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Based on interviews and review of records and procedures, it was determined that the facility did not comply with patients' rights notification requirements related to the lack of documented provision of the Important Message From Medicare notices (IM's) to eligible patients or their representatives.
This finding is noted in 5 of 6 applicable inpatient records reviewed.

Findings include:

The facility did not consistently comply with its policy and procedure for the timely distribution of the Important Message From Medicare notices (IM's).

Medical Record (MR) #3
The patient referenced in MR #3 is a 75 year old patient who was admitted to the facility on 02/23/14 for right sided neck pain and shoulder pain. The patient was worked up and treated with medication and muscle relaxants and was discharged on 02/24/14. Review of the record on 03/26/14 determined no evidence of provision of the initial notice for the Important Message from Medicare as required. Interview with Staff #6 and #7 on 03/27/14 at approximately noon confirmed this finding.


MR #4:
This 72 year old non verbal male was admitted from a nursing home for suspected bladder infection on 02/20/14 and was discharged on 02/25/14. There was no documented evidence of the provision of the initial or follow up IM notices for this patient or the person acting on the behalf of the patient.

MR #5
This 75 year old patient was hospitalized between 02/12/14 and 02/16/14 following presentation for shortness of breath and underwent work up including cardiology and renal consults. The patient signed the initial IM on 02/12/14 but the record lacked documented evidence of provision of the follow up IM to inform the patient as required. This was confirmed during interview with staff #6 and #7 on 03/27/14 at approximately noon.


MR #6
Review of this medical record on 3/25/14 found this 68 year old male was admitted on 2/16/14 after presenting with a change in mental status after sniffing an unidentified substance. The patient requested heroin detoxification. The patient was discharged on 2/19/14. The record lacked evidence of provision of the required IM notices on admission and prior to discharge.

MR #7
Review of this record on 3/25/14 noted this 68 year old patient was admitted on 02/19/14 with a bruise on the arm. The record noted this patient was a social admission after having been brought in by her daughter because of dissatisfaction with the care provided at her nursing home. The patient was discharged on 02/27/14 to a different nursing home. There was no evidence in the record that the initial or follow up IM notices were provided to the patient or her daughter.

Review of the Utilization Management written procedure, section IV titled "Important Message from Medicare (IMM)" found that the initial IMM is to be provided to the patient or their representative within 2 days of admission by Admitting staff and that the follow up notice is to be given by the physician within 2 days prior to discharge.

Interview with staff #6 and #7 on 03/27/14 at approximately noon found that Patient Access staff deliver the IM notification to the patient or the representative and then continually follow up until the notice is delivered. The staff confirmed that the notices were missing from the records noted above.

Based on observation and staff interview it was determined that the medical record department failed to participate in the hospital-wide quality improvement program.

Findings include:

An interview with staff #5, Director of Medical Records, was conducted on 03/27/14 at approximately 3:00 PM. The surveyor asked to see the annual quality improvement plan submitted to the hospital wide quality assurance committee. The surveyor was informed by the Director that she was hired for this position on 10/13 and she did not have a formal quality improvement program for her department. There was also no evidence of a quality improvement program for the year 2013.

Based on observation and staff interview, it was determined that the facility failed to ensure that patient's medical record is stored in a secure location free of water damage and other threats.
Findings include:

A tour of a room in the hospital basement where medical records are kept was conducted on 03/27/14 at approximately 1:00 PM. The tour was conducted with staff # 5, Director Medical Records. The surveyor interviewed staff #5, Director of Medical Record, who informed the surveyor that the hospital has an electronic medical record since 1999. She informed the surveyor that she stores pediatric medical records for 21 years. Some of these medical records have been scanned and others are stored in the basement and in a room on the second floor. Both rooms were toured. The medical records located on the second floor of the administrative building were clean and the medical records were stored in enclosed metal cabinets.
The other room located in the basement contained Pediatric medical records, Pediatric Fetal Heart Monitor strips and same day surgery medical records. There was one wall that had a large hole approximately 12 centimeters that you can see through to the outside. This same wall had water stains throughout the wall. In addition, the ceiling tiles had round water stains. The room was very dusty and cluttered with other hospital department's belongings.



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Based on observation and staff interview the facility's medical records were not stored in a secure area that was protected from water damage and pests. Additionally, the medical records stored in this room were inaccessible.

