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Based on record review and interview the facility failed to meet the Condition of Participation to ensure patients are discharged with the accurate medication list for continuation of care.

The finding are:

A. The facility failed to discharge patients with a complete medication list and follow-up appointments. Refer to tag 813

Based on record review, observations, and interviews the facility failed to provide patients with accurate information for continuation of care at discharge including but not limited to full medication list and follow-up appointments for 8 (P (Patient) P1, P3, P5, P6, P8, P9, P10 and P11) of 11 (P1-P11) patients.
1. Medication lists were not provided for 8: P1, P3, P5, P6, P8, P9, P10 and P11 patients.
2. Follow-up appointments were missing or incorrect on the "Discharge Continuing Care Plan Assessment" for 2: P1 and P5 patients.
These deficient practices could lead to serious harm or death to all patients if correct medication regimen and follow-up appointments are not provided.

The findings are:

A. Record review of facility policy "Medication Reconciliation" dated 12/2022 stated, "POLICY: In addition, this procedure will ensure, upon discharge or transfer of any client that the next provider of care will have all necessary information regarding medications this client is currently taking. This process includes a comparison of the medications [facility name] provides to those on the list. PROCEDURE: 4. Prior to discharge, the nurse will review the prescribed discharge medication list with the client and provide them with a copy of the medication reconciliation record.

B. Record review of facility policy "Discharge of Clients" dated 3/2020 stated, "PROCEDURE: 2.4.4. Medication information to include a copy of the medication reconciliation form" [process of comparing a patient's medication].

C. Record review of P1's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Aripiprazole 10 mg (Indication: mood), Mirtazapine 7.5 mg (indication: sleep), Oxcarbazepine 300 mg 9 (Indication: Mood), Acetaminophen 325 mg (Indication: for pain), Insulin Lispro 100 units/mL SOLN [solution] (indication: diabetes), Al hydroxide-Mg hydroxide-simethicone 200 mg-200 mg-20 mg/5 mL SUSP (Indication: indigestion), Aspirin 81 mg DRT (indication: CAD [coronary (heart) artery disease]), Atorvastatin 10 mg (indication: Hyperlipidemia [High Cholesterol]), Azithromycin 250 mg (Indication: not noted), Citalopram 20 mg (Indication: not noted), Docusate Sodium 100 mg (Indication: Constipation), Fluticasone nasal 50 mcg/INH SPR 9 (Indication: Not noted), Insulin Glargine 100 units/mL (Indication: Not noted), Insulin Lispro 100 units/mL (indication: diabetes), Levetiracetam 500 mg (Indication: seizures), Lamotrigine 200 mg (Indication: Not noted), Metformin 1,000 mg (Indication: Not noted), Olanzapine 15 mg (Indication: not noted), Omeprazole 20 mg (indication: GERD [acid reflux]), Prednisone 20 mg (Indication: Not noted), Terbinafine 250 mg (Indication: not noted), and Trazodone 100 mg (Indication: not noted).

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are Aripiprazole Oral 10 mg (Indication: mood), Mirtazapine Oral 7.5 mg (Indication: Sleep), and Oxcarbazepine 300 mg (Indication: mood). Discharge Medication Reconciliation note stated, "I have reviewed and reconciled the patient's current medication regimen with the prescribed medications to be continued at discharge listed above." 19 of 22 medications are not listed on the "Discharge Continuing Care Plan Assessment" that are listed on the "Discharge Medication Reconciliation Final".

D. Record review of P3's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Clonazepam 0.5 mg (Indication: anxiety), Escitalopram 20 mg (Indication: Mood), Mirtazapine 7.5 mg (Indication: sleep), Acetaminophen 325 mg (Indication: for pain), Albuterol 90 mcg/INH (Indication: not noted), Chlordiazepoxide 25 mg (Indication: not noted), Fluoxetine 20 mg (Indication: not noted), Fluoxetine 40 mg (Indication: not noted), Acetaminophen-hydrocodone 325 mg-5 mg (Indication: Not noted), Magnesium Hydroxide 8% SUSP (Indication: for constipation), Prazosin 1 mg (Indication: not noted), and Prednisone 20 mg (Indication: not noted).

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are, Clonazepam 0.5 mg (Indication: anxiety), Escitalopram 20 mg (Indication: Mood), Mirtazapine 7.5 mg (Indication: sleep). Discharge Medication Reconciliation note stated, "I have reviewed the medications listed upon Admission Medication Inventory/Reconciliations forms...I have reviewed and reconciled the patient's current medication regimen with the prescribed medications to be continued at discharge listed above." 9 of 12 medications are not listed on the "Discharge Continuing Care Plan Assessment" that are listed on the "Discharge Medication Reconciliation Final".

