TORRANCE, CA - Federal inspectors cited Driftwood Healthcare Center for violating resident rights after staff required a cognitively impaired resident to sign a binding arbitration agreement despite multiple staff members acknowledging she lacked the mental capacity to understand legal documents.
Violation of Legal Consent Requirements
The August 2024 inspection revealed that Resident 83, who has fetal alcohol syndrome and autism, was asked to sign an arbitration agreement on July 20, 2024, without any assessment of her ability to understand the legal implications. The agreement waives the resident's right to pursue legal action through the court system.
Medical records showed the resident had a Brief Interview for Mental Status score of 99, indicating she was unable to complete the cognitive assessment. Her care notes specifically stated she is "alert to name only" and "severely impaired cognitively."
Licensed Vocational Nurse 5 told inspectors that Resident 83 "should not be asked to sign forms regarding care because Resident 83 is not capable of understanding what is being signed." The Registered Nurse Supervisor confirmed the resident "does not have the mental capacity to sign consents."
Staff Acknowledged the Error
The Business Office Manager Assistant, who was responsible for obtaining the signature, admitted she failed to check the resident's medical chart or assess mental capacity before presenting the agreement. "She should have assessed Resident 83's mental capacity because if she would have, she would have not had Resident 83 sign the AA," the staff member told inspectors.
The Director of Nursing confirmed that Resident 83 is "only alert to name and rarely understands" and stated she "should have not been asked to sign the AA because she is cognitively impaired."
Understanding Arbitration Agreements in Nursing Homes
Arbitration agreements are legal contracts that require disputes to be resolved through private arbitration rather than court proceedings. These agreements significantly limit residents' legal options if they experience harm or neglect.
Federal law requires nursing homes to ensure residents understand these agreements before signing. The facility's own policy mandated staff to "explain the agreement to the resident in a form or manner that they understand" and "confirm that the resident understands the agreement."
Medical Context of Cognitive Impairment
Fetal alcohol syndrome results from prenatal alcohol exposure and can cause intellectual disabilities, learning difficulties, and problems with decision-making. Autism spectrum disorders affect communication and social interaction abilities. Combined, these conditions significantly impact a person's capacity to understand complex legal documents.
When residents lack decision-making capacity, federal regulations require involvement of legal representatives or guardians to make informed decisions on their behalf. In this case, no legal representative signature appeared on the arbitration agreement.
Quality Assurance Failures
Inspectors also cited the facility for failing to maintain proper oversight through its Quality Assessment and Assurance Committee. The committee is designed to identify and correct quality deficiencies but failed to detect issues with dietary staff competencies and meal service accuracy.
The inspection found problems with dietary policies not being properly reviewed annually, with some documentation gaps extending back to 2022. This lack of systematic review creates conditions where outdated practices may continue unchecked.
Food Safety and Ice Machine Concerns
Additional violations included improper maintenance of the facility's ice machine, which showed brown discoloration when tested during the inspection. The Maintenance Supervisor confirmed the contamination, stating the tissue used to clean the machine "appeared to be a rustic brown color."
This violation affected 83 out of 85 sampled residents and created potential for foodborne illness. Contaminated ice can harbor microorganisms that cause stomach upset, cramping, nausea, vomiting, diarrhea, and fever, potentially leading to serious medical complications requiring hospitalization.
Regulatory Standards and Best Practices
Federal nursing home regulations exist to protect vulnerable residents who may not be able to advocate for themselves. Proper assessment of decision-making capacity ensures residents receive appropriate protections when they cannot fully understand the consequences of legal agreements.
Industry best practices require facilities to maintain comprehensive policies for identifying residents who need legal representatives and ensuring all legal documents are properly executed with appropriate oversight.
Facility Response and Ongoing Monitoring
The inspection report requires the facility to develop corrective action plans addressing each violation. State survey agencies will monitor compliance through follow-up visits and documentation review.
Families considering nursing home placement should inquire about facilities' policies for protecting residents' legal rights and ensuring proper oversight of vulnerable residents who may lack decision-making capacity.
The violations at Driftwood Healthcare Center highlight the importance of robust safeguards to protect nursing home residents' legal rights and ensure they receive appropriate representation when making important decisions about their care and legal protections.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Driftwood Healthcare Center from 2024-08-19 including all violations, facility responses, and corrective action plans.
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