HospitalInspections.org

Based on interview and record review, the facility failed to ensure the discharge of a patient to appropriate post-acute care service providers for home health and hospice in a setting which was authorized by the State of Florida, through licensure, to host such services in three of three sampled patients. (#1, #2, #3)

Findings:

A review of the medical record of patient #1 was performed. The patient was admitted to the facility on 7/5/20. The History and Physical of 7/5/20 read: "Patient seen and examined on 7/5/2020, at 3:15 AM ... -year old ... female, lives in assisted living facility for the past 2 months ..."

An initial case management assessment was performed on 7/5/20 at 3:20 PM. It read: "Living arrangement: assisted living facility." It read: "Lives at Cristal Palace now Ardent ALF (Assisted Living Facility). ... Plan return to the ALF." Case Management documentation of 7/6/20 at 4:22 PM read: "Pt (patient) not able to return to Ardent Health ALF as per administrator as they have lost licensure."

The document "AHCA (Agency for Health Care Administration) form 1823" of 7/6/20 indicated that the facility which the patient came from was "Ardent ALF." The form read: "PT (Physical therapy) 3 X (times) week for 6 visits." Thus, there were orders for home health.

A Case Management note of 7/7/20 at 4:42 PM read: "Spoke with ... at Ardent and he has accepted the pt back ... Requested 1823 be faxed ..." A Case Management note of 7/8/20 at 8:33 AM read: "Completed 1823 and COVID screening transfer form faxed and spoke to (person at the ALF). He confirmed acceptance."

The Discharge Summary of 7/8/20 read: "Patient was cleared medically for discharge to home setting." The document "Physician Discharge Orders and Instructions" of 7/8/20 at 11:29 AM read: " "Discharge patient to: ALF."

Thus, facility staff was aware that the patient's ultimate discharge location was a newly unlicensed assisted living facility and that physical therapy was required after discharge.

A review of the medical record of patient #2 was performed. The patient was admitted to the facility under observation status on 7/6/20. The History & Physical of 7/6/20 read: " ... year-old male patient with Vitas hospice was brought to the hospital from Crystal Palace ..."

A Case Management note of 7/6/20 at 1:22 PM read: "Vitas SW (Social Worker) reported to SW that pt is a resident at Cristal Palace / Ardent ALF but that the facility has lost their appeal with the state and will be shutting down. Pt's Vitas SW states that pt can not go back to Cristal Palace ..."

The document "AHCA form 1823" of 7/8/20 indicated that the facility which the patient came from was "Ardent Senior Living."

A Case Management note of 7/8/20 at 8:12 AM read: "Patient is discharging back to Ardent ALF with Vitas Hospice."

The document "Physician Discharge Orders and Instructions" of 7/8/20 read: "Discharge patient to: Assisted Living ... with Hospice."

As to why the patient was sent to an unlicensed ALF when the facility was aware, per documentation, that it was unlicensed, during an interview of A-RN, the last Case Manager who had record entries concerning the patient, on 8/4/20 at approximately 3:15 PM, she stated that she did not look on the internet for information on the license status. She stated that the patient's wife, who was also at Crystal Palace, wanted him to come back. She stated she was under the impression that the facility was doing an appeal, since they accepted the patient back.

Thus, facility staff was aware that the patient's ultimate discharge location was a newly unlicensed assisted living facility and that hospice services were required after discharge.

A review of the medical record of patient #3 was performed. The patient was admitted to the facility on 7/12/20. The History & Physical of 7/13/20 at 12:56 AM read: "Pt is a ... y/o male ... He resides at Crystal Palace ALF."

A Case Management note of 7/13/20 at 8:57 AM read: "Patient is A&O (alert and oriented) and lives at Cristal Palace (Ardent Health). Patient did state that Cristal Palace did lose their license, and they are working with him to find other arrangements. ... Anticipated D/C/ (discharge) plan is to return to Cristal Palace w (with)/Health First Home Care."

Physician discharge orders of 7/13/20 at 9:26 AM read: "Discharge patient to: Assisted Living with HHC (Home Health Care)."

A Case Management note of 7/13/20 at 1:00 PM read: "Per (name of person at Ardent Health), ... DCF (Department of Children and Families) is working with a select group of patients and their placement as Ardent is no longer licensed. ... If they (another ALF facility) are not able to take him, he can return to Arden ALF ..." A Case Management note of 7/15/20 at 9:10 AM read: "Pt has a d/c (discharge) order and will be returning to Ardent ALF w/HHC (with home health care). ... patient is able to return to ALF today."

The document "AHCA form 1823" of 7/13/20 indicated that the facility which the patient came from was "A Cristal Palace Resort (Argent)." The document also read: "Therapy as needed. HHC (home health care) Health First Homecare."

The Discharge Summary of 7/15/20 read: " ... ready for discharge to ALF with home health." Discharge orders of 7/15/20 at 9:26 AM read: "Discharge patient to: assisted living with HHC (home health care)."

As to why the patient was sent to an unlicensed ALF when the facility was aware, per documentation, that it was unlicensed, during an interview of B-RN, the last Case Manager who had record entries concerning the patient, on 8/4/20 at approximately 3:30 PM he stated that he was under the impression that the facility was under appeal. He talked to the facility Administrator in the morning, but the issue did not come up on the day of discharge. He stated that he did not look up the facility's licensure status on the computer prior to discharge.

During an interview of the Vice President of Quality on 8/4/20 at approximately 4:15 PM, she confirmed the preceding.