The finding was:

1. On the afternoon of 03/27/2014 observation revealed that the Bracker Memorial Home Medical Records Room was not protected form water damage and pests. Specifically:

a) There were multiple holes within the room, including an unsealed hole on the exterior wall. The boxes located directly under this hole had various debris on them including dirt, leaves, and broken concrete. The entire length of the exterior wall had multi-colored streaks on it indicating water leakage had occurred on this wall.

b) The drop ceiling in the room was in disrepair. Besides six stained ceiling tiles, there were also multiple ceiling tiles missing.

c) There was a live cockroach walking on one of the medical record boxes.

2. On the afternoon of 03/27/2014 observation revealed that the medical records stored in the Bracker Memorial Home Medical Records Room were blocked. Specifically:

a) There were multiple pallets found in this room that were blocking access to medical records (i.e. pallets leaning against the walls, leaning against the medical records, and in the middle of the room).

The above findings were concurrently verified by Staff #1.

Based on observation, staff interview and review of dietary policy and procedures, the Food Service Director did not ensure that the daily operation of the food service department is maintain in a sanitary manner.

Findings include:

A tour of the hospital kitchen was conducted on 03/24/14 at approximately 10:00 AM. The surveyor was accompanied by staff #2, the Food Service Director, and staff #4, Senior Vice President. The Food Service Director was interviewed by the surveyor and she informed the surveyor that she was new to this hospital, arriving on 10/13. She also informed the surveyor that the Food and Nutrition Department is managed by a contractor named "Sodexho". Examples of issues observed, included, but are not limited to, the following:
A. Unsanitary Environment/ Food Safety
1. Multiple bags of food in all refrigerators and freezers were observed to have been opened and re-wrapped in saran wrap with no date of expiration. These foods were as follows: shredded cheddar cheese, powder parmesan cheese, tuna, pureed Spanish rice, croutons, jalapeno wraps, sliced American cheese, multiple types of cold cuts (sliced turkey, sliced ham, sliced provolone etc.), open containers of seasoning, and chopped onions. Department's policy on food labeling was not followed.
2. Multiple foods wrapped in saran wrap had dates of expiration that had passed, but were still in the refrigerator: frozen pork sausages-03/18/14, pork patties-03/18/14, and jalapeno wraps dated 12/19/13.
3. Pans of foods had no label: macaroni and cheese, ham and cheese sandwiches, tuna salad and cole slaw.
4. One section of florescent lights in the dish room was out and a light bulb was out in the food bank refrigerator.
5. A freezer condenser was packed with ice.
6. Kitchen ceiling tiles were dirty and the amber in color. Some ceiling tiles were missing.
7. There were multiple large openings in the ceiling and wall.
8. It was observed at the dish room area that one floor quarry tile was missing and another quarry tile was completely loose, which is hazardous.


B. The Food Service division of the Food and Nutrition Department had no quality improvement program. During interview with the Clinical Nutrition Manager and Food Service Director a sheet of paper with the number of "100s" printed on the sheet for all quarters was provided to the surveyor. Neither the Food Service Director nor the Clinical Nutrition Manager could explain how the number "100s" were obtained. A plan for the department's quality improvement was not submitted to the hospital quality improvement committees to describe the department quality improvement program for food service, hence no program was implemented.

C. A review of the food service "Tray Assessments" were incomplete. The tray assessment process informs the department the temperature of food and time when the tray arrives on the unit. The policy titled "Tray Assessment" was not followed. The policy states that weekly tray assessment would be conducted. However, from 01/8/14-03/15/14 there was no more than 3 tray assessments per month. The surveyor observed two different forms utilized for this process. One form was titled "Chef Select- Classic Dining- Patient Tray Assessment", the other form was titled "Patient/Resident Tray Assessment". Both forms came from the contractor Sodexho. They both differ in content. For example, one form asks for the time meal was ordered and the other form asks for the time floor tray assembly begins. All data with the exception of the temperature was not documented. Example:

1. Patient Tray Assessment dated 01/23/14 noted food temperature did not meet the standard temperature for food items on the tray. Chicken had 104 degree reading -the standard is 130 degrees, this food item is cold; collard greens had 99 degree reading - the standard is 130 degrees, this food item is cold; tea had 139 degree reading - standard is 150 degrees, the tea is cold; diced pears had 61 degree reading -standard is 50 degrees, this dessert is too warm; and milk had 65 degree reading - the standard is 41 degrees, the milk is too warm. Corrective action was documented. Food items did not meet the standard.

