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Based on clinical record reviews, interviews with facility staff members, and a review of facility documents, it was determined the facility's staff failed to ensure patient's were allowed to participate in the development and implementation of their discharge plan for one (1) of six (6) patients sampled (Patient #9).

The findings were:

The surveyor's review of Patient #9's clinical record provided the following evidence:

· The patient was admitted to the facility with an acute MCA (Middle Cerebral Artery) stroke and had a five (5) day stay at the inpatient hospital facility. The patient was an inpatient on the 5th floor-room 568 until discharge.
· Upon admission, the patient's home address listed was the same address as the hospital.
· The record contained a total of five (5) "Discharge Planning" notes, and each note is described below. Those five (5) notes were documented by SM/Staff Member #32 - the RN/ Registered Nurse-CM/Case Manager assigned to the patient, and SM #29 -the SW/Social Worker and member of the discharge planning team. The Discharge Planning team's notes documented the discharge plan was for the patient to be admitted to an inpatient rehabilitation/rehab hospital for ongoing needs when discharged from the hospital facility. The Discharge Planning note with the heading "High Risk Screening" documented the patient "Needs Assistance From Others" for meal prep, eating, grooming, toileting, dressing, and mobility. The record failed to contain documentation by the Discharge Planning team that those high risk findings changed during the patient's length of stay. The Discharge Planning notes provided evidence the discharge plan (for an inpatient stay at a local rehab hospital) had been discussed with the patient and the patient was in agreement with the plan.
· Discharge Planning note #1 was documented by SM #32 (CM) and was dated 2 days after the patient's admission, at 3:22 p.m. That note documented, "CM spoke with patient via phone" and the patient reported having came to the area "for a job and is transient with no place to return to." The note documented the patient's "family is in New York currently and [the patient] wants to get closer to them." SM #32 documented having informed the patient "the only thing CM can offer due to [the patient's] insurance [or lack thereof] is a charity bed with [a local rehab hospital]." SM #32 documented the patient was agreeable to have the referral sent to that rehab hospital, so the referral was sent.
· Discharge Planning note #2 was documented by SM #32 (CM), and was dated 3 days after the patient's admission, at 11:38 a.m. That note documented "CM has completed charity app [application] at bedside with patient" and "uploaded" same to the local rehab hospital.
· Discharge Planning note #3 was documented by SM #32 (CM), and was dated 4 days after the patient's admission, at 10:29 a.m. That note documented the CM received a call from the local rehab hospital that they were unable to accept the patient at that time, and "CM will pursue other options."
· Discharge Planning note #4 was documented by SM #29 (SW), and was dated 4 days after the patient's admission, in the afternoon at 3:54 p.m. That note reads entirely, "SW met w/patient to discuss the charity bed wasn't approved. Patient is requesting a written explanation for [his/her] records from [the declining rehab hospital] as to why [he/she] was denied. 'I wondered why the nurse [first name of SM #32] came in and asked me if I was a US citizen, as I found this to be an odd question. I want to know if the declining of the charity bed was racially motivated.' Patient also requesting access to [his/her] medical record while [he's/she's] currently admitted inpatient. Patient voiced the closest relative is in NY, and [he/she] tested positive for COVID-19 is under currently quarantine [sic]. This relative is unable to come pick [him/her] up. Patient then requested to speak w/the nursing manager."
· Discharge Planning note #5 was documented by SM #32 (CM), and was dated 4 days after the patient's admission, at 4:31 p.m. That note documented as follows: "CM spoke with [someone from the declining rehab hospital] regarding incident with MSW [first name of Social Worker-SM #29],..states [he/she] will speak with [his/her] leadership and call CM in AM regarding how to proceed."
· The record failed to contain any further entries or documentation by the Discharge Planning team members after note #5 (described above) until an entry by SM #32 dated one day after the patient was discharged, that documented the patient's "Final Discharge Disp: ...Disc/Trans to Court/Law Enforcement." The record failed to provide evidence the patient was included in further discussion regarding an alternative discharge plan, after the original discharge plan of obtaining placement in a "charity bed" at a local rehab hospital was no longer an option. The record failed to provide evidence the Discharge Planning process was continued after the "charity bed" placement was no longer an option. Though SM #32 documented in Discharge Planning note #3 (described above), "CM will pursue other options" - there was no evidence found in the record of that having occurred.
· The record contained a discharge order by SM #35 - the NP/Nurse Practitioner providing care for Patient #9, dated three days after the patient's admission in the afternoon. That order directed, "Discharge Patient"... "to Rehab, When bed available." There was no additional order to revise the directive/order for the patient to be discharged to a rehab hospital when a bed was available.
· The record contained a "Discharge Summary" documented by SM #35 (the NP), dated on the morning of the patient's discharge at 8:21 a.m., and "verified" by the physician at 2:05 p.m. on the same day. The NP documented the patient "was declined to rehabilitation facility Case manager [sic] working on safe disposition for patient" and in the section titled, "Discharge Plan" the NP documented "Okay to discharge once safe disposition is determined." The record failed to contain additional entries by the NP after the aforementioned Discharge Summary, regarding what the "safe disposition" (discharge) for Patient #9 was determined to be.
· There were no Discharge Planning notes for the day of the patient's discharge, nor were there Discharge Planning notes addressing efforts to ensure the patient had a "safe disposition" for discharge as described in the NP's Discharge Summary and Discharge Plan (see above).
· The record failed to contain any documentation by any discipline explaining why the patient's discharge involved a police escort from the facility.
· The patient was documented as alert and oriented by physicians and nurses throughout the stay.
· The record failed to contain evidence the patient was aggressive, belligerent, or exhibiting behaviors to explain the police involvement in the discharge.
· On the afternoon of the patient's discharge (the 5th inpatient day) at 4:50 p.m., SM #31 (the RN assigned to Patient #9) documented, "IV removed and intact, vital signs stable. Patient verbalized understanding of discharge instructions. Patient wheeled to lobby to leave in private vehicle by Petersburg Police."
· The record failed to provide evidence that any arrangements were made for the patient to have rehabilitation services (physical, occupational, or speech therapy services) post discharge.

