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Based on policy review, medical record review, document review, and interview the hospital failed to determine the appropriate post-hospital discharge destination, identify what the patient would require for a smooth transition, determine the patient's post-hospital needs, and have knowledge of the types of services provided at receiving facilities for all patients 1 of 3 (Patient #1) sampled discharged patients received appropriate discharge and post-hospital care. Patient #1 was inappropriately discharged to a facility that was unable to meet her needs.

The findings included:

1. The hospital failed to ensure all patients received appropriate discharge planning in order to ensure their needs could be met.
Refer to A-0813,

Based on policy review, medical record review, document review, and interview the facility failed to ensure each patient received an appropriate discharge planning process to ensure the post-hospital discharge needs of all patients are identified and approbate placement for patients are determined for 1 of 3 (Patient #1) sampled discharged patients received appropriate post-hospital care. Patient #1 was inappropriately discharged to a facility that was unable to meet her needs.

The findings included:

1. Review of the facility policy titled Discharge revealed, "To facilitate timely, appropriate, and continuous post-discharge care, discharge planning begins when the patient enters the treatment setting...Specific problems and/or needs will be identified and become part of the treatment planning and discharge planning process...The attending physician, or designee, will issue the order for discharge, either verbally, by telephone written in the physician's order section of the patient's medical record, or entered by the physician into the patient's Electronic Health Record making sure to include...The specific date of discharge...Any contingencies which would affect the discharge...Any limitations on the order...No discharge may occur without the physician's order...Discharge Criteria...The patient's psychiatric condition is able to be managed in a less restrictive environment...Prior to discharge of the patient, the following assurance will be made by appropriate staff...an aftercare plan has been completed and appropriate referrals made to provide reasonable assurance of continued care..."

2. Medical record review for Patient #1 revealed an admission date of 2/5/2020 with diagnoses which included Schizoaffective Disorder, Depressive Type.

Review of the High Risk Notification Form dated 2/5/2020 showed the patient was "Physically Aggressive."

Review of the Crisis Assessment dated 2/5/2020 showed Patient #1 "...presents as a danger to self and others evidenced by erratic behavior and psychosis..."

Review of the document titled, "First Certificate of Need for Emergency Involuntary Admission" dated 2/5/2020 revealed Patient #1 was, "responding to internal stimuli...has been off medication...patient is aggressive and violent towards others...Patient's mother reports that she tried to run her over. Patient was observed to be driving aggressively and almost hit someone's house. Patient is displaying aggressive behavior...Treatment, medication, and stabilization in a safe, secured inpatient psychiatric setting is necessary to ensure the personal safety of self/others at this time...Patient is not able to return to home unless treated at inpatient psychiatric hospital for stabilization. Patient will need a safe and secure environment during treatment..."

Review of the Psychiatric Evaluation dated 2/5/2020 showed "Patient was very irritable and uncooperative in answering questions. Appears to be responding to internal stimuli and displays bizarre behavior...Reportedly during assessment she tried to make someone angry by lying down on the bench as though she was tired, moving heavy furniture in room and laying on floor. She became verbally aggressive with another patient. She began banging on the windows and demanding to be allowed to go home...Very argumentative regarding diagnosis and reason for hospitalization. She displays intrusive and impulsive behaviors, verbal and physical aggression and threatening at times...She is admitted for mediation [medication] stabilization..."

Review of the Behavioral Health (BH) Interdisciplinary Treatment Master Sheet dated 2/5/2020 showed an anticipated date of discharge of 2/26/2020. The initial discharge criteria included, "...Improved Stabilization in Mood, Thinking, and-or-Behavior...will take medications as ordered without prompting or verbally persuasion...will hold a rational conversation, will be free of any auditory/visual hallucinations and will comply with medication regime by discharge..."

Review of a Seclusion/Restraint Progress Note dated 2/6/2020 showed a physician's order was obtained to use mechanical and chemical restraints from 8:15 AM until 9:55 AM due to Patient #1 exhibiting threatening behaviors directed toward staff, "...refusing to cooperate with staff and grabbing at computer in hallway..." The patient was given Prolixin 5 milligrams (mg) intramuscularly (IM) and Benadryl 50 mg IM and was placed in a restraint chair until she was able to calm down (Proloxoin and Benadryl were administered to calm the patient).

A Discharge Planning note dated 2/6/2020 showed, "...Patient refused to communicate...Patient received a PRN [a medication administered as needed to calm a patient] for behavior and difficulty to redirect today. This is patient's 2nd [second] PRN since admission..."