2. Form dated 02/15/14 noted milk and juice arrived with a temperature of 71 and 74 degrees Fahrenheit, yet no corrective action was noted.
Section 1a through 1f which notes the time of the process was left blank and the menu used for this assessment was not attached.

D. Walk-in freezer log for March 2014 had temperatures that were out of range yet no corrective action was noted. A freezer should be at 0 degrees Fahrenheit or lower. The temperatures that were out of range were: 03/08/14 at 6:30 AM "22" degrees and 03/13/14 at 6:30 AM "5" degrees, 03/19-03/22/14 temperature was off by 1 to 2 degrees.

Based on staff interview, review of hospital master menus and nutrient analysis of menus, it was determined the Food and Nutrition Department failed to ensure that physician prescribed diets met the therapeutic nutritional needs of patients. This finding was noted in 4 of 20 menus.

Findings include:

A review of hospital master menu and nutrient analysis was conducted on 03/24/14 at approximately 1:00 PM. This review was done in the presence of staff #3, the Clinical Nutrition Manager.
It was observed that all diets had a nutrient analysis except menus for infant, toddler and school age child. The Clinical Nutrition Manager was interviewed and confirmed that she had menus for the age groups, however, the only nutrient analysis she had done was the pediatric adolescent. She informed the surveyor that she will review all menus with their nutrient analysis and provide all nutrient analysis not present.

Based on observation and staff interview, the condition of the physical plant and the overall hospital development was not maintained in such a manner that the safety and well-being of patients are assured.

The findings are:

1. On the morning of 03/24/2014 observation of the Inpatient Pediatrics Unit revealed that:

a) the Shower Room wooden door was splintered/damaged.

b) there was an unsealed gap where the shower-head pipe penetrates the wall of the Shower Room.

c) there was exposed metal corner-bead on the edges on one of the walls in Isolation Room #129.

2. On the afternoon of 03/24/2014 observation of the Labor and Delivery Unit revealed that

a) there was a dust laden vent in the On-Call Room Bathroom.

b) there were open electrical circuits present within the medical head wall in the On-Call Room.

c) there were four holes in the walls of Room 119.

d) there was one stained ceiling tile in Room 118.

3. On the afternoon of 03/24/2014 observation of the Mother/Baby Unit revealed that

a) there was a unsealed hole in the ceiling by the ventilation duct in the Dirty Utility Room.

b) the floor was cracked/damaged in LDR2 Room.

c) there was one stained ceiling tile in LDR2 Room.

d) there was paint peeling from the ceiling of the Shower Room, located next to Room 107.

e) in Isolation Room 107 an oversized ceiling vent cover was improperly cut down to fit the size of the ceiling vent.

f) in the Visitor's Bathroom there was a missing wall tile and a missing floor tile. This gap in the floor had water in it.

4. On the afternoon of 03/24/2014 observation of the Emergency Department revealed that

a) throughout the Emergency Department and the Pediatric Emergency Department walls there had exposed metal corner-beads.

b) there were dust laden ceiling vents within the Patient Bathroom and the Observation Room.

c) there were two stained ceiling tiles over the Trauma Bay entrance.

d) there were three stained ceiling tiles in the Staff Lounge.

e) there were two stained ceiling tiles in Shock Trauma Room #1.

f) there were two stained ceiling tiles in the Janitors Closet.

g) there were six holes in the walls of the Janitors Closet.



5. On the afternoon of 03/24/2014 observation of the Kitchen revealed that

a) all the ceiling tiles in the kitchen, although they are washable as required, were visibly stained.

b) in the kitchens there were two floor drains that were broken and a tripping hazard.

c) there was a hole in the wall by the Trayline Support Area.

d) there were dust laden ceiling vents within the Tray Line Area and the Tray Storage Area.

e) there was a missing floor drain cover by the Salad Bar Area.

6. On the morning of 03/25/2014 observation of the Operating Rooms revealed that

a) there were two stained ceiling tiles in the vicinity of Emergency Exit Stairwell H.

b) in the Janitors Closet there was not a solid ceiling and there were no ceiling tiles in the room.

c) there were two holes in one of the Janitors Closet walls.
7. On the morning of 03/25/2014 observation of Central Sterile Supply revealed that

a) there were two dust laden ceiling vents in the Sterile Room.

b) there were three dust laden ceiling vents in Decontamination Room.

