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Based on observation, medical record review, staff interview, and policy review, the facility failed to ensure a policy and procedure was available to address likely emergency issues related to obstetrics. The findings were:

Observation of the emergency room (ER) on 5/3/17 at 11:05 AM showed an obstetric emergency kit was available. Review of a 2/15/17 ER record revealed patient #21 was admitted to the ER with pending pre-mature labor at 28 weeks gestation. The patient delivered a 28 week newborn, both were stabilized, then transferred via ground EMS transport to a facility with obstetric services. Review of the facility's emergency services policies showed no policy was in place that addressed obstetric emergencies. Interview with the director of patient services on 5/4/17 at 9 AM confirmed the facility failed to formulate an obstetric emergency policy, and it was a reasonable expectation that the ER would treat obstetric emergencies, and this situation had occurred in the past.

Based on review of patient admission information, and staff interview, the facility failed to ensure swing bed patients were fully informed of all required rights. The swing bed patient census was 7. The findings were:

Review of the swing bed patient admission information showed written information was provided which included patient rights. This information review included a list of patient rights and the "Skilled Swing Bed Program Patient Handbook." The information failed to include the right to work or not work, or to share a room if a married couple. In addition, the contact information listed in the handbook for the State survey and certification agency had an outdated address. Interview with the director of patient services on 5/3/17 at 4:44 PM verified the information provided to swing bed patients did not include all the requirements.

Based on medical record review and staff interview, the facility failed to ensure a comprehensive assessment was completed for 3 of 3 sample swing bed patients (#2, #3, #5) who required a comprehensive assessment. The findings were:

1. Review of the medical record showed patient #2 was admitted to swing bed status on 4/5/17 and continued to be an active patient. Review of the comprehensive assessment showed it was done on admission 4/5/17, and covered all required areas. However, each area was a collection of data with no summary or analysis of the data to determine if care planning was needed.

2. Review of the medical record showed patient #3 was admitted to swing bed status on 12/5/16 and continued to be an active patient. Review of the comprehensive assessment showed it was done on the admission date, and covered all required areas. However, each area was a collection of data with no summary or analysis of the data to determine if care planning was needed.

3. Review of the medical record showed patient #5 was admitted to swing bed status on 9/16/16 and continued to be an active patient. Review of the comprehensive assessment showed it was done on the admission date, and covered all required areas. However, each area was a collection of data with no summary or analysis of the data to determine if care planning was needed.

4. Interview with the director of patient services on 5/3/17 at 4:30 PM verified the data was available and was not analyzed. She stated the electronic record could be used/adapted to complete the needed information.