Failure to Ensure Follow-Up and Documentation for Optometry Services
Summary
The facility failed to ensure adequate follow-up regarding optometry services for a resident with multiple cardiac diagnoses, including CHF, ischemic cardiomyopathy, and a history of sudden cardiac arrest. The resident was provided glasses by the facility's contracted optometry service, but later reported, through family, an inability to see out of the glasses. The Social Services Director (SSD) added the resident to the list for the next optometry visit but did not follow up to confirm if the resident was seen or if the issue was resolved. There was no documentation in the resident's medical record regarding vision or optometry services, and the SSD had not received any visit reports from the contracted optometry service since starting at the facility. These actions and omissions resulted in a lack of documented follow-up and unresolved vision concerns for the resident.
Penalty
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Below are regulatory guidelines relevant to this citation:
A resident on hospice with multiple diagnoses, including hearing loss, had documented moderate hearing difficulty and a care plan addressing hearing deficits, and later signed consent requesting an audiology consultation due to a new hearing deficit and decreased responsiveness. Despite this, the resident was never scheduled or seen by an audiologist for an extended period, could not hear normal conversation, and reported having no hearing aids or ear evaluation since admission. Facility leadership and the LSW confirmed the resident was omitted from the audiology list, missed a scheduled visit, and was affected by provider issues that left her without timely access to audiology services.
A resident with severe vision impairment and multiple comorbidities was recommended for cataract evaluation by an eye care consultant. Although staff attempted to find an ophthalmologist who accepted the resident's insurance and could accommodate bariatric needs, no appointment was scheduled, leaving the resident without necessary follow-up for vision care.
A resident with Alzheimer's disease and glaucoma did not receive a required eye doctor visit despite physician orders and a care plan indicating the need for vision services. Staff confirmed the resident had not been seen by an eye doctor since admission, and her glasses could not be located, contrary to facility policy requiring referrals for eye care.
A resident with severe cognitive impairment and diabetic retinopathy was not provided with corrective lenses or scheduled vision care appointments as ordered by physicians. The resident's glasses were missing, the prescription had expired, and there was no documentation of attendance or rescheduling of required eye appointments. Staff interviews confirmed a lack of documentation and awareness regarding the resident's vision needs, and the facility could not provide a policy for managing vision appointments or following physician orders.
Two residents with significant vision and hearing impairments did not receive timely optometry care. One resident had not seen an eye doctor since admission and could not locate her glasses, despite requests from her guardian to access ancillary services. Another resident, admitted with broken glasses and severe hearing loss, was not scheduled for a vision appointment and staff were unaware of the condition of the glasses.
A resident with end stage macular degeneration did not receive a timely follow-up appointment with a retina specialist as ordered by a physician. Although an LPN entered the referral order and passed it to the unit manager, there was no evidence the appointment was scheduled or completed, and the resident reported repeatedly requesting the appointment without resolution. Facility staff confirmed the lapse, and required documentation and coordination per facility policy were not found.
Failure to Provide Timely Audiology Services for Resident With Hearing Deficit
Penalty
Summary
The facility failed to ensure timely access to audiology services for a hospice resident with documented hearing loss and identified hearing concerns. The resident was admitted with multiple diagnoses, including unspecified hearing loss, and an MDS showing moderate difficulty hearing while remaining cognitively intact. Her care plan included interventions for a hearing deficit, such as getting her attention before speaking, facing her in good light, and minimizing background noise. An ancillary services consent form, signed several months after admission, documented a request for an audiological consultation due to a new hearing deficit and decreased responsiveness. The hospice agreement sample indicated that the facility was responsible for providing facility services at the same level of care as before hospice election and in compliance with applicable regulations. Despite the documented need and consent for audiology services, the resident was not seen by an audiologist during her stay up to the time of the survey. Observation showed she could not hear an introduction from the foot of the bed, appeared frustrated, and stated she could not hear unless someone came very close and spoke loudly. She reported she did not have hearing aids, had not seen anyone about her ears since admission, and knew she needed her ears checked before getting help for her hearing. The Administrator, DON, and LSW confirmed the resident had not been seen by an audiologist, explaining she was not placed on the list when first admitted, was omitted from the March audiology schedule after signing consent, and that there were subsequent issues with the provider not having an audiologist in the area while the facility transitioned to a new provider.