The surveyor's interviews with facility staff provided the following evidence:

· On 09/16/20 at 1:30 p.m., the surveyor conducted a phone interview with SM #32, the CM assigned to Patient #9. Also present via phone for that interview was SM #3, the Director of Quality. The surveyor asked SM #32 why Patient #9's discharge involved security or police, and why Patient #9 was discharged on that day, when the discharge plan was for a discharge to a rehab hospital when a bed was available. SM #32 stated he/she recalled Patient #9, but did not recall seeing the patient on the day of discharge. SM #32 stated he/she was not involved in security being called to the unit or patient's room related to the discharge, and was not aware that security or police were involved or that the discharge occurred until the day after the patient's discharge. SM #32 stated the patient "wanted us to keep trying [the local rehab hospital that declined]" and "our energy went into that." SM #32 acknowledged "a question was warranted regarding the discharge" and that a new discharge plan should have been developed. The surveyor asked, considering the patient had orders for a discharge to a rehab facility, what prompted a seemingly sudden change to a security and police assisted discharge, when there was still no rehab facility to discharge to? Both SM #32 and SM #3 stated it seemed there was "something missing in the story."
· On 09/17/20 at 12:15 p.m., the surveyor conducted a phone interview with SM #34, the Director of Case Management. Also present via phone for that interview was SM #3, the Director of Quality and SM #37, the Quality Coordinator. Regarding the above described discharge of Patient #9, SM #34 acknowledged that after the charity bed for rehab placement was declined, he/she would expect that discharge planning would continue for the patient and would be documented in the patient's record. When asked by the surveyor, what was the revised plan, SM #34 stated, "I'm not seeing that in the record." SM #34 stated that on the 5th day after admission, the day the patient was discharged with security and police involved, he/she (SM#34) would have expected that CM/Discharge Planning would be continuing with documentation of such by identifying other options for discharge, since the charity bed option was seemingly no longer a possibility.
· On 09/17/20 at 1:00 p.m., the surveyor conducted a phone interview with SM #35 (the NP treating the patient). The NP stated that after the original discharge plan was no longer an option, it was his/her understanding the Case Manager was working on other safe discharge options. The NP acknowledged he/she saw the patient on the morning of [the day that turned out to be the discharge] and informed the patient the CM was still working on the discharge plan and once that was established the patient could be discharged. The NP stated he/she was relying on the CM to update him/her when they came up with a new discharge plan but that did not happen. The NP stated he/she did not know what prompted the discharge for the patient on the day it took place, and was not aware the patient had been discharged, nor that it involved security and police, until the day after it occurred. The NP stated the patient was medically cleared but did have ongoing needs for rehabilitation (therapy services) which could have been met with either inpatient or outpatient rehab services upon discharge.

