Failure to Ensure Routine and Emergency Dental Services for Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents received needed routine and emergency dental services as required, including annual oral examinations and timely follow-up for identified dental problems. For one resident, admitted in early December, provider progress notes documented a dental infection on mid-January requiring an urgent dental referral, mandibular x-rays, chlorhexidine mouthwash, and multiple antibiotics. A subsequent provider note in late February documented gingivitis and continuation of chlorhexidine. Nursing notes over the following months repeatedly identified obvious cavities or broken teeth, inflamed or bleeding gums, mouth or facial pain, difficulty chewing, and rotting tooth decay. The resident complained of dental pain and was noted to be taking antibiotics prior to planned dental work, and staff documented that the resident was to have dental extractions due to poor dental health. Dental records for this resident showed a dental visit in late March, initiation of antibiotics, and a plan for dental extraction pending insurance authorization. However, subsequent dental appointments were rescheduled, canceled when the resident did not want to go, or missed as no-shows on multiple dates. After mid-June, there was no further documentation in the medical record regarding any additional dental appointments, the status of the gingivitis, or whether the planned dental extractions were ever completed. Despite ongoing documentation of dental decay and pain, the record lacked evidence of continued efforts to secure or complete the necessary dental treatment. For a second resident, admitted in late February of the prior year, the face sheet and interview revealed that the resident reported not having been to the dentist, experiencing dental pain, and having a missing denture. Physician orders from admission included a standing order to obtain dental consultation and treatment as needed for health and comfort, and a later order to schedule a dental evaluation that was subsequently discontinued without clear directions. In January of the following year, the resident was prescribed Amoxicillin-CLAV for dental pain, but progress notes contained no documentation of dental pain, no indication that the provider was contacted about dental issues, and no referral for a dental appointment. The quarterly MDS did not reflect any dental issues such as broken or loose dentures or mouth/facial pain, despite the care plan noting a suspected or actual dental infection. Interviews with the social services director and scheduler confirmed that no dental referral existed for this resident, that no routine dental appointments were being done, and that there were no past or future dental appointments scheduled, contrary to the facility’s own dental policy and the DON’s stated expectation that all residents receive annual dental exams and that staff follow dental orders.
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