Review of a Seclusion/Restraint Progress Note dated 2/6/2020 showed a physician's order was obtained to use mechanical and chemical restraints from 5:00 PM 5:40 PM due to Patient #1's, "agitation continued to escalate and [named Physician #1] ordered a prn [as needed] med. The patient refused and was informed due to 603 status [involuntary commitment] she could not refuse medications. We told her we would have to restrain her to give med. The patient voluntarily sat in restraint chair...The pt [patient] was attempting to bite staff and was verbally threatening staff..." The patient was given Geodon 10 mg IM and Benadryl 50 mg IM.

A Nurse Progress Note dated 2/6/2020 at 12:10 AM showed Patient #1 was given Geodon 10 mg and Benadryl 50 mg IM, "...pt anxious, refusing redirection, stating she doesn't want to be here..."

A Nurse Progress Note dated 2/6/2020 at 3:49 PM showed, "patient is agitated and following one of the doctors around and not allowing her to speak with her patients. [Physician #1] was notified and ordered Geodon 5 mg and Benadryl 50 mg IM once..."

A BH Daily Progress Note dated 2/7/2020 showed Patient #1 was noted as "Argumentative and aggressive" and required medications for "disruptive and aggressive behavior..." The note further documented Patient #1 was experiencing homicidal ideations and her "Response to Treatment" was documented to as "Unstable." The discharge plan revealed Patient #1 would be discharged "back to her home".

A Discharge Planning note dated 2/7/2020 showed "...Patient received a PRN Geodon 5mg and Benadryl 50 mg IM. Patient continue to walk around angrily, boxing in the air..."

The BH Daily Progress Note dated 2/8/2020 showed Patient #1 was "Argumentative and aggressive. Displaying Manipulative and attention seeking behavior. The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

The BH Daily Progress Note dated 2/9/2020 showed Patient #1 was having "Rambling with racing thoughts. Argumentative and aggressive...continues to be attention seeking-challenging staff and rules (despite community meeting this am-which included behavioral expectations/consequences of behavior)...continues to taunt peers and staff...refused to come back inside from smoke break...Requires frequent redirection..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

The BH Daily Progress Note dated 2/10/2020 showed Patient #1 was "...Loud and demanding...Defiant and oppositional at times..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

A Discharge Planning note dated 2/10/2020 at 11:23 AM showed, "counselor spoke with patient in group. Patient interrupted group arguing with her peer about beating up their mother...uncooperative with the group process...court date is...Wednesday 02/12/2020..."

A Discharge Planning note dated 2/10/2020 at 12:59 PM showed, "...spoke with patient's mother...conservator...she is afraid for her life. She is afraid for her daughter to come back to her home...is requesting that patient be sent someplace for long term treatment...Counselor as [asked] if she had consider group home placement for patient...[patient's mother] stated but if she goes she will elope. She will just leave...faxing referral to [named 4 facilities.]..."

Review of the Treatment Authorization Form showed Patient #1's insurance authorized 3 additional hospital days 2/11/2020 through 2/13/2020 with a review scheduled for 2/14/2020.

The BH Daily Progress Note dated 2/11/2020 showed Patient #1 "...Says being in here is not productive...Mood is "up and down". Paranoid. Refusing to take shot..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

The BH Daily Progress Note dated 2/12/2020 showed Patient #1 was "Very argumentative about everything. Very aggressive and threatening. Mood is up and down. Poor insight "I don't have problems." Says taking pills I don't need..." The note further documented Patient #1 continued to have homicidal ideations was unstable and would be discharged to her home.

The BH Daily Progress Note dated 2/13/2020 showed Patient #1 had "...Poor anger control. Had PRN Geodon + [plus] Benadryl 50 mg IM...Very aggressive and threatening..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

A Discharge Planning note dated 2/13/2020 showed "...Patient went to court on Wednesday 02/12/2020. patient continues to present hyperactive and intrusive behavior and agitating other individuals, patient was given a PRN..."

The BH Daily Progress Note dated 2/14/2020 showed Patient #1 remained "argumentative, hyperactive, intrusive and impulsive but is easier to redirect...Staff reports mother is making multiple phone calls daily. Mood is up and down....States she has ADHD [Attention Deficit Hyperactivity Disorder] not bipolar...Constantly challenging staff and unit rules...Poor sleep but refusing to take sleep meds..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

Review of the Treatment Authorization Form showed a review was held on 2/14/2020 and Patient #1's insurance authorized 7 additional hospital days 2/14/2020 through 2/20/2020 with a review scheduled for 2/21/2020 if not discharged.