8. On the afternoon of 03/25/2014 observation of the Endoscopy Suite revealed that

a) there was a stained ceiling tile in the Storage/PIXIS Room.

b) the Post Anesthesia Care Unit sink countertop was delaminating.

c) there were four full oxygen tanks, and one empty oxygen tank being stored in Bay #2.

9. On the afternoon of 03/25/2014 observation of the Intensive Care Unit revealed that

a) there was a dust laden ceiling vent in the Patient Room #513 internal bathroom.

b) there were dust laden ceiling vents within the Patient Bath Room, the Patient Shower Room, and the Pantry.

c) there were two stained ceiling tiles in the Janitors Closet.

10. On the afternoon of 03/26/2014 observation of the 3rd. Floor Psychiatry Unit revealed that

a) there was one stained ceiling tile in Room #341.

b) there was one stained ceiling tile in the TV Room.

c) there were dust laden ceiling vents within Room #358 and Room #359.

11. On the afternoon of 03/26/2014 observation of the 2nd. Floor Psychiatry Unit revealed that:

a) there were dust laden ceiling vents within the Seclusion Room and the Environmental Closet.

b) there were two stained ceiling tiles in the Environmental Closet.

c) there was paint peeling from the walls and ceilings of Room #249 and Room #245.

12. On the morning of 03/27/2014 observation of the 7th Floor Medical/Surgical Unit revealed that:

a) within the Shower Room a faucet handle and an escutcheon plate were missing.

b) there was a dust laden ceiling vent in Room #702.

c) there were multiple holes in the walls of the 7 North Janitors Closet.

Based on observations and staff interviews, it was determined that the facility failed to meet the applicable provisions of the Life Safety Code, NFPA 101, 2000 Edition.

Findings include:

During the survey of the facility from 03/24/14 - 03/27/14, Life Safety Code deficiencies were noted in multiple areas of the Code requirements and were cited under the following Fire / Life Safety Code K-Tags:

K 11 (having at least a two-hour fire resistance rating constructed of materials as required).

K 25 (Smoke barriers are constructed to provide at least a one half hour fire resistance rating in accordance with 8.3).

K 29 [One hour fire rated construction (with ¾ hour fire-rated doors) or an approved automatic fire extinguishing system in accordance with 8.4.1 and/or 19.3.5.4 protects hazardous areas].

K 70 (Portable space heating devices are prohibited in all health care occupancies).

K 72 (Means of egress are continuously maintained free of all obstructions or impediment).

Based on observation and staff interview the facility failed to ensure that the facility's environment was maintained to prevent the spread of infections.

The findings are:

1. On the afternoon of 03/24/2014 observation of the Mother/Baby Unit revealed that:

a) there were "clean" paper towels being stored in the "dirty" Janitors Closet.

b) there was no ventilation duct in the Janitor's Closet. This room did not have negative airflow as required by code.
2. On the afternoon of 03/24/2014 observation of the Pediatric Emergency Department revealed that the Pediatric Isolation Room ceiling tiles were not washable as required by code.

3. On the afternoon of 03/24/2014 observation of the Kitchen revealed that:

a) a discharge vent for a spot cooler was secured to the ceiling with medical tape.

b) there was a hole in ceiling tile located above a hand-wash sink.

c) in the vicinity of the Tray Line there was a ceiling escutcheon missing for a large cable that was passing through a ceiling tile.

4. On the morning of 03/25/2014 observation in the Operating Rooms revealed that:

a) the air flow for all three Sub-Sterile Rooms was positive to the outside hallway. These rooms are required to have negative airflow from the outside hallways.

b) there were two carts of "sterile" orthopedic instrumentation being stored in the "non-sterile" general corridor.

5. On the morning of 03/25/2014 observation in Central Sterile Supply revealed that:

a) behind a clock there was an unsealed hole in a wall. All wall penetrations are required to be sealed in "sterile" rooms.

b) there was an exhaust vent ceiling penetration from a spot cooler in the vicinity of the sterilizer that was not sealed. This ceiling tile was also damaged. All ceiling penetrations are required to be sealed in "sterile" rooms.

c) there was an unsealed extension cord ceiling penetration in the vicinity of the sterilizer. All ceiling penetrations are required to be sealed in "sterile" rooms.

