A resident with macular degeneration and moderate cognitive impairment had a care plan directing staff to arrange eye care consultations and a written consult order to schedule an appointment with a cataract surgeon. The resident’s family reported missed eye appointments due to lack of facility follow-up. The Medical Records Director admitted he had not scheduled the surgery because he was backed up with other work, while the Administrator was unaware of the order and the Medical Director stated he expected Social Services to arrange the appointment and transportation. As a result, the facility did not coordinate the ordered vision services in accordance with its own policy.
Failure to provide hearing services for a resident with documented hearing loss. The resident used a journal to communicate, staff reportedly spoke loudly to the resident, and the resident said the facility had assessed hearing but had not followed up. Records showed moderate difficulty hearing, a care plan for poor hearing, and an audiology eval finding moderately severe to profound sensorineural hearing loss in both ears with a recommendation for hearing aids and medical clearance.
A resident reported requesting a hearing screening but still waiting for a hearing test, and the medical record lacked documentation of any hearing appointment or consultation. The DON later acknowledged the facility failed to submit the required audiology paperwork to the outside consultant, so the resident did not receive the hearing screen.
A resident with visual impairment reported that bedside glasses did not work and that a requested ophthalmology visit had not occurred, while documentation showed earlier notes of adequate vision followed by entries indicating vision loss, need for assistance, and a provider recommendation for ophthalmology follow-up. Staff described a process for arranging ophthalmology services and acknowledged the resident’s partial blindness and non-functioning glasses, and an NP documented the resident’s complaints of difficulty seeing and dry eyes, noting attempts to schedule an ophthalmology appointment complicated by insurance questions. Despite these documented concerns and awareness by nursing, NP, and DON, there was no evidence that an ophthalmology evaluation was obtained or that the resident’s vision impairment was appropriately assessed and treated.
Failure to arrange a vision follow-up appointment for a resident. The resident reported not receiving new glasses that were expected months earlier. Record review showed an ophthalmology referral to a retinologist for retinal injection evaluation, an Avastin injection with a 1-month follow-up recommendation, and a rescheduled retina appointment that was not arranged by the DON or facility.
A resident reported being unable to see without glasses and that their glasses were broken, and an NP documented the need for glasses. Despite ongoing notes about frequent falls, dizziness, and blurred vision, and documentation that the resident’s baseline vision was poor and that no glasses were at the bedside, there was no record that vision services were arranged or that glasses were obtained. The resident later confirmed that the glasses had not been replaced and that staff had only stated they would address it, while an RN on the unit was unaware of the glasses issue. The NP stated she had informed nursing staff but could not recall whom, and the Medical Director agreed that the glasses issue and the resident’s complaints of poor vision should have been followed up on.
A resident repeatedly complained of left ear wax buildup and difficulty hearing, and an LPN documented that the NP ordered Debrox and an ENT consult because it was a recurring problem. A consult provider recommended irrigating the left ear to remove wax, but the record showed multiple Debrox orders and no ENT consult order. The UM stated she was unaware the resident needed an ENT consult.
Failure to provide ordered vision assistive devices. A resident stated he/she was fitted for glasses but never received them, and no glasses were observed at bedside. Records showed an in-house eye visit for frame measurement, a later note indicating mild to moderate cataract with observation preferred, and a nursing entry stating the resident wore glasses. Staff and the DON could not provide documentation showing the resident refused glasses or that the facility had the ophthalmology recommendations or plan for the resident's vision care.
A resident with cataracts and prior R eye surgery reported that the facility never scheduled the recommended L eye cataract surgery. Eye care notes documented bothersome cataracts, stable VA, and repeated recommendations for ophthalmology consult and cataract extraction, but the EMR did not show a scheduled appt after the most recent eye exam until a later physician order listed one.
Failure to ensure residents received vision care and a recommended assistive device. Two residents had impaired vision: one reported blurred vision with a history of glaucoma, and another had a prior eye exam recommending new glasses but stated the glasses were never received. The DON said Health Drive provides vision services, but the survey found the residents had not received the needed follow-up care or the recommended glasses.
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