Failure to Ensure Timely Ophthalmology Follow-Up for Severely Impaired Vision
Penalty
Summary
A resident with multiple diagnoses, including chronic diastolic heart failure, type 2 diabetes mellitus, morbid obesity, asthma, insomnia, major depressive disorder, dry eyes syndrome, and bilateral age-related cataracts, was admitted to the facility and assessed as having severely impaired vision. The resident was alert, oriented, and cognitively intact. Medical records showed that the resident was seen by an eye care consultant, who recommended a follow-up with an ophthalmologist for cataract evaluation. Despite this recommendation, the resident reported being unable to see due to cataracts and stated that cataract surgery had been recommended but no appointment had been scheduled. Facility staff documented attempts to contact eight ophthalmologist offices, noting difficulties in finding a provider who accepted the resident's insurance and could accommodate bariatric patients, but there was no evidence that an appointment was ultimately scheduled.
Failure to Provide Vision Services as Needed
Penalty
Summary
The facility failed to ensure that a resident received necessary vision services as required. The resident, who had diagnoses including Alzheimer's disease, major depressive disorder, hypertension, and glaucoma, had a physician's order for an eye doctor visit as needed and was prescribed Latanoprost eye drops for glaucoma. The care plan identified impaired visual function and included interventions such as arranging consultations with an eye care practitioner. Despite a referral being sent in June for the resident to be seen by the facility eye doctor, the resident had not been seen by an eye doctor since admission in 2020. Interviews with staff confirmed that the resident had not received an eye doctor visit and that her glasses could not be located. The resident herself was unaware of the whereabouts of her glasses, and a CNA reported never having seen her wear glasses during nine months of employment. The facility's policy required referrals for eye care appointments as needed, but this was not followed, resulting in the resident not receiving appropriate vision services.
Failure to Provide Vision Services and Corrective Lenses as Ordered
Penalty
Summary
Resident #29, who has a history of diabetes mellitus with proliferative diabetic retinopathy and severe cognitive impairment, was not provided with corrective lenses or vision care appointments as ordered by physicians. The resident's care plan included interventions to arrange consultations with an eye care practitioner as required, and there were physician orders for both glasses and scheduled eye appointments. However, medical record review showed no documentation that the resident attended the scheduled optometrist or ophthalmologist appointments, nor was there evidence that these appointments were rescheduled or reasons documented for the missed visits. Additionally, the resident's prescription for glasses had expired, and there was no follow-up to obtain a new prescription or replacement glasses after the resident's glasses were reported missing. Interviews with facility staff, including the DON and regional directors, confirmed a lack of documentation regarding the missed appointments and the absence of a facility policy related to vision appointments or following physician orders for ancillary services. The resident's POA reported the missing glasses and noted that the resident did not have them during a leave of absence or recent visits. Observations confirmed the resident was not wearing glasses, and staff were unaware of their absence. The facility was unable to provide evidence of compliance with physician orders for vision care or corrective lenses for this resident.
Failure to Provide Timely Vision Care to Residents
Penalty
Summary
The facility failed to provide adequate and timely vision care to two residents. One resident, admitted with multiple diagnoses including dementia and psychiatric disorders, reported wearing glasses for distance vision prior to admission but had not seen an eye doctor since entering the facility. The resident was unable to locate her glasses and there was no evidence in her record of an optometry consult during her stay. Her guardian confirmed the resident was eligible for veteran's benefits and had previously requested staff assistance in accessing ancillary services, but no such services had been arranged. The Director of Nursing verified that the resident had not received optometry care since admission. Another resident, admitted with complex medical conditions including encephalopathy, HIV, malnutrition, and sensorineural hearing loss, was documented as having impaired vision and hearing. The resident was observed wearing broken glasses with only one lens and tape holding the frame together. Despite these issues, the resident was not included on the list for vision appointments, and staff interviews confirmed the resident had not seen an eye doctor since admission. Staff were also unaware of the condition of the resident's glasses. These findings were based on observation, record review, and interviews, and affected two of three residents reviewed for vision care.
Failure to Coordinate Follow-Up Vision Appointment
Penalty
Summary
A deficiency occurred when the facility failed to coordinate a follow-up vision appointment with a retina specialist for a resident diagnosed with end stage macular degeneration. The resident, who had intact cognition and required moderate assistance with activities of daily living, was seen by an eye doctor at the facility who recommended a follow-up with a retina specialist within one to two weeks. A physician order was entered for this referral, and the order was given to the unit manager to schedule the appointment. However, there was no evidence that the appointment was ever scheduled or completed, and the unit manager responsible for this task was no longer employed at the facility. The resident reported having requested the appointment multiple times and not being informed of any scheduled visit. Review of facility policy indicated that social services should collaborate with nursing staff to arrange such referrals and document them in the medical record, but no documentation of the referral or appointment was found. Interviews with facility staff confirmed the lack of follow-through on the physician's order, resulting in the resident not receiving the recommended specialist care.
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