6. On the afternoon of 03/25/2014 observation of the Endoscopy Suite revealed that:

a) the air flow for the Sub-Sterile Room was positive to the outside hallway. This room is required to have negative airflow from the outside hallways.

b) There was a wheelchair being stored in the Soiled Utility Room, which is considered a "dirty" room.

7. On the morning of 03/27/2014 observation of the 7th Floor Medical/Surgical Unit revealed that:

a) there were four patient commodes, a patient scale, an IV pole, and a suction pump found in the Soiled Utility Room, a "dirty" room. The above referenced equipment was coved with plastic tarp indicating that these are "clean" items. The above finding was concurrently verified by Staff #1.

b) there were multiple holes in the walls of the Janitors Closet. Also, multiple layers of medical tape was used for a shelving unit within this room.

The above findings were concurrently verified by Staff #1.

Based on review of procedures, records, and staff interview, the facility failed to establish a process to ensure timely identification and assessment of the discharge planning needs of patients who are discharged in less than 72 hours and where there is risk for adverse complications in the absence of discharge planning.

Findings include:

Review of Social Work Discharge planning manual procedure titled "Department Plan for Providing Care /Service" noted patients who meet defined high risk criteria are referred to social workers by clinical providers. The policy titled: "Interdisciplinary post hospital care planning" documents that the initial nursing assessment, physician health and physical, and daily activities, including white board rounds and case discussions, are mechanisms through which discharge planning is integrated with other departments.
The policy titled "Documentation/Progress notes" indicates the social worker will complete an initial psychosocial assessment upon admission or no later than 72 hours after admission.

No procedure was provided that considered how high risk patients who are discharged in less than 72 hours are assessed for social work /discharge planning needs in order to minimize the potential for complications.

2. In 1 of 1 applicable records reviewed, the facility did not provide a discharge planning/ social work assessment following nursing referral for a patient whose length of stay was less than 72 hours.

Review of MR #3 on 03/26/14 found this 75 year old male was admitted to the hospital at 2:00 AM on 02/24/14 for complaints of right sided neck and shoulder pain. Patient's history was significant for chronic-obstructive pulmonary disease (COPD), hypertension, chronic lower back pain, prostate cancer, severe degenerative joint disease in the lumbar sacral spine, and osteoarthritis of the knees.
The admission profile noted at 2:08 AM on 02/24/14 the patient has chronic pain, requires assistance (assistive person) with bathing, dressing, bed mobility, and toileting. The initial discharge plan documented by the nurse noted a referral to social work was requested by the patient because he needs assistance at home, since the wife works in a church and he is alone at home.
A rehabilitation evaluation documented by the occupational therapist noted patient needs assistance with bathing and dressing. It was noted the wife assists with some activities of daily living and the patient ambulates with a rollator walker outdoors. Outpatient occupational therapy clinic was recommended. This assessment also noted the need for social work. The patient received antinflammatory medications, and received osteopathic manipulative treatment. A discharge order was written at 11:42 AM on 02/24/14. The patient was discharged at 2:23 PM on 02/24/14 with pain medication and outpatient appointment with plan to be contacted by the Occupational therapy clinic.
There was no social work assessment provided for discharge planning needs. This patient met high risk criteria defined in social work/discharge planning procedures due to advanced age, chronic condition impacting post discharge capacity, and functional deficits. No discharge planning assessment from social work was provided despite referral from nursing, as this patient was discharged in less than 24 hours following admission.

During interview on 03/26/14 at 4:00 PM with Care Transitions Department staff #11, #12, and #18 it was stated that social workers are expected to complete assessments within 72 hours of admission.
At subsequent interview with staff #9, it was acknowledged the referral for social work services was recorded, but that no assessment was evident in the record. It was also acknowledged that this patient's request for help should have been addressed despite the short length of stay.

Based on interviews and review of documents and procedures, it was determined the hospital staff, in the course of formulating discharge plans, failed to comply with regulations for written patient notification about available options for the selection of home health care or skilled nursing facility providers. This finding was identified in 2 of 2 applicable records reviewed.