E. Record review of P5's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Amantadine 100 mg (Indication: Dyskinesia [Uncontrolled involuntary movements]), Benztropine 2 mg (Indication: EPS [Involuntary and uncontrollable movement]), Gabapentin 300 mg (Indication: Neuropathy [damage to the nerves]), Dextromethorphan-Quinidine 20 mg (Indication: pseudobular affect [uncontrollable outbursts of crying or laughing]), Prazosin 2 mg (Indication: Nightmares), Risperidone 2 mg (Indication: Psychosis), Aspirin 81 mg (Indication: CVA [cerebrovascular accident (stroke)]), and Atorvastatin 10 mg (Indication: Hyperlipidemia [high cholesterol]). For this specific patient there is a section titled "DO NOT CONTINUE THESE MEDICATIONS" Under this section Amlodipine 5 mg (Indication: Hypertension [high blood pressure]) is listed.

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are, Amantadine 100 mg (Indication: Dyskinisia), Benztropine 2 mg (Indication: EPS), Gabapentin 300 mg (Indication: Neuropathy), Dextromethorphan-Quinidine 20 mg (Indication: pseudobular affect), Prazosin 2 mg (Indication: Nightmares), and Risperidone 2 mg (Indication: Psychosis). Discharge Medication Reconciliation note stated, "I have reviewed the medications listed upon Admission Medication Inventory/Reconciliations forms." There is no instruction for this patient on this form to stop taking Amlodipine 5 mg as noted above. 6 of 9 medications are not listed on the "Discharge Continuing Care Plan Assessment" that are listed on the "Discharge Medication Reconciliation Final".

F. Record review of P6's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Gabapentin 300 mg (Indication: Cravings) Desvenlafaxine 50 mg (Indication: Depression), Lorazepam 2 mg (Indication: Anxiety Secondary to withdrawal symptoms) , and Thiamine 100 mg (Indication: Nutritional supplement).

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are Gabapentin 300 mg (Indication: Cravings), and Desvenlafaxine 50mg (Indication: Depression). Discharge Medication Reconciliation notes stated, "I have reviewed the medications listed upon Admission Medication Inventory/Reconciliations forms." There is no instruction for this patient on this form to stop or continue taking Lorazepam 1 mg, and Thiamine 100 mg.

G. Record review of P8's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Aripiprazole 15 mg (Indication: Unspecified mood disorder), and Methylphenidate 36 mg (Indication: Attention Deficit Hyperacticity Disorder). For this patient there is also a section titled "DO NOT CONTINUE THESE MEDICATIONS" under this section medications listed are Aripiprazole 300 mg (Indication: Not noted), Aripiprazole 15 mg (Indication: not noted), Methylphenidate 54 mg (Indication: not noted), and Oxcarbazepine 150 mg (Indication: Not noted).

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are Aripiprazole 15 mg (Indication: Unspecified mood disorder), and Methylphenidate 36 mg (Indication: Attention Deficit hyperactivity disorder). Discharge Medication Reconciliation note stated, "I have reviewed the medications listed upon Admission Medication Inventory/Reconciliations forms...I have reviewed and reconciled the patient's current medication regimen with the prescribed medications to be continued at discharge listed above." There is NO instruction for patient to stop taking Aripiprazole 300 mg, Aripiprazole 15 mg, Methylphenidate 54 mg, and Oxcarbazepine 150 mg as noted above.

H. Record review of P9's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Bupropion ERT Wellbutrin XL 150 MG (Indication: MDD [Major depressive disorder]) , Topiramate 25 mg (Indication: Unspecified mood disorder), Benzoyl peroxide topical 10% (Indication: Acne), Clindamycin topical 1% (Indication: acne) Tamsulosin 0.4 mg (Indication: Urinary retention), Ibuprofen 600 mg (Indication: Pain), Melatonin 5 mg (Indication: Sleep), Ondansetron 4 mg (Indication: nausea), Benzocaine topical 20% (Indication: Canker sore), and cetirizine 10 mg (Indication: seasonal allergies). For this patient there is a section titled "DO NOT CONTINUE THESE MEDICATIONS" under this section medication listed are Acetaminophen 325 mg (Indication: for pain) Divalproex Sodium ERT 500 mg (Indication: Not noted), and Cetirizine 10 mg (Indication: not noted).

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are Bupropion ERT 10 mg (Indication: MDD), and Topiramate 25 mg (Indication: Unspecified mood disorder). No Discharge Medication Reconciliation note was on this form. There is no instruction to stop taking Acetaminophen 325 mg, Divalproex Sodium ERT 500 mg, and Cetirizine 10 mg as noted above.

