, but there is no documentation that POAHC-M relinquished primary decision-making authority beyond this limited unavailability. On the day of the care conference, staff identified two new skin alterations: a chronic open area on the left ear related to phone use and poor neck strength, and an abrasion on the left side of the head from BiPAP straps. These areas were measured, documented, and discussed in person with POAHC-N, who attended the care conference and visited the resident weekly, but the facility did not notify POAHC-M of these new skin conditions. The wound care LPN confirmed discussing the left ear scab and head abrasion with POAHC-N at the conference. The Nursing Home Administrator stated that staff typically correspond with POAHC-M via email and that social services is designated to respond, and also acknowledged that POAHC-N, as the alternate POAHC, frequently interacts with staff and was present when the abrasions were discovered. POAHC-M later reported not being informed by the facility of the sores and learned of them from POAHC-N, who stated that POAHC-M had asked them to attend the care conference due to a brief period of unavailability and that they subsequently relayed information about the resident’s skin integrity to POAHC-M.
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