A Discharge Planning note dated 2/14/2020 showed Patient #1 was approached about the possibility of going to a group home after discharge. "Patient stated, no...engaged patient in a conversation about her behavior...Patient was receptive..." The note continued and with a phone conversation between the counselor and the owner at one of the facilities indicating they would accept Patient #1 if she was willing to go. In the latter part of the note, the counselor documented, "received a call [telephone message] from patient's mother...requested a family conference with her and [Patient #1], or with the team that is making decision...'I [Patient #1's mother] would like to be a part of the team that is making decision about [Patient #1's] care. I just want to make sue [sure] [Patient #1] discharge Plan is successful for her'...Counselor returned [Patient #1's mother] call...no answer and mail box is full unable to leave a message..."
There was no documentation Patient #1's mother was involved in the Discharge planning process.

The BH Daily Progress Note dated 2/15/2020 showed Patient #1 was "Observed dancing in dayroom. Hyper verbal and loud. Pressured speech with racing thoughts. Manipulative, Manic behavior and mood...Angry and irritable at mom..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

A Nurse Progress Note dated 2/15/2020 at 11:00 PM, showed, "...several attempts to encourage patient to take medication, pt refused..."

The BH Daily Progress Note dated 2/16/2020 showed Patient #1 was "Pacing with psychomotor agitation. Remains argumentative. Verbally abusive toward staff. Paranoid toward her mother. Per staff- yelled and cursed at mother and walked out during visitation. Poor insight...Sleeping better...Took meds..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

A Nurse Progress Note dated 2/16/2020 at 10:00 PM showed, "Refused all night medication..."

A Nurse Progress Note dated 2/17/2020 at 4:00 AM showed, "Walking around unit attempting to demean staff and provoke peers...Pt is intrusive, several peers asked her to stop harassing them; however she does not follow request of peers had to verbally redirected several times to comply with boundaries and limits..."

A Nurse Progress Note dated 2/17/2020 at 5:17 PM showed, "...Agitating peers by arguing...Peers threatening physical harm is she not redirected. Staff offer [Patient #1] something to calm her down...standing PRN given per order..."

The BH Daily Progress Note dated 2/17/2020 showed Patient #1 was "...Argumentative. Intrusive. Impulsive. Provoking and agitating peers. Refused pm medicines. Got PRN IM. Verbally abusive toward staff..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

Review of the BH Interdisciplinary Treatment Plan Update dated 2/17/2020 showed, "...Patient referred to [named accepting residential treatment facility and 2 additional facilities]...Psychiatric Problems...pacing with psychomotor agitation. Argumentative, Intrusive, Impulsive, Provoking and agitating peers. Refused pm medicines. Got PRN [as needed] IM [intramuscular]. Verbally abusive toward staff. Paranoid toward her mother. Poor insight...Manipulative, Manic behavior and mood...Constantly challenging staff and unit rules...attends activity group, and has been disruptive but is able to be redirected..."

A Discharge Planning note dated 2/17/2020 showed the counselor received voice mail messages from both a nurse on the unit and Patient #1's mother informing her that Patient #1's mother did not want her to return to her home because she was afraid of her and that she didn't want her to go to a "care home, group home or shelter but a long term facility...she wants to be at the next team meeting..." There was no documentation Patient #1's mother was involved in the Discharge planning process.

A Discharge Planning note dated 2/18/2020 at 8:45 AM showed, "Counselor received a VM [voice mail] fro [Patient #1's mother] that patient is not on the right medication because her behavior is still acute...insist no group home or homeless shelter and patient cannot come home with her...wants more long term placement for patient..."

Review of a Seclusion/Restraint Progress Note dated 2/18/2020 showed a physician's order was obtained to use mechanical restraints from 10 AM until 12:00 PM due to Patient #1 "being very intrusive, making derogatory toward peers, unable to redirect, making verbal threat toward counselor/nursing staff...physical altercation with peer...place in restraint chair..."

A Nurse Progress Note dated 2/18/2020 at 10:53 AM, showed Patient #1 was "Threating [threatening] verbal and physical harm to staff and peers. Unable to redirect. MD notify. New order received, place in restraint chair..."

