Observations
Based on a review of client records, the facility failed to document a dated signature of the client on each consent to release information in one of eight client records.
Client #2 was admitted on September 7, 2021 and is currently an active client. All of the consents to release information contained in client record #2 were signed by staff; however, there was no dated client signature present on any of the consents.
These findings were reviewed with facility staff during the licensing process.
This is a repeat deficiency from the June 29, 2021 licensing inspection.
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Plan of Correction
The consents in question were completed verbally and mailed to the patient for signature, but were not returned, for a telehealth-only patient. This process was completely replaced shortly after this patient was admitted by an electronic signature process in which telehealth-only patients sign consents electronically and no verbal consents are accepted. The consent completion process is monitored on a daily basis by medical records staff and ongoing by the site managers. This deficiency has already been corrected by the new process. |