I. Record review of P10's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Venlafaxine ERC 75 mg (Indication: Depression), Trazodone 100 mg (Indication: sleep), Oxcarbazepine 300 mg (Indication: mood), and Hydroxyzine Pamoate 50 mg (Indication: anxiety), For this patient there is a section titled "DO NOT CONTINUE THESE MEDICATIONS" under this section medications listed are Acetaminophen 325 mg (Indication: For pain), Aripiprazole 10 mg (Indication: Not noted), Aripiprazole 10 mg (Indication: Not noted), Clonidine 0.1 mg (Indication: withdrawal), Gabapentin 300 mg(Indication: Not noted), Gabapentin 100 mg (Indication: Not noted), Ziprasidone 40 mg (Indication: Not noted), Ibuprofen 600 mg (Indication: for pain), Lithium 300 mg (Indication: Not noted), Methocarbamol 500 mg (Indication: Not noted), Naltrexone 50 mg (Indication: Not noted), Oxcarbazepine 300 mg (Indication: Not noted), Prednisone 10 mg (Indication: Not noted), and Quetiapine 50 mg (Indication: Not noted).

2. Medication reconciliation form states "none" on Discharge Continuing Care Plan Assessment. There is no instruction to stop or continue taking the medications listed above given to the patient.

J. Record review of P11's medical record revealed;

1. Medications listed on the "DISCHARGE MEDICATION RECONCILIATION FINAL"; Aripiprazole 5 mg (Indication: Anxiety), Prazosin 2 mg (Indication: Flashbacks), Acetaminophen 325 mg (Indication: For pain), Aripiprazole 2 mg (Indication: Not noted), Ascorbic Acid 250 mg (Indication: Supplement), Atenolol 50mg (Indication: Not noted), Azelastine Nasal 137 mcg/INH (Indication: Not noted), Benztropine 0.5 mg (Indication: Not noted), Buspirone 10 mg (Indication: Not noted), Celecoxib 200 mg (Indication: Not noted), Cephalexin 500 mg (Indication: Not noted), Cholestyramine 4 g/9 g powder (Indication: Not noted), Duloxetine 20 mg (Indication: Not noted), Levocetirizine 5 mg (Indication: Not noted), Levothyroxine 150 mcg(Indication: Not noted), Levothyroxine 100 mcg (Indication: hypothyroidism [low thyroid horomone]), Lisinopril 10 mg (Indication: Not noted), Mirtazapine 7.5 mg (Indication: Not noted), Multivitamin with Iron (Indication: Nutritional supplement), Naproxen 500 mg (Indication: Not noted), Oxcarbazepine 150 mg (Indication: Not noted), Prednisone 20 mg (Indication: Not noted), Risperisone 0.5 mg (Indication: Not noted), Spironolactone 25 mg (Indication: Hypertension), and Topiramate 25 mg (Indication: Not noted).

2. Medications listed on the "Discharge Continuing Care Plan Assessment" under "Discharge Medication Reconciliation" are Aripiprazole 5 mg (Indication: Anxiety), and Prazosin 2 mg (Indication: Flashbacks). Discharge Medication Reconciliation notes stated, "I have reviewed the medications listed upon Admission Medication Inventory/Reconciliations forms." No other medications listed. 23 of 25 medications are not listed on the "Discharge Continuing Care Plan Assessment" that are listed on the "Discharge Medication Reconciliation Final".

K. During an interview on 12/07/2023 at 11:30 AM with Staff (S) 5, Assistant Director of Nursing, confirmed that a "Discharge Medication Summary for Patient" is not provided to patients, it can be printed, it's not part of our policy to print that for every patient. The nurse will explain any of the medications that they come in with. S5 stated that they don't feel that it is dangerous and is assumed that the patient will continue taking medications not listed on the "Discharge Continuing Care Plan Assessment.

L. During an Interview with S6, Nursing supervisor, on 12/07/2023 at 11:00AM, S6 confirmed the only thing the patient is sent home with is the "Discharge Continuing Care Plan Assessment" No other forms are sent home with the patient.

M. Observation of the discharge for P11, on 12/07/2023 at 1:10 PM, verified the only form given to the patient was the "Discharge Continuing Care Pan Assessment." No other medication lists were given with the patient.

N. Record review of facility policy "Case Management Discharge Planning" dated 10/1999 stated, "Procedure: 3. Clinical/Nursing Staff proceed with discharge planning activities in a timely manner. Discharge planning activities are identified in two categories: 3.2. Clinical and Utilization Management Staff are responsible for disposition and aftercare activities related to the planning and arranging of services necessary to support the client's participation in the treatment process and in the aftercare plan."

O. Record review of facility policy "Discharge of Clients" dated 3/2020 stated, "PROCEDURE: 2.4.3. Follow-up instructions."

P. Record review of P1's "Discharge Continuing Care Plan Assessment" showed a follow-up appointment for Tuesday 08/15/2023 and patient was discharged on Wednesday 08/16/2023.

Q. Record review of P5 "Discharge Continuing Care Plan Assessment" showed a follow up appointment with no date or time listed.

R. During an interview on 12/08/2023 at 4:08 PM with S11, Lead Case Manager, confirmed case managers are responsible for discharge planning and ensuring follow up appointments are scheduled prior to a patient being discharged. S11 stated, "Rule of thumb, we have to by law get them an appointment for discharge. If you're still here on the date of the discharge, we have to change the appointment. S11 confirmed that there should not be any reason an appointment is not scheduled.