§483.55 Dental services.
The facility must assist residents in obtaining routine and 24-hour emergency dental care.
§483.55(a) Skilled Nursing Facilities
A facility-
§483.55(a)(1) Must provide or obtain from an outside resource, in accordance with with §483.70(g) of this part, routine and emergency dental services to meet the needs of each resident;
§483.55(a)(2) May charge a Medicare resident an additional amount for routine and emergency dental services;
§483.55(a)(3) Must have a policy identifying those circumstances when the loss or damage of dentures is the facility's responsibility and may not charge a resident for the loss or damage of dentures determined in accordance with facility policy to be the facility's responsibility;
§483.55(a)(4) Must if necessary or if requested, assist the resident;
(i) In making appointments; and
(ii) By arranging for transportation to and from the dental services location; and
§483.55(a)(5) Must promptly, within 3 days, refer residents with lost or damaged dentures for dental services. If a referral does not occur within 3 days, the facility must provide documentation of what they did to ensure the resident could still eat and drink adequately while awaiting dental services and the extenuating circumstances that led to the delay.
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Observations:
Based on review of clinical records and resident payor source data, and staff interview, it was determined that the facility failed to ensure that routine annual and emergency dental services were provided for four Medicare/private payor source residents out of 13 residents sampled. (Resident 7, 11, 12 and 13).
Findings include:
Review of Resident 7's clinical record revealed admission to the facility on September 27, 2019, as a private pay payor source.
A Dental Consult form was completed on February 15, 2017, which indicated that the resident had a dental exam with findings of a cracked tooth evaluated and to follow-up in 6 months.
According to dental status report from the facility's contracted dental services dated December 9, 2021, as of September 23, 2021, dental treatment remained pending for Resident 7, needing resident or responsible party approval.
There was no documented evidence that from September 23, 2021, to the survey of December 9, 2021, the facility had secured the necessary follow-up for necessary dental services to be provided to Resident 7. The facility was unable to evidence that the resident had received dental services since February 15, 2017.
Review of Resident 11's clinical record revealed admission to the facility on April 29, 2016, as a Medicare payor source.
According to dental status report dated December 9, 2021, as of October 28, 2021, dental treatment was pending for Resident 11 requiring the resident or responsible party approval. There was no documented evidence that from October 28, 2021, to the time of the survey of December 9, 2021, that the facility had completed the follow-up steps necessary for dental services to be provided to Resident 11.
Review of Resident 12's clinical record revealed admission to the facility on September 11, 2021, as a Medicare payor source.
Review of dental consult performed on November 23, 2021, revealed that Resident 12 had moderate plaque and calculus, root concerns with tooth #19, and that the resident was not interested in dentures. Dental Recommendations included that the resident be referred to dental hygiene and extract tooth #19.
According to the dental status report dated December 9, 2021, as of November 24, 2021, the recommended dental treatment was pending for Resident 12, requiring resident or responsible party approval. Review of the dental status report revealed that treatment remained outstanding for adult prophylaxis (cleaning), surgical removal of tooth #19, and perapical x-ray. There was no documented evidence that the facility had secured the necessary follow-up to ensure that resident 12 received the recommended dental services in a timely manner.
Review of Resident 13's clinical record revealed admission to the facility on December 31, 2020, as a Medicare payor source.
According to dental status report dated December 9, 2021, as of October 28, 2021, dental treatment was pending, needing resident or responsible party approval. There was no documented evidence that from October 28, to December 9, 2021, the facility had completed the necessary follow-up for Resident 13 to receive dental services.
Interview with the Nursing Home Administrator on December 9, 2021 at approximately 2:00 p.m. revealed that the facility does not review the dental consult sheets and does not follow-up with the recommendations from the dentist. The NHA further stated that the dental consult forms are uploaded into the resident's electronic medical record and it is the responsibility of the facility's contracted dental office to contact the resident or the resident and/or residents' family regarding services. The NHA confirmed that he was not aware of the outstanding dental recommendations or residents' need for dental services prior to surveyor inquiry on December 9, 2021.
28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services
28 Pa. Code 201.21 (b)(c) Use of outside resources
28 Pa Code 211.15(a) Dental services
28 Pa. Code 201.18 (e)(3) Management
| | Plan of Correction - To be completed: 01/25/2022
Wesley Village submits that its policies, systems, and procedures related to resident care and comprehensive quality improvement program for monitoring of resident care are appropriate. Additionally, it is important to make clear that the submission of this plan of correction is not to be construed as an admission that the cited deficiencies are accurate or that at the time of the survey, Wesley Village did have policies, procedures and systems in place to maintain compliance with federal and state requirements; however, in an effort to enhance the care furnished to our residents, we have augmented some of our existing policies, procedures and systems.
Facility cannot address this as it relates to Resident 7. as resident was discharged from the facility on 12/11/21.
The facility cannot correct this as it relates to Resident 11, as this resident was discharged from facility on 10/31/21.
Resident 12 was seen by a Hygienist on 12/14/21 and received prophylaxis treatment
Resident 13's daughter was waiting on MA to be approved. Consent received on 12/11/21 and resident is scheduled to see the dentist on 12/30/21.
All facility residents who are Medicare/private pay will be evaluated by the facility contracted or personal dentists by 1/24/2022 to ensure they receive their routine annual visits and have initiated emergency dental services. All necessary appointments have been scheduled. All residents through these appointments with newly identified dental needs will have new appointments schedule for follow-up by 1/24/2022.
The Nursing Secretaries will be provided with a scheduling tool and be educated by 12/31/2021 on the necessity to track dental consults in addition to the scheduling conducted by the contract dental company. In addition, all dental consults will be reviewed by the ADON to ensure appropriate follow-up.
The facility QAPI Team has audited 100% of Medicare/private pay residents to ensure they received or are scheduled for their routine annual exam and have initiated existing emergency dental services as desired by the resident or and/or the Resident Representative. In addition, they will audit to ensure all newly identified dental needs have appointments established to address identified issues.
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