cms_WV: 10804
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10804 | MARMET CENTER | 515146 | ONE SUTPHIN DRIVE | MARMET | WV | 25315 | 2009-09-25 | 152 | D | 0 | 1 | 7F5X11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records and staff interview, the facility failed to ensure the rights of residents were exercised by an individual appointed in accordance with State law. One (1) resident, who been determined to lack capacity prior to admission, had a health care surrogate appointed while in the hospital. Documentation indicated some staff was aware of this; however, others were a party to completion of a medical power of attorney document (MPOA), which would not be valid as the resident had not been deemed to have the capacity to make the appointment. Additionally, the MPOA had been witnessed by two (2) facility staff members, which was prohibited by the facility's policy. Two (2) residents, who were found to have capacity, had health care decisions made by others. Three (3) of the fifteen (15) current residents on the sample were affected. Resident identifiers: #6, #81, and #46. Facility census: 86. Findings include: a) Resident #6 This resident was admitted to the facility on [DATE]. 1. Review of the resident's medical record found a document entitled "Health Care Decision Making" that listed the resident's representative as Individual A and noted he was the resident's health care surrogate (HCS). At the bottom of the document, "Surrogate Decision Maker for Health Care" was marked as being the resident's advance directive. A date of 08/17/09, initialed by Employee #58, had been entered as the date the HCS document had been obtained. A "Physician order [REDACTED]. This form had been prepared by Employee #20, a registered nurse. This was further evidence some staff was aware the resident had previously had a health care surrogate appointed due to a determination of incapacity. 2. A copy of a "State of West Virginia Medical Power of Attorney" was also found in the resident's medical record. The form was dated 08/24/09 and signed by the resident. This form named Individual A as the resident's MPOA representative. There was no indication why the MPOA had been completed, given that the resident had a HCS appointed and needed only to be reviewed by the physician. 3. A "Physician Determination of Capacity" had been completed by the resident's physician on 08/25/09. The physician determined the resident lacked capacity to make health care decisions, because she lacked the capacity to appreciate the nature and implication of healthcare decisions. 4. To execute an MPOA, a resident must have capacity. This document had been completed, although her hospital records documented she lacked the capacity to make such an informed decision as this. Additionally, the day after it was signed, her attending physician at the facility also determined that she lacked capacity. 5. The MPOA, executed on 08/24/09, had been witnessed by facility staff - Employees #86 (the assistant director of nursing) and #89 (the food services director). The facility's policy entitled "Health Care Decision Making" includes: "GHC (Genesis Health Care) staff will not act as witnesses to signing of any forms or documents concerning health care decision making .... " 6. A copy of the HCS appointment from the hospital was found with the records the hospital had sent to the facility. There was also a "Determination of Capacity" form dated 08/05/09, where the physician had noted the resident demonstrated incapacity to make medical decisions based on his examination of her in the hospital. The incapacity was expected to be long term. 7. The social worker who had completed the "Health Care Decision Making" form (which noted the resident had a HCS) was not available. The director of nursing was asked if she was aware of what had prompted the completion of the MPOA document when the resident had a HCS from the hospital in place. She did not know why this had been done. She agreed the MPOA document would not have been valid, since the resident had determinations of incapacity before and after the MPOA document was executed. b) Resident #81 This resident's medical record contained a form entitled "Consent for Treatment and Release of Information". The form had the resident's name written on it and a date of 09/11/09. It was apparent this had been written by the same nurse (Employee #54) who also signed the form and dated her signature 09/11/09. The resident's MPOA representative had signed the document, which authorized medical care but also authorized disclosure of information to the resident's daughters, the resident's son, and two (2) in-laws. The determination of the resident's capacity was not completed until 09/15/09, at which time, he was determined to possess the capacity to make his own health care decisions. There was no indication why the resident's MPOA representative had signed the document, nor was there evidence the document had been reviewed with the resident to see whether he agreed. c) Resident #46 Medical record review, on 090/2/09, revealed this resident was admitted to the facility on [DATE]. Upon admission, the person whom this resident had appointed as her MPOA representative signed for the resident to be resuscitated in the event of cardiopulmonary arrest. There was no evidence of the resident's involvement in this decision. This was verified by the social worker at 4:00 p.m. on 09/22/09. At the time the MPOA signed for resuscitation, the resident had not been determined to lack the capacity to make informed health care decisions. In fact, on 09/09/09, the physician evaluated the resident and determined she did possess the capacity for medical decision making. . | 2014-12-01 |