The surveyor's review of other facility documents provided the following evidence:

· A Security Incident Report documented that on the 5th day after admission for Patient #9 at 15:45 (3:45 p.m.), the Security Department was asked by the Manager of Security (SM #36) to check out a situation on the 5th floor. A Security Officer (SM #30) responded to the 5th floor and the Security Report's narrative read as follows: "Upon arrival [SM #30] was briefed by [the Nurse Manager and the RN assigned to Patient #9] that the patient in room 568 [Patient #9's medical record #-withheld] had been discharged since 1000hrs [sic] this morning but [the patient] refused to leave the property. [The patient] had been explained to that [the patient] was well enough to be discharged but [the patient] still refused. [Security Officer/SM #30] spoke with the patient to explain further that [the patient] had been discharged and to see if there were any real issues as to why [the patient] did not want to leave. The patient made excuses like [he/she] didn't understand and that [he/she] were [sic] paralyzed. After several attempts by Security the patient still did not want to leave so the decision was made to call Petersburg Police. The Police arrived at 1620hrs [sic] and spoke with the patient. Ultimately the patient got dressed and was placed in a wheelchair and escorted off the property by the police at 1650hrs [sic]. The patient was not arrested. END OF REPORT."
· The facility's Policy titled, "Rights and Responsibilities of Patients" with "Original Effective Date: 2/1/2003" and "Revision Date: 2/1/2019" was reviewed by the surveyor. Under the heading of "PATIENT RIGHTS" the policy included in part, "Patients have the right to: ... Participate in the creation and implementation of one's care plan to include discharge and pain management plans."
· The "Notice of Patient Rights and Responsibilities" document that was provided to patients upon admission was reviewed. That document included, in part, "You have the right to: ...Participate in decisions about your care, including developing your treatment plan, discharge planning and having your family and personal physician promptly notified of your admission. Have the hospital provide you or your surrogate decision-maker with the information about the outcomes of care, treatment, and services that you need in order to participate in current and future health care decisions."
· No facility documents provided evidence that facility staff intervened to protect the patient's right to be involved in decisions regarding his/her care and discharge, when the patient questioned the discharge and stated he/she did not understand. There was no evidence provided by the facility that attempts were made by the nursing staff or social workers to clarify the discharge was an appropriate discharge with an appropriate order that would allow discharge regardless of the fact that a rehab bed was not available at that time.

This was a complaint related deficiency.

Based on medical record reviews, staff interviews, and facility document reviews it was determined the facility staff failed to monitor restraints according to their policy for two (2) of three (3) patients sampled who had restraints ordered (Patient #13 and 14).

The findings were:

The clinical record of Patient #13 was reviewed by the surveyor on 09/14/20. The record contained evidence that Patient #13 was restrained with mittens and bilateral soft wrist restraints during the timeframe of 09/06/20 to 09/10/20 (five (5) days). The restraints were ordered related to non-violent behaviors that interfered with medical care- pulling at devices, tubes and/or drains. The ongoing monitoring of the patient for restraint safety and physical needs was reviewed for the aforementioned 5 day time frame. The restraint monitoring flowsheets documented that on 09/08/20 there was a five (5) hour span between the restraint monitoring that occurred when the patient was monitored/assessed at 6:00 a.m., then was not monitored again until 11:00 a.m.

