Opinion ID: 612907
Heading Depth: 4
Heading Rank: 4

Heading: Necessary Care and Services

Text: Pursuant to 42 C.F.R. § 483.25, Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Golden's treatment of R1's hyperkalemia supports a finding that Golden failed to provide necessary care and services. Merely two days after the hospital diagnosed R1 with hyperkalemia, critically high potassium levels, Golden's staff resumed administration of potassium pills to R1 and R1 was diagnosed with hyperkalemia again when she was admitted to the hospital on December 25, 2007. Evidence in the record shows R1's potassium levels were not monitored after her admission to the emergency room on December 15. A Golden employee conceded that the hyperkalemia just got missed. ( id. at 1588) The CMS expert opined that excessive potassium administration can lead to complications in patients with R1's level of kidney function. This and other evidence in the record supporting the violations described above constitutes substantial evidence that Golden did not provide R1 with the necessary care and services to satisfy this regulation. See 42 C.F.R. § 488.404(c)(1) (one of the factors to be considered in assessing a fine is the relationship of the one deficiency to other deficiencies resulting in noncompliance); Lakeridge Villa Health Care Ctr. v. Leavitt, 202 Fed.Appx. 903, 909 (6th Cir.2006) (A single act can easily violate more than one provision[.]).