Findings include:

1. The hospital did not comply with the regulatory requirement for provision of lists containing written options for selection of home care agencies or skilled nursing care providers to patients or their representatives, where applicable. This requirement mandates documentation of these lists be provided in order to ensure freedom of choice in selection of post hospital care providers.

2. Review of the Discharge Planning procedure titled "Post Hospital Follow-Up- Home Care ", Section VI, on 03/27/14 at 1:00 PM notes that "referrals are made to a home care agency with patients and families choice in mind". This procedure is incomplete as there is no description of how choice is ensured nor reference to provision of written lists containing available choices of home care agencies.

The procedure titled: "Patient/Family Education" Code PF 2.2.5, PF 2.2.6, Section V was reviewed on 03/27/14 at 1:00 PM. This policy notes patient and family education should include clarification of choices regarding home care or residential facility placement.

The procedure titled: "Nursing Home Placements, PE3, CC 1.8, Section VI" was reviewed on 03/27/14 at 1:00 PM and notes the family is provided with a list of RHCF's (Residential Health Care Facilities).

The policy titled "Documentation / Progress Notes", Manual P.E.1-P.E.1.6, CC.3-PF.3, Section VI was reviewed on 03/27/14 at 1:00 PM. This notes that "Social work notes must reflect evidence that all options and alternatives have been presented to the patient and family."

3. During interview with Care Transitions Department staff #11, #12, and #18, on 03/26/14 at approximately 4:00 PM, it was stated that the hospital has contracted with two agencies that have representatives on site in the hospital, but that options are given to patients for home care and residential facility selection. Lists are printed out and given to patients receiving new referrals. It was reported none is provided when the patient is returning to the same nursing facility or when the patient is being referred back to a home care agency that has provided services prior to hospitalization.


4. Review of two of two applicable medical records on 03/27/14 found no evidence that a written list containing written agency/facility options was presented to the patient or the individual acting on the behalf of the patient. The hospital did not comply with its practice to provide written listings of home care agencies or facilities to inform applicable patients or their representatives about choices prior to discharge.

4a. Review of MR #7 on 03/26/14 found this patient was admitted on 02/19/14 for complaint of a left arm bruise. Past history notes includes dementia, cerebrovascular accident (CVA), diabetes mellitus (DM), and hypertension (HTN). A discharge planning note on 02/24/14 reported the daughter was dissatisfied with the care at the nursing home in Brooklyn where the patient had resided, and was seeking nursing home placement in the Bronx .

The Social work note of 02/27/14 indicated patient review instrument (PRI) and screen forms were sent to different facilities. The patient was discharged on 02/27/14 to a Bronx Nursing home and agreement by the daughter was recorded. However, this record lacked documentation that a written list of skilled nursing facility options was provided to the patient or to or the individual acting on the behalf of the patient which covered the geographical area of stated preference.

4b. During tour of inpatient Unit 6 North on 03/27/14 at approximately 11:00 AM, staff #10 was interviewed during which it was stated that written home care agency listings are given if requested by the patient.
Review of the Vendor Agency list provided to the surveyor by this employee noted the names of multiple home care agencies.

Review of MR #8 on 03/27/14 at approximately 11:15 AM found this 28 year old male was admitted on 03/20/14 with shaking tremors and confusion. He was found to have hyperosmolar hyperglycemic syndrome and diabetic ketoacidosis. A social work note in this record dated 03/26/14 indicated the patient required nursing diabetic teaching since he is a newly diagnosed diabetic. The note indicated a home care nursing referral was discussed with the patient, who had agreed. The patient was referred to an agency nurse who would assess the patient at the bedside.
However, there was no documentation in this patient's medical record that a written home care agency option listing was presented to the patient nor confirmation that the patient was informed of agency selection options.

The patient referenced in MR #8 was interviewed during continued tour of unit 6 North at approximately 11:20 AM. The patient reported he was being discharged to home. He stated he was being taught to inject his own insulin. When asked about the discharge plans, the patient reported a nurse from a home care agency came to speak with him and he would be receiving a visit after discharge. He showed the surveyor the card of the nurse from the vendor home care agency who had visited him in the hospital. The patient was asked if written home care agency choices were provided and he replied he did not receive any list of agencies to choose from.

During follow up interview with Staff #9 on 03/27/14 at approximately 4:00 PM, the above findings were shared regarding the requirement for provision of written lists to patients or their representatives that detail options for choice of post hospital care providers.