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Based on record review and staff interview it was determined that the facility failed to ensure a complete discharge plan for four (#3, #4, #5, #11) of eleven sampled patients. This does not ensure appropriate post hospital placement.

Findings include:

42 CFR 483.100 requires that the facility transferring a patient to a Skilled Nursing Facility (SNF) ensures that a Pre-Admission Screening and Resident Review (PASRR) be completed prior to the patient's being transferred to the SNF to ensure appropriate placement.

Review of the medical records of patients #3, #4, #5 and #11 revealed each was transferred to a SNF for continuing care. None of the records had evidence the PASRR was completed prior to the transfer.

The findings were confirmed by the Director of Case Management on 8/25/11 at approximately 2:30 p.m.

Review of facility policies revealed CM-17 "Patient Transfer & Continuum of Care (3308) and PASRR Form" with an effective date of 4/96 and a revision date of 4/11 indicated that the Case Manager, as of 9/1/07, will complete the PASRR form, for all patients who are being discharged to a skilled nursing facility (SNF); #4. The PASRR Level I and possibly Level II must be completed and sent with those being discharged to a Skilled Nursing Facility (SNF). Policy Review CM-18 "PASRR Level I & II Forms" with an effective date of 9/07 and revision date of 4/11 reads under the heading PROCEDURE: The Case Manager will complete the PASRR Level I and/or Level II, per the patient's medical condition at time of discharge. The case manager will than make a copy of the form for the patient's chart and the original goes with the patient to the skilled nursing facility.

Based on observation, record review and staff interview the facility failed to inform six (#2, #4, #5, #8, #9, #11) of eleven sampled patient records for their option in selecting a provider of their choice for their post discharge options for skilled nursing care. This practice does not ensure patient rights to choice are maintained.

Findings include:

On 8/25/11 during the electronic medical record review and open record review that was conducted with the Director of Health Information Management and the Director of Case Management revealed the following:

1. A review of patient #2's electronic record was conducted with the Director of Health Information Management on 8/25/11 at approximately 2:30 p.m. The patient was admitted on 5/4/11 and discharged on 7/7/2011. The medical record revealed no evidence of a Patient Information and Choice Letter for the patient's post hospital continuum of care.

2. A review of patient #4's electronic record revealed that the patient was admitted on 7/1/11 and transferred to a Skilled Nursing Facility (SNF) on 7/4/11. The record revealed no evidence of a Patient Information and Choice Letter.

3. A review of patient #5's electronic record review revealed that she had been admitted on 7/8/11 and transferred to a SNF on 7/12/11. The medical record revealed no evidence of a Patient Information and Choice Letter.

4. On 8/25/11 a review of patient #8's medical record was conducted on the second floor. The patient was chosen from the list for possible discharges for 8/26/11 that had been provided by the Director of Case Management. A review of the case manager's last entry dated 8/24/11 indicated that the discharge planning assessment was completed.

An interview was conducted with the Director of Case Management in regards to the case manager's note of 8/16/11 indicating that a choice form had been completed for the patient. At approximately 2:00 p.m. she was asked to demonstrate the form in the medical record or electronically and was unable to locate the Patient Information and Choice Letter.

5. An interview was conducted with patient #9 on 8/25/11 at approximately noon. The patient was asked if she had been provided with a patient choice list of Skilled Nursing Facilities to ensure that she had the right to select a provider. The patient stated that she had not been provided with a list of SNFs that she would be able to choose a facility.

An interview was conducted with the patient's Case Manager and the Director of Case Management at approximately 12:10 p.m. During the interview the patient's case manager stated that she did provide the patient with a choice list but had not documented evidence to this effect. The Director of Case Management confirmed the lack of a patient choice form in the medical record.

6. An open record review was conducted for patient #11. The patient was admitted on 8/5/11 with severe sepsis. An interview was conducted with the Director of Case Management in regards to the patient being provided with a choice of providers for continuum of care. She confirmed that there was no documented evidence that the patient had been provided with the required patient choice form.

Review of policy CM-6 "Referrals for Post-Hospital Community Services" effective 5/95 Purpose: To ensure patient choice of post-hospital medical care/equipment providers. Policy: Patients have a right to select the provider of their choice for post-discharge health services. Section B: A patient choice letter will be used to document the patient, family, guardian or POA's choice.