A Discharge Planning note dated 2/18/2020 at 11:30 AM, showed, "...on the unit at 9:45 AM to assist another patient...Patient [#1] paced and knocked at the window of nursing unit. Counselor asked patient to wait until after group before we meet. Patient asked repeatedly, "why can't we meet now...don't want to wait until after group."...Patient paced and stared in the window...Charge Nurse...tried reasoning with patient. Patient very difficult to redirect, non-compliant...continue with the intrusive behavior. Patient was placed in a mechanical restraint. Patient mother...was called...place on speaker phone...stating...I want her in a long term facility to see what can be done to protect her. [Patient #1's mother] was advised the team will discuss the best option for patient in the 2:30 meeting today...asked if she could be present. [Patient #1's mother] was informed this was a meeting for the treatment team only..." There was no documentation Patient #1's mother was allowed to participate in the discharge planning process.

The BH Daily Progress Note dated 2/18/2020 showed Patient #1 "Was in seclusion observation room for aggression. Aggravating and provoking peers. Intrusive and impulsive. Mood is up and down. Accusatory when demands not met. Minimizing her behaviors. Poor insight "There is nothing going to help me...Slept fair..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

The Interdisciplinary Treatment Plan Update Team/Conference form dated 2/18/2020 showed Patient #1 was "Unable to participate (reason) Patient in Restraint Chair..." There was no documentation Patient #1's mother was notified in order to participate in the meeting.

A Discharge Planning note dated 2/18/2020 at 2:02 PM showed, "...spoke with [named owner at accepting residential facility]...stated she still have a bed and is willing to accept...they [accepting residential facility] have an extensive Behavior Health care unit. Patient time at the facility [accepting residential facility] will depend on her progress and insurance approval. Patient mother will not be allowed to call and interrupt patient treatment..."

A Discharge Planning note dated 2/18/2020 at 5:27 PM showed, "[Physician #1] Treatment team met to day and discussed [discussed] safe discharge for patient...called patient mother...and explained the Residential Treatment Facility to her...informed [Patient #1's mother] she has to follow the directions for the facility [accepting residential facility] when contacting the patient. The facility is located on 5 acres and patient cannot get opff [off[ the property...I [Physician #1] agree with her going to the facility...informed if patient requires signing in and refuses, she may have to as the patient's conservator..."

The BH Daily Progress Note dated 2/19/2020 showed Patient #1 "Remains argumentative. Accusatory. Negative toward mental health - This place does nothing for no one...medications not going to help...I don't need help...States suffers from ADHD...Mood is up and down..." The note further documented Patient #1 continued to have homicidal ideations, was unstable and would be discharged to her home.

The BH Daily Progress Note dated 2/20/2020, the day before she was discharged, showed, "...I am not going to another facility...Remains argumentative. Hyperactive and Intrusive. Oppositional...Admitted to poor anger control. Denies SI/HI [suicidal or homicidal ideations]. Denies psychosis. Erratic sleep. Compliant with medications. Pending discharge tomorrow...Slept fair. Went to group..." The note further documented Patient #1 was unstable and would be discharged to her home.

A Discharge Planning note dated 2/20/2020 at 5:45 PM showed the Counselor and the Director of Social Services met with Patient #1 to discuss discharge set for 2/21/2020. The note documented Patient #1 "was oppositional, argumentative, and not in agreement with the discharge to the Residential Treatment Facility. Patient presented a threatening verbal tone and body movements and very demanding...Patient insist on going home. Patient informed that she was not able to go back to her mother home for hear of her safety as well as her mother's safety..."
The Counselor continued and documented she had called the local sheriff's department as well as the sheriff's department in the county of the receiving residential facility, "to find out what the procedures are for transporting potentially aggressive, at risk for elopement, and aggressive patients from one facility to another...was informed a court order must be obtained. [Patient #1's mother] was called to inform her of patient's reaction and concerns of safe transport for patient to the facility [accepting residential facility]...reminded she [the mother] is patient's permanent conservator and has to sign patient in if [Patient #1] does not sign herself into the facility. [Patient #1's mother] was also informed of obtaining a possible order from the Judge to transport patient to the facility...Transportation was a key concern. Because patient is difficulty to redirect, a possible flight risk at risk of combative behavior, patient will be transported by [named ambulance service] for a safe transport..."

