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Based on review of facility policies and procedures, medical records, and staff interview, it was determined that the facility lacked policies and procedures regarding providing notifications to Medicare beneficiaries of their hospital discharge appeal rights for eight (8) of eight (8) sampled discharged Medicare inpatient records (#s 1, 3, 6, 7, 8, 10, 13 and 16).

Findings were:

Review of facility policies and procedures failed to reveal evidence that the facility had developed policies and procedures to address the Medicare requirements at 42 CFR Part 405.1205, Notifying Beneficiaries of Hospital Discharge Appeal Rights, by providing inpatients, who were Medicare beneficiaries, with the Important Message (IM) notice from Medicare at or near admission, but no later than 2 calendar days following admission, which informed Medicare beneficiaries and/or their representatives of the beneficiaries' rights as a hospital inpatient.

Eight (8) of eight (8) medical records reviewed of Medicare inpatients (#s 1, 3, 6, 7, 8, 10, 13 and 16) lacked documentation that the facility had provided Medicare inpatients with two (2) copies of the Important Message from Medicare, as required.

During an interview at 12:30 p.m. on 06/03/10 in the hospital's conference room, the Director of Nursing stated that the facility was unaware that they were to provide Medicare inpatients with the Important Message from Medicare notice, on admission and no more than 2 days prior to discharge.

Based on observation and interview, it was determined that the facility failed to assure that outdated, mislabeled, or otherwise unusable drugs and pharmaceuticals were not available for patient use.

Finding were:

During a random drug check in the pharmacy at 4:43 p.m. on 06/01/2010 with employee #15 present, the following outdated medications were found on shelves and available for patient use:
a. Renagel (reduces phosphorus in the blood of kidney dialysis patients) 800 milligrams (mg) with an expiration date of 05/21/2010;
b. Armour Thyroid (used to replace thyroid hormone) 30 mg with an expiration date of 03/11/2010;
c. Zonisamide (used to treat seizures) 25 mg with an expiration date of 04/2010;
d. Bisoprolol (for high blood pressure) 5 mg with an expiration date of 01/2010; and
e. Zonegran (used to treat seizures) 25 mg with an expiration date of 04/2010.

During an interview at the time of the drug check, employee #15 confirmed that the medications were expired and stated that employee #15 and the technician had been in the process of rechecking medication dates.

Based on review of personnel files and staff interview, it was determined that the facility failed to ensure that the manager of food and dietary services had training and experience in management of a health care food service system.

Findings were:

During an interview at 1:43 p.m. on 06/02/2010, the Food Services Manager (employee # 11) revealed that he/she had not received any food and dietary training. Review of employee #11's personnel file lacked evidence of a job description for Dietary Director and lacked evidence of dietary training.