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Based on review of facility documents, medical records, (MR) and a staff interview (EMP), it was determined the facility failed to provide evidence that Medicare patients were informed of their rights regarding the Important Message From Medicare (IMM) within two calendar days of admission for three of five Medicare medical records reviewed [MR1, MR4, and MR8] and 48 hours prior to discharge from the facility as required per facility policy and regulation for two of five Medicare medical records reviewed. [MR1, MR4, MR7, MR8 and MR9].

Findings include:

Review, at approximately 1:00 PM on September 26, 2019, of the facility "Important Message from Medicare (IMM)" policy dated January 10, 2019, revealed, "... Policy: It is the policy of Ohio Valley General Hospital to provide each Patient or his/her representative, in advance, the patient's rights, for providing or discontinuing patient care whenever possible. I. During the admission process an admissions representative will provide the patient or his/her representative the Important Message from Medicare (IMM) for review and signature. ... The IMM must be provided at admission but no later than two calendar days following the date of the admission to the hospital. ... the attempts for a signature must be documented on the notice. ... If the discharge is unanticipated, the second notice can be given on the day of discharge or as early as possible allowing for ample time for the patient or beneficiary to be aware of their rights. The Case Management team will continue to monitor daily for the compliance of the initial and second signatures. ..."

1. Review of MR1 on September 26, 2019, at approximately 10:15 AM revealed that the patient was admitted to the facility on July 4, 2019, and discharged on July 30, 2019. There was no documentation that the patient or the patient's representative was provided an Important Message from Medicare to Medicare (IMM) on admission or discharge.

2. Review of MR4 on September 25, 2019, at approximately 12:40 PM revealed the patient was admitted to the facility on June 27, 2019, and was discharged on July 2, 2019. There was no documentation that the patient or the patient's representative was provided an IMM on admission or on discharge.

3. Review of MR7 on September 25, 2019, at approximately 1:00 PM revealed the patient was admitted to the facility on June 19, 2019, and was discharged on July 17, 2019. There was no documentation that the patient or the patient's representative was provided an IMM on discharge.

4. Review of MR8 on September 25, 2019, at approximately 1:10 PM revealed the patient was admitted to the facility on July 05, 2019, and was discharged on July 17, 2019. There was no documentation that the patient or the patient's representative was provided an IMM on admission or discharge.

5. Review of MR9 on September 25, 2019, at approximately 1:45 PM revealed the patient was admitted to the facility on July 04, 2019, and was discharged on July 17, 2019. There was no documentation that the patient or the patient's representative was provided an IMM on discharge.

On September 26, 2019, at approximately 1:30 PM EMP2 confirmed the above findings for MR1, MR4, MR7, MR8 and MR9, and confirmed that the patients were Medicare or Medicaid qualifying patients.

Based on review of facility documents, observation and staff interview (EMP), it was determined the facility failed to follow their policy related to the receipt and disposition of home medications for one of one patient (MR2).

Findings include:

Review of Facility policy on September 26, 2019, at 10:00 AM revealed, "220.01-O Patient's Own Medications" dated March 22, 2017, revealed, "... Following their use for medication history process, patient's own medications should be sent home with the patient's caregiver, unless ordered by the physician to be administered in the hospital. ... For all medications sent home must be documented by a nurses to what they are, the number of each drug, and who took the drugs to the patients home. If they are not to be used in the hospital, the home medications are to be inventoried, then placed to the pharmacy in a Patient Valuables bag. The nurse sending the bag shall record the patients name, room number, time and date on the paper segments on the back of the bag. In the space on the front of the envelope record all the medications to be sent to pharmacy. If controlled substances are to be sent the name and quantity of the controlled substance, and the envelope must have a second nurse signature. There must be a co-sign on the back with the patient and the nurse. The nurse is then to take the envelop to the pharmacy and receive a Brought-in Drug Label Receipt from pharmacy personnel. Place the special removable self-stick receipt on front of the patient's chart. Pharmacy shall maintain proper documentation of all patient medications received via the medication log. ... To obtain the patient's medications, a nurse shall take the patient's receipt to the pharmacy. Obtain the medications and sign the patient Medication Log with the pharmacist. Cut open the valuables bag infront of the patient and review the counts."

1. A tour of the Gero-psych unit was conducted on September 25, 2019, at approximately 10:00 AM. Tour of the medication room at approximately 10:00 AM revealed a bag of medications under the refrigerator.

When questioned, on September 25, 2019, at 10:00 AM, about the mediations found on tour, EMP11 stated, "The medications were from a patient (MR2) who was admitted to the psychiatric unit then was transferred to another unit on the medical side." EMP11 further stated, "The meds should have gone to the pharmacy, but for some reason they had not made it there yet."

2. Observation and tour of the Gero-psych unit at approximately 11:00 AM on September 25, 2019, in attempt to determine the names and amounts of medication contained in the bag, it was determined that the bag was no longer on the unit.

On September 25, 2019, at approximately 11:00 AM, EMP10 confirmed that the medications for MR2 were no longer on the unit and had been sent to the pharmacy.

3. On September 25, 2019, at approximately 11:30 a tour of the pharmacy, revealed that there were no home medications for MR2. Following the tour, EMP12 confirmed that there was no form with a signature from the patient's family member indicating that the medications had been recovered from the pharmacy, and there was no list as to what medications or the amount of medications that were received by the patient/patient's family member.