The clinical record of Patient #14 was reviewed by the surveyor on 09/14/20. The record contained evidence that Patient #14 was restrained with mittens, bilateral soft wrist restraints, and bilateral soft ankle restraints during the timeframe of 09/05/20 to 09/09/20 (five (5) days). The restraints were ordered related to non-violent behaviors that interfered with medical care- pulling at devices, tubes and/or drains. The ongoing monitoring of the patient for restraint safety and physical needs was reviewed for the aforementioned 5 day time frame. The restraint monitoring flowsheets documented that on 09/06/20 there was a three (3) hour span between the restraint monitoring that occurred when the patient was monitored/assessed at 5:00 p.m., then was not monitored again until 8:03 p.m. The restraint monitoring flowsheets documented that on 09/08/20 there was a six (6) hour span between the restraint monitoring that occurred when the patient was monitored/assessed at 2:00 p.m., then was not monitored again until 8:00 p.m.

The facility's policy titled, "Restraint and Seclusion" with an "Original Effective Date: 3/1/2004" and a "Revision Date: 1/23/2019" was reviewed by the surveyor. The policy read in part, "F. Periodically Assessing, Assisting and Monitoring the Patient in Restraint or Seclusion... 4. Monitoring of patients is done during patient rounding. Care is provided as needed and at intervals of approximately 2 hours taking into consideration variables such as patient condition and cognitive status."

The surveyor informed the Director of Quality on 09/15/20 at 10:15 a.m., that record reviews had provided evidence that restraint monitoring was occurring at greater than 2 hour intervals for Patient #13 and #14. The dates and times of lapses in monitoring every 2 hours were shared with the Director of Quality as well. During the discussion, the Director of Quality verified that per facility policy the intervals between staff monitoring patients in restraints should not be greater than two (2) hours.

The survey team had a phone conference with the Director of Quality on 09/18/20 at 3:00 p.m. During the call the surveyor again informed the Director of Quality of the record review findings for Patient #13 and #14, related to restraint monitoring by the staff. The Director of Quality acknowledged that finding and verified the facility had no additional evidence to provide regarding the identified issue/concern.

Based on clinical record reviews, interviews with facility staff members, and a review of facility documents, it was determined that for one (1) of one (1) patients (Patient #9) having changes and/or barriers identified in the plan for discharge, the facility's staff failed to ensure the discharge plan was updated as needed when those barriers/changes were identified and affected the original discharge plan.

The findings were:

