HospitalInspections.org

Based on interview and record review, the facility failed to provide a safe and appropriate discharge plan for 2 of 3 sampled patients who were discharged to an assisted living facility (#1 & 2).

Findings:

1. Patient #1's record revealed a 50-year old admitted to the hospital on 6/05/19 and discharged on 6/25/19. Diagnoses included hypertension and schizophrenia. The patient was admitted under an involuntary Baker Act which was discontinued on 6/11/19 by a psychiatrist. The case manager notes on 6/20/19 reflected that the patient's daughter was consulted and agreeable to a privately owned counseling/referral service to assist with assisted living facility (ALF) placement for the patient. On 6/21/19, case management notes read, "CM (case manager) spoke with (name of counselor service) who stated 'The note documented the patient has a place to go with contract'." The name and address of the ALF was documented and that the "case manager spoke to the manager, who stated they can take patient today under contract."

A State form entitled "Resident Health Assessment for Assisted Living Facilities, AHCA Form 1823" was signed by a physician and documented the patient was independent in ambulation, bathing, dressing, eating, self-care (grooming) toileting, transferring, making phone calls, but required supervision with preparing meals, shopping, and needed assistance with handling personal affairs and handling financial affairs due to periods of confusion. Documentation also reflected that the patient needed help with taking medications, and the "Needs assistance with Self- Administration" box was checked, indicating the patient required assistance with self-adminsitration of medications.

A case management note on 6/25/19 read, "contract for ALF for one month has been approved....spoke to (private counselor/referral company) who stated pt. (patient) is still accepted at (Name of ALF/address/phone number).... spoke with ALF manager....confirmed address and is expecting patient today." The patient was discharged to the ALF on 6/25/19 and family was notified.

2. Patient #2's record revealed he was a 69-year old admitted to the hospital on 3/14/19 with a diagnoses of chronic obstructive pulmonary disease exacerbation and respiratory distress. The case management notes revealed the patient had been living in an unsafe and unclean hotel prior to admission. Referrals were completed and skilled nursing was documented as not an option. The case manager contacted a private owned counseling/referral service for placement assistance with the consent of the patient. A case management note dated 3/12/19 at 3:50 PM documented orders for oxygen were sent to a medical supply company for patient upon discharge. A 3/14/19 case management note reflected that the counseling/placement service "had found a place for the patient", and the name and the address of the assisted living was given to the case manager. Case management notes of 3/14/19 at 1:18 PM read, "CM (case management) has found ALF (Name and address of facility)....patient is agreeable to skilled nursing, physical therapy, and occupational therapy via hone health care." The case management "Final DC Arrangements documented "disposition ALF with HHC" (home health care) and documented the name of the ALF, medical equipment company and home health agency.

Patient #2's State form entitled "Resident Health Assessment for Assisted Living Facilities, AHCA Form 1823" was signed by a physician and documented the patient was independent in all activities of daily living and tasks listed. Documentation also read the patient needed help with taking medications, and the "Needs assistance with Self-Administration" box was checked, indicating the patient required assistance with self-adminsitration of medications. There was no documentation on the 1823 regarding oxygen or home health care at home.

On 12/16/19 at 2:10 PM, the Risk Manager and the Director of and System Director of Care Management revealed when an ALF placement is needed, the care/case management staff working on the placement will discuss with the patient/family and upon selection, it was an expectation of the hospital, that the Agency for Health Care Administration (AHCA) website would be checked and consulted to verify a current State license of the facility. They related patient #1's record documented in the software that an ALF was chosen in the system, however the wrong name of the facility was chosen by the care manager. They related there was no documentation in patient #1 or #2's records that supported the staff member went to the AHCA website to verify the ALF had a current license. They stated they were unaware that the ALF mentioned in patient #1 and #2's record was not a licensed ALF.

The facility policy entitled "Discharge Planning-Inpatient Policy #305.037" and "Care management: Discharge Planning Work Instruction", reviewed 9/17/18 were reviewed with the Risk Manager and Care Management directors. They related these are the guidelines/processes for staff to follow regarding patient discharge planning tasks. They confirmed there was no documentation in the the policy or the worksheet that included the staff must verify a current ALF license by the AHCA, although it is expected. During the investigation on 12/16/19, the AHCA website for license verification was viewed and showed the ALF where the patients were discharged to did not have a current AHCA license.

On 12/16/19 at 2:10 PM, the Director of and System Director of Care Management further related they use a private company to assist in finding placements for patients and their website documented they only use AHCA State licensed facilities for their referrals. They were informed the ALF documented in the patient's records did not have a current State License for operation, and patient #1 and #2 were discharged by the hospital to an unlicensed ALF.