Review of the Discharge Summary dated 2/21/2020 showed "...Medications were adjusted during the hospital course to stabilize symptoms and improve functioning. Patient made slow but steady improvement. Patient's participation in milieu and groups improved toward the latter part of the hospital course. Patient's mood and psychotic symptoms improved with brighter affect and increased social interaction. Patient denied suicidal and homicidal ideations and expressed desire to be discharged. Treatment team felt that patient is nearing baseline and is ready for discharge...Physical-Medical Condition on Discharge stable...Discharge Diagnoses...Schizoaffective disorder Bipolar Type..."

The Nursing Discharge Summary dated 2/21/2020 revealed Patient #1 was discharged on 2/21/2020 at 12:33 PM by ambulance to "another hospital".

There were no documentation of physician's orders for Patient #1's discharge.

Review of a Discharge Planning note dated 2/24/2020 at 7:47 AM, after Patient #1 had been discharged, revealed "02-21-2020 Counselor went to ITU [Intensive Treatment Unit] to visit patient to be sure she was prepared for discharge. Patient became argumentative and threatening, intrusive, Counselor was unable to communicate with her because of her behavior. Patient was informed that her mother stated she could not come home, getting additional help is better at this time...[name ambulance company] was called...Patient was protesting the discharge to the facility. When counselor arrived on the floor, staff and transport attendants were present with patient to assist with discharge. Patient was angry...Counselor went inside the nursing unit and patient calm down and got on stretcher without assistance and became tearful...Staff and transporters stopped patient at security to get her belongings. Counselor observed from a distance as thoughts of being a current trigger to patient after she had calm down. Counselor was unaware that patient had a cell phone among her items. 02-24-2020 counselor received a VM from [Patient #1's mother] stating that patient left the facility...she thought the facility was a locked facility. Counselor was informed by [named owner of the receiving facility] that the facility was on 5 acres of property, away from the city, and staff would be available to monitor patient..."

Review of the ambulance service's Patient Care Report dated 2/21/2020 revealed "...EMS [emergency medical service] unit...responded immediate to...transport involuntary schizoaffective disorder...Patients mental state is alert x [by] 4 [alert, oriented to person, place, time and date]..aggressive and uncooperative...". The EMS staff documented the patient was administered a sedative prior to the EMS arrival.
EMS documented, ...Pt [Patient #1] refused to be assessed on scene or at start of transport...During transport patient yelling when asking or telling what she wanted...Pt deemed herself not a pt, talked almost constantly..." The EMS documented upon arrival at the receiving residential facility the patient entered the building and, "accosted [attacked] LPN [licensed practical nurse] and demanded to leave at once...".
Review of additional notes by the EMS during transport revealed, "...Pt threw temper tantrum at scene [receiving facility] throwing her bags on floor, sitting and refusing to get up, cursing [name of registered nurse at receiving facility] and MSW [medial social worker at receiving facility]...Pt is self absorbed and talking on phone about her 'being stuck in this B.S...".
The EMS documented, "...Patient left under care of facility staff...Pt pacing on front porch of facility when EMS departed".

Review of the residential receiving facility's nursing notes dated 2/21/20 revealed, "...[Patient #1] arrived via ambulance....entered building & [and] was very agitated & verbally aggressive....started slamming doors & slinging chairs upon entrance & stated was not staying here...grabbed luggage & walked out front door...started walking down road...to neighboring house & thru [threw] luggage at neighboring houses car. Nurse was able to...have AMA [Against Medical Advice] papers signed...[Patient #1] took off walking down road towards interstate c [with] personal belongings...".

Review of the referral packet sent by the discharging hospital to the receiving residential facility via fax on 2/10/2020 revealed the receiving residential facility was sent Patient #1's Face Sheet, a Psychiatric Evaluation, the Nursing Admission Assessment, and Patient #1's History and Physical. There was no documentation the receiving residential facility had received any information about Patient #1's aggressive behaviors, combative behaviors, and elopement risks.

3. During an interview on 3/4/2020 at 1:06 PM, the hospital's Chief Nursing Officer (CNO) was asked if there were any transfer papers completed and she stated, "The patient was discharged to another facility. It was not a transfer." The CNO was asked if the nurses called report to the facility and the CNO informed surveyor that someone from Social Services (SS) made the arrangements.

