Failure to Provide Ordered Speech Therapy Services
Penalty
Summary
The deficiency involves the facility’s failure to provide physician-ordered specialized rehabilitative services, specifically speech therapy (ST), to a resident. Facility policies on Physician Orders required that treatment orders be carried out in accordance with the physician’s order, and the Speech Therapy policy described the purpose of identifying, assessing, and treating speech, language, and swallowing disorders. The resident was admitted with essential tremor, dysphagia in the oropharyngeal phase, and a cognitive communication deficit, and was their own responsible party. The admission MDS showed a BIMS score of 12/15, indicating intact memory, and documented difficulty or pain with swallowing. A physician’s order dated shortly after admission, based on an ST evaluation and plan of treatment, specified that the resident required ST services three times a week for four weeks. During interviews and record reviews with the Director of Rehab and the Regional Director of Therapy Services, it was confirmed that the ST evaluation was completed and that the ordered frequency of three ST visits per week for four weeks was established, but the resident was only seen once for the initial evaluation and was not placed on the ordered treatment schedule. The resident’s care plan for cognitive communication deficit documented that ST would provide skilled treatments three times a week for four weeks, including voice and breathing exercises, group treatment, and speech and hearing interventions, with a goal of improving functional skills to return home safely. On observation, the resident was seen lying in bed with shaking hands, speaking slowly, pausing between words, and reporting that they expected the ST to work with them on speech but had only received the evaluation and no further visits. The Regional Director of Therapy Services confirmed that no ST visits were provided in accordance with the physician-ordered frequency.
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