Failure to Provide Access to Dental Services
Summary
The facility failed to provide access to oral surgery dental services for a Medicare resident, identified as Resident #26, who was reviewed for dental services. The resident was observed sitting in bed with missing top and bottom teeth and expressed a desire to see a dentist. The facility's Dental Services Policy and Procedure indicated that dental needs should be identified through assessments and addressed in the resident's care plan, with assistance provided for making dental appointments and arranging transportation. However, there was no dental care plan available for Resident #26. The resident's records showed a history of periodontal exams with recommendations for oral surgery to extract problematic teeth. Despite these recommendations, the facility did not make the necessary arrangements for the resident to receive oral surgery. Progress notes indicated attempts to schedule appointments and arrange transportation, but these efforts were unsuccessful due to issues with insurance coverage and transportation provider reimbursement. The resident was informed of the situation and expressed a desire to have her dental issues addressed. Interviews with facility staff, including a registered nurse and the Director of Social Services, confirmed that no further arrangements were made for the resident's oral surgery. The MDS Coordinator also confirmed the absence of a dental care plan for the resident. This deficiency highlights the facility's failure to comply with the statutory requirement to provide access to necessary health-related services, including dental care, for its residents.
Plan Of Correction
The corrective action accomplished for those residents affected include: Resident # 26 was reviewed and discussed with the resident's dentist on [date] for a secondary dental [procedure], and resident # 26 was seen by the dentist on [date]. Additional referral received and additional dental [procedure] scheduled at Nova Dental for [date] on [date]. Other residents having the potential to be affected were identified by: An audit was conducted by the Director of Social Services on [date] to identify if any other residents had missed their out-of-facility dental [appointments]. No other residents were identified as missing dental services by the audit. The measures of systematic changes made include: The Social Service Department reviewed the policy and procedure on Dental Services on [date]. Nursing Staff were reinserviced on [date] and [date] regarding scheduling and follow-ups. The corrective actions put in place include: The Director of Social Services or designee will perform random audits on a monthly basis for dental visits, recommendations, and compliance in follow-up and attendance. The Director of Nursing or designee will monitor ongoing compliance through random observations and chart reviews of nursing documentation and physician orders regarding dental updates. Findings will be reported to the QAPI Committee quarterly over the next six months with any necessary additional in-services.
Penalty
A resident with intact cognition and multiple medical conditions reported ongoing dental pain and difficulty eating, stating that dental care access was a persistent problem, with appointments delayed or cancelled without explanation. Facility records showed a prior in-house dental visit documenting a mobile root fragment causing discomfort and the resident’s interest in extraction, but there was no subsequent documentation of pain, broken tooth, or dental follow-up in progress notes or Social Services notes, and the MDS oral/dental section did not reflect the resident’s reported issues. The dental provider later returned on-site, but the resident was not seen, and no rationale was documented for the lack of timely dental services.
Failure to Ensure Timely Access to Needed Dental Services
Penalty
Summary
The facility failed to ensure access to needed dental services for one resident, resulting in a deficiency under the requirement to provide access to dental and other health-related services. The facility’s undated Dental Policy stated it would assist residents in obtaining routine and emergency dental care, including treatment for broken or otherwise damaged teeth or other oral problems requiring immediate attention. The resident, admitted with diagnoses including muscle wasting and atrophy, legal blindness, and anemia, reported ongoing dental problems and pain when eating, stating that receiving dental care at the facility was always a big issue. The resident indicated he had seen the dentist only once, had to initiate his own appointments because the facility took a long time, and that scheduled appointments were cancelled at the last minute without explanation. He reported that he mainly ate soft foods to accommodate his discomfort. Record review showed that a dental service note from 08/18/2025 documented a mobile root fragment on tooth #8 causing slight discomfort, with the resident interested in extraction. Despite this, there was no documentation in the resident’s progress notes of tooth pain, a broken tooth, or any follow-up regarding dental services, and the MDS oral/dental section did not reflect mouth or facial pain, chewing difficulty, or broken teeth. Social Services progress notes contained no documentation of offering dental services or any rationale for the lack of access to dental care. The Social Services Director later acknowledged that the resident had been seen by an in-house dentist on 08/18/2025 for the root fragment and that the dental company had been on-site again on 02/27/2026, but the resident was not seen and there was no explanation for the lack of follow-up after the initial visit.
Plan Of Correction
The statements made in this plan of correction are not an admission to and do not constitute an agreement with the alleged deficiencies herein. To remain in compliance with all federal and state regulations, the Center has taken or will take the actions set forth in the following plan of correction. The following plan of correction constitutes the Center's allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date indicated. 1. What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice. Resident #1 was immediately assessed for further dental needs or concerns on 3/27/2026 by LPN, Unit Manager. Pain assessment completed for resident # 1 with no complaints of dental pain at the time assessment was completed on 3/27/2026 by LPN, Unit Manager. On 3/26/2026 a dental appointment was immediately scheduled by Social Services Director for 4/10/2026 for evaluation and treatment of the identified root fragment on tooth #8 with facility dental provider. Review of resident #1s clinical record. Resident is alert and oriented and capable of making own decisions. Resident had no weight loss Per Dietician resident trending weight gain with meal consumption noted at 75-100% and no difficulty chewing or swallowingPain evaluation for last six months resident noted to have no complaints of pain by resident 2. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken. A facility wide quality review audit was initiated on 3/27/2026 by social services for long term care residents residing in the facility to identify those residents with dental concerns or needs.All identified residents with dental needs will be referred to dental services and scheduled for evaluation and treatment as indicted, as appropriate. 3. What measures will be put into place or what systematic changes you will make to ensure the deficient practiceOn 3/27/2026 The Social Service Director and Social Services Assistant was educated by NH/designee on the components of this regulation with emphasis on ensuring that residents with dental issues or concerns receive dental referrals and evaluation and treatment as indicated.New residents upon admission will be assessed for dental services and residents residing in the facility with identified dental issues/ concerns will be seen by dental services and any follow-up needed will be addressed.MDS Accuracy: The MDS coordinator was re-educated to ensure section L (Oral/Dental status) accurately reflects resident condition based on assessments and resident reports. 4. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into placeThe NHA/ Designee will audit 10 residents weekly x 4 weeks, twice monthly x1 month; then monthly and as indicated until substantial compliance has been met on the following: Ensuring that any identified resident with dental issues or concerns will be seen by the dental services and any follow-up needed will be addressed. Information will be brought to QAPI monthly and monitored until substantial compliance has been met.
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