During an interview on 3/4/2020 at 1:17, the SS Counselor informed surveyor Patient #1 had been "basically difficult, aggressive, intrusive, outspoken, very demanding and hostile most of the time."
The SS Counselor reported placement was sought at the receiving facility at the request of Patient #1's mother who was also her conservator.
The SS Counselor was asked what Patient #1's mother was told regarding the receiving facility and the SS Counselor stated the patient's mother was told the receiving residential facility was located on 5 acres of land in the country away from town where the patient would have a place to walk and would be supervised.
The SS Counselor was asked if the patient's mother was told the receiving residential facility was a locked facility and the SS Counselor stated, "No, I told it her it was on 5 acres of land in a country area and that it was secure as far as being staffed properly and people taking care of her. I know that was a concern because she had told me she had left other places..."
The SS Counselor hen informed surveyor the [named ambulance service] was called to transport Patient #1 to the receiving facility "because we thought she might be a flight risk. They sent the 1st truck but it didn't have restraint capabilities so we requested a 2nd truck with EMT [emergency medical technician] in case needed restraint intervention..."
The SS Counselor was asked if the treatment team ever had a meeting with Patient #1's mother and the Counselor stated, "No, she [Patient #1's mother] talked with the nurse and the nurse informed her that the meeting was for treatment team members only because they discussed several different patients..."
The Counselor was asked if Patient #1's condition improved during her hospital stay and the Counselor stated, "[Patient #1] restlessness and intrusiveness didn't improve."
The Counselor was asked how receiving facilities determined whether or not to accept a patient and the Counselor stated, "We do a referral packet and they base the decision on what we send them as to whether they accept them or not."
The SS Counselor was asked if she was aware that Patient #1 had left the receiving facility and the SS Counselor sated when she returned to work on 2/24/2020 she had an email stating the patient had eloped, police were called, and the patient had been taken to the emergency room.
The SS Counselor was asked if she knew where Patient #1 was, she stated, "No..."

During an interview on 3/4/2020 at 2:30 Physician #1 was asked if Patient #1 had been ready for discharge from the physician stated, "Yes, it was appropriate placement. The facility [receiving residential facility] was a safe place as far as treatment...they were willing to work with a difficult patient."
The physician was asked if the receiving facility was a secured facility and the physician stated, "I don't' know."

During a telephone interview on 3/9/2020 at 9:20 AM, Patient #1's mother stated she had spoken with the hospital's SS Counselor many times regarding long term placement for her daughter. She stated, "I told them [the hospital] it has to be locked down because she [Patient #1] will elope."
The patient's mother continued and stated she called the receiving facility and they informed her, "This is not a lock down place." The patient's mother stated the receiving facility informed her Patient #1 "walked out of the building to a gas station and police had to be called and she was taken to the emergency room...[named discharging facility] knew that place was not locked...nobody has responded to my calls since she came back home...She needs help...She doesn't think anything is wrong with her..."

During a telephone interview on 3/9/2020 at 9:24 AM, the owner of the receiving residential facility informed surveyor that Patient #1 was never admitted to their facility. The owner stated, "As soon as [Patient #1] walked in the door [the patient] started throwing things and we called the law..."
The owner was asked what information she had received from the discharging hospital regarding Patient #1 and the owner stated the Social Worker (SS Counselor) felt like we were a good fit for her because we had 24/7 supervision and, "On the day [Patient #1] was to come here, she [SS Counselor] said it will be good for her since you're a locked facility. I told [the SS Counselor] I never told you we were a locked facility.
The owner stated, "[Patient #1] tore up the vehicle [ambulance] on the way here and they had to sedate her. They [the ambulance] pulled up and dropped her off. I thought she was stable. We can't take her like this. She threw 3 chairs; threw luggage at neighbor's car. Social Worker told me she had to come by ambulance. We never get anybody like that...That was very unprofessional to send me an unstable patient like that..."

During a second interview on 3/9/2020 at 10:55 AM, the SS Counselor was asked if Patient #1's behaviors ever improved during her hospitalization and the SS Counselor stated, "No, the calmest I ever saw her wash when she got on that stretcher to leave here."
The SS Counselor was asked why Patient #1 was discharged since the patient hadn't improved, and the SS Counselor stated, "In my opinion, it was more or less that she had more behavioral health issues than mental health issues..."
The SS Counselor was asked if she was aware Patient #1 was never admitted to the receiving facility and the Counselor stated, "No."
The SS Counselor was asked if Patient #1 was appropriate for discharge and the SS Counselor stated, "Well, that's instructions we get from the doctor. The doctor makes those decisions..."