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Tag No.: A1671
Based on review of records and staff interviews it was determined the facility failed to ensure that Patient #1's right to participate actively in the development of a discharge plan addressing aftercare issues extended to Patient #1's parent; which included the individual's mental health, physical health, and social needs.
In addition, Social services staff failed to document in Patient #1's medical records that the parent was notified of the date, time and location of the discharge planning meetings to include the day of discharge plans; and in accordance with the facility's Discharge Planning Policy.
Findings included:
Review of complaint intake information for TX00360475 revealed the following:
Patient #1 had been residing with his maternal parent who was involved in his overall care due to his diagnosis of schizophrenia. Patient #1 was admitted to the behavioral health facility on 8/18/20 for attacking his parent with a knife. The parent was attempting to assist the facility in finding him an assisted living facility or boarding home to discharge Patient #1 to after his acute care psychiatric treatment. Patient #1's parent initially was involved in the discharge planning for Patient #1 however, was not in agreement of the facility/boarding home the facility was wanting to discharge Patient #1 to. The parent asked the hospital social worker to not discharge the patient to that facility as the family was searching for another place. The parent never heard back from the social worker and then the parent found the patient walking near their home at 10PM [date not specified] where he was barefoot and relieving himself in the street. The parent/family had not been contacted or informed by anyone at the facility that he was going to be discharged. The parent stated she did not even know how the patient got home.
Review of the facility's policy and procedure for Discharge Planning, Policy # PC.7.01, last revised 1/25/2017 indicated the following, in part:
Policy- "All patients leaving the hospital shall have a formal discharge plan that is initiated at the time of admission, based on input from the patient, family/significant other and the treatment team."
Procedure- 2. Potential for out-of-home placement will be assessed and appropriate level of care options for long term care will be explored with the patient and family.
4. The patient will be advised of recommendations for programs and services in the community and with consent of the patient/family, appropriate referrals will be made by the Social worker.
7. Prior to discharge, the nurse or social worker shall ensure that receiving agencies or family/caretakers are aware of the upcoming discharge.
Review of Patient #1's Multidisciplinary Progress notes revealed the following:
8/26/20 at 10:10 AM, Social Services Staff A documented she spoke with Patient #1's parent/mother after obtaining verbal consent. Patient #1's mother stated the patient could not return back home with her after discharge as Patient #1 had been physically assaultive towards her and she was scared of him returning to her home. Mother requested for Patient #1 to go to a group home or assisted living and was willing to cover the difference. Social Services Staff A informed mother that this info would be provided to the treatment team so that placement could be found. Mother was thankful for the help, is supportive and willing to be involved in treatment.
8/28/20 at 16:30, Social Services Staff A documented she spoke with Patient #1's mother to provide an update on Patient #1's progress and placement. Informed mother that Case Manager A was still working on placement. Mother provided the name of a possible group home; "A" named. Informed Mother that "she would be notified once placement was found."
9/1/20 (no time), Case Manager (CM) A documented that Patient #1 was "projected to discharge today. Client has confirmed transportation. Client has the option to follow up with outpatient services. Collateral has been scanned, emailed and faxed." There was no indication where Patient #1 was being discharged to. There also was no documentation or indication that Patient #1's mother had been notified of the planned discharge. In conclusion, there was not any documentation in the record that CM A had any contact with Patient #1's mother during his inpatient stay.
There were not any further social services notes documented for 8/29/20 (Saturday), 8/30/20 (Sunday) and 8/31/20 (Monday).
Interview on 10/22/20 at 2:45PM with Social Services Staff A indicated she spoke with Patient #1's mother on 8/26/20 and 8/28/20 because Patient #1's assigned Case Manager A "was out" and she filled in for her. Social Services Staff A stated that Patient #1's mother mentioned a group home named "A" for Patient #1 to be discharged to. She further stated that Case Manager A had been working on a facility for Patient #1 to be discharged to and that she was to follow up with Patient #1's mother on the finalization of discharge plans.
Interview on 10/22/20 at 3:00 PM with Case Manager A state she had verbally spoke with Patient #1's mother regarding placement because she had requested a supervised home for him to be discharged to; "like an assisted living facility;" but they were like "$2,100" and Patient #1 did not meet the medical criteria. CM A stated she suggested a facility named "B" to the mother as an option. CM A confirmed there was not any documentation in Patient #1's record that she had spoken with Patient #'1 mother regarding possibility of facilities for discharge. CM A also confirmed there was not any documentation in Patient #1's record that the parent/mother was notified of the date, time and location of the discharge planning meetings to include the day of discharge plans; and in accordance with the facility's Discharge Planning Policy.