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On the days of the Initial Swing Bed Certification based on interview and clinical record review, the Hospital failed to notify, in writing, of the impending discharge for 2 of 2 resident records reviewed for discharge. (Resident #1 and #2)


The findings are:


On 04-11-11 at 1500, clinical record review revealed Resident #1 was discharged on 01-07-11 with the diagnosis of Left Hip Fracture/Open Reduction Internal Fixation of Left Hip. There was no documentation in the patient's record that the Resident had been informed in witting of the discharge.
On 04-12-11 at 0900, clinical record review revealed Resident #2 was discharged on 01-07-11. There was no documentation in the patient's record that Resident #2 had been informed in witting of the impending discharge. On 04-12-11 at 1000, the Clinical Director revealed that patients in the acute phase of hospitalization are given a notice but residents in the Swing Bed unit are not given a written discharge notice. Review of hospital policy showed the hospital did not have a policy regarding a written discharge notice for the Swing Bed Resident.

On the days of the Initial Swing Bed Certification based on record review and interview, the facility failed to ensure that the content of the resident's discharge notice specify the reason for discharge and the effective date of the discharge. The facility failed to stipulate that the resident has the right to appeal the discharge to the State and failed to have the necessary contact information for 2 of 2 resident records reviewed in the hospital. The hospital failed to provide the residents with a written discharge notice with the necessary content. (Residents #1 and #2)


The findings are:


On 04-11-11 at 1500, resident record review revealed Resident #1 who had a diagnosis of Left Hip Fracture/Open Reduction Internal Fixation of Left Hip was discharged on 01-07-11. There was no documentation that the Resident had received a written discharge notice with the required content of information related to the resident's right to appeal the discharge decision prior to the resident's discharge from the Swing Bed Unit.

On 04-12-11 at 0900, resident record review revealed Resident #2 who had a diagnosis of Diverticulitis and Peritoneal Abscess was discharged on 01-07-11. There was no documentation that the Resident had received a written discharge notice with the required content of information related to the resident's right to appeal the discharge decision prior to the resident's discharge from the Swing Bed Unit. On 04-12-11 at 1000, the Clinical Director revealed patients are given a discharge notice in the acute hospital but residents in the hospital's swing bed unit do not receive the right of appeal information. Review of hospital policy revealed the hospital had no policy for the swing bed unit regarding a written discharge notice or the content of the notice for the Swing Bed Resident.

On the days of the Initial Swing Bed Certification Survey based on clinical/facility record review and interview, the facility failed to have an ongoing program of activities to meet the needs of 2 of 2 resident records reviewed for care and services. (Residents #1 and #2) Furthermore, the facility failed to appoint a qualified professional to direct the Activity Program.


The findings are:


On 04-11-11 at 1500, clinical record review revealed Resident #1 was admitted to the swing bed unit on 01-05-11 with the diagnosis of Left Hip Fracture/Open Reduction Internal Fixation of Left Hip. On 04-12-11 at 0900, clinical record review revealed Resident #2 was admitted on 01-05-11 with the diagnosis of Diverticulitis and Peritoneal Abscess. Review Resident #1 and Resident #2's records while on the hospital's swing bed service revealed that neither patient had received an evaluation of their activity likes or dislikes, or received information on what activities were available, or actually engaged in any activities while residents on the swing bed unit. There was no documentation in the residents's record of their attendance/response to any activity. The Clinical Director on 04-11-11 at 1530 confirmed that the hospital's swing bed residents did not attend any group activities and none were scheduled. The Clinical Director explained that the residents did not stay long enough. On 04-11-11 at 1315, the hospital was able to only produce one Activity Calendar that was for 7 days that included Lunch daily at 1200. There were no planned activities for Friday, Saturday and Sunday except: nightly news at 1900, sports on television at 1200, television worship service at 1100 and again at 1830.

On 04-12-11 at 0930, the Clinical Director revealed that the plan for the Swing Bed Unit was for only short stay residents. If the residents are there longer, than the facility will at that time develop an activity program based on their needs. The Clinical Director submitted a facility record, titled, Activities Policy and Procedure, that read, ".... An Activities program will be addressed in patients whose length of stay is greater than 14 days. Swing bed care offers a special activity program designed for the resident's needs and interests if their length of stay exceeds 14 days.... the licensed nurse and the certified nursing assistant will provide the patient with ongoing activities designed to meet the interests, the physical, mental, and psychosocial well-being of the resident. The resident will spend a large amount of their time completing their rehab program with the physical therapist and occupational therapist and if indicated the speech therapist. This will be taken into account when developing the patient's individualized activity program. The Social Worker will assist the licensed nurse and the Nursing Assistant to develop an activities plan for the patient based on the patient's needs. Occupational Therapy will also assist with addressing the patient's activity needs. The nursing staff will make every effort to plan an activity that meets the patients needs...".

On 04-11-11 at 1250, the Clinical Director revealed that the Occupational Therapist was the Activities Director. An interview with Occupational Therapist (TO)#1 at 04-11-11 at 1335 revealed that the therapist does groups for activities of daily living that are part of occupational therapy, but only for those swing bed residents referred by a physician order. TO #1 explained that any activity groups would be shared between nursing and TO. TO#1 confirmed that he/she had not been given any additional responsibilities for as a director of the activistic program.

On 04-12-11 at 1000, a review of the Job Description and Performance Review dated 11-24-10, reads, " A. Job Summary: Administers optimal patient care by planning, organizing, and implementing an occupational therapy program including assessment, evaluation, documentation and treatment for individual patiens referred by treating physician...". On 04-12-11 at 1000, the Administrative Assistant for Human Resource revealed the hospital has no job description for an Activities Director, and the job description for TO #1 had not been updated to include the responsibilities for Director of Activities or for any the planning, implementing, and evaluation of a hospital activity program.