1. The surveyor's review of Patient #9's clinical record provided the following evidence:

The patient was admitted to the facility with an acute MCA (Middle Cerebral Artery) stroke and had a five (5) day stay at the inpatient hospital facility. The patient was an inpatient on the 5th floor-room 568 until discharge. Upon admission, the patient's listed home address was the same address as the hospital.
The record contained a total of five (5) "Discharge Planning" notes, and each note is described below. Those five (5) notes were documented by SM/Staff Member #32 - the RN/ Registered Nurse-CM/Case Manager assigned to the patient, and SM #29 -the SW/Social Worker and member of the discharge planning team. The Discharge Planning team's notes documented the discharge plan was for the patient to be admitted to an inpatient rehabilitation/rehab hospital for ongoing needs when discharged from the hospital facility. The Discharge Planning note with the heading "High Risk Screening" documented the patient "Needs Assistance From Others" for meal prep, eating, grooming, toileting, dressing, and mobility. The record failed to contain documentation by the Discharge Planning team that those high risk findings changed during the patient's length of stay. The Discharge Planning notes provided evidence the discharge plan (for an inpatient stay at a local rehab hospital) had been discussed with the patient and the patient was in agreement with the plan.
· Discharge Planning note #1 was documented by SM #32 (CM) and was dated 2 days after the patient's admission, at 3:22 p.m. That note documented, "CM spoke with patient via phone" and the patient reported having came to the area "for a job and is transient with no place to return to." The note documented the patient's "family is in New York currently and [the patient] wants to get closer to them." SM #32 documented having informed the patient "the only thing CM can offer due to [the patient's] insurance [or lack thereof] is a charity bed with [a local rehab hospital]." SM #32 documented the patient was agreeable to have the referral sent to that rehab hospital, so the referral was sent.
· Discharge Planning note #2 was documented by SM #32 (CM), and was dated 3 days after the patient's admission, at 11:38 a.m. That note documented "CM has completed charity app [application] at bedside with patient" and "uploaded" same to the local rehab hospital.
· Discharge Planning note #3 was documented by SM #32 (CM), and was dated 4 days after the patient's admission, at 10:29 a.m. That note documented the CM received a call from the local rehab hospital that they were unable to accept the patient at that time, and "CM will pursue other options."
· Discharge Planning note #4 was documented by SM #29 (SW), and was dated 4 days after the patient's admission, in the afternoon at 3:54 p.m. That note reads entirely, "SW met w/patient to discuss the charity bed wasn't approved. Patient is requesting a written explanation for [his/her] records from [the declining rehab hospital] as to why [he/she] was denied. 'I wondered why the nurse [first name of SM #32] came in and asked me if I was a US citizen, as I found this to be an odd question. I want to know if the declining of the charity bed was racially motivated.' Patient also requesting access to [his/her] medical record while [he's/she's] currently admitted inpatient. Patient voiced the closest relative is in NY, and [he/she] tested positive for COVID-19 is under currently quarantine [sic]. This relative is unable to come pick [him/her] up. Patient then requested to speak w/the nursing manager."
· Discharge Planning note #5 was documented by SM #32 (CM), and was dated 4 days after the patient's admission, at 4:31 p.m. That note documented as follows: "CM spoke with [someone from the declining rehab hospital] regarding incident with MSW [first name of Social Worker-SM #29],..states [he/she] will speak with [his/her] leadership and call CM in AM regarding how to proceed."
The record failed to contain any further entries or documentation by the Discharge Planning team members after note #5 (described above) until an entry by SM #32 dated one day after the patient was discharged, that documented the patient's "Final Discharge Disp: ...Disc/Trans to Court/Law Enforcement." The record failed to provide evidence the patient was included in further discussion regarding an alternative discharge plan, after the original discharge plan of obtaining placement in a "charity bed" at a local rehab hospital was no longer an option. The record failed to provide evidence the Discharge Planning process was continued after the "charity bed" placement was no longer an option. Though SM #32 documented in Discharge Planning note #3 (described above), "CM will pursue other options" - there was no evidence found in the record of that having occurred.

The record contained a discharge order by SM #35 (the NP/Nurse Practitioner providing care for Patient #9), on the afternoon of the 3rd day after the patient's admission. That order directed, "Discharge Patient"... "to Rehab, When bed available." There was no additional order to revise the order for the patient to be discharged to a rehab hospital when a bed was available.
The record contained a "Discharge Summary" documented by SM #35 (the NP), dated on the morning of the patient's discharge (5th day of stay) at 8:21 a.m., and the NP's Discharge Summary note and plan was "verified" by the physician at 2:05 p.m. on the same day. The NP documented the patient "was declined to rehabilitation facility Case manager [sic] working on safe disposition for patient" and in the section titled, "Discharge Plan" the NP documented "Okay to discharge once safe disposition is determined." The record failed to contain additional entries by the NP after the aforementioned Discharge Summary, regarding what the "safe disposition" (discharge) for Patient #9 was determined to be.

There were no Discharge Planning notes for the day of the patient's discharge, nor were there Discharge Planning notes addressing efforts to ensure the patient had a "safe disposition" for discharge as described in the NP's Discharge Summary and Discharge Plan (see above).

The record failed to contain any documentation by any discipline explaining why the patient's discharge involved a police escort from the facility. The patient was documented as alert and oriented by physicians and nurses throughout the stay. The record failed to contain evidence the patient was aggressive, belligerent, or exhibiting behaviors to explain the police involvement in the discharge.

On the afternoon of the patient's discharge (the 5th inpatient day) at 4:50 p.m., SM #31 (the RN assigned to Patient #9) documented, "IV removed and intact, vital signs stable. Patient verbalized understanding of discharge instructions. Patient wheeled to lobby to leave in private vehicle by Petersburg Police."

The record failed to provide evidence that any arrangements were made for the patient to have rehabilitation services (physical, occupational, or speech therapy services) post discharge.


2. The surveyor's interviews with facility staff regarding the care and discharge of Patient #9 provided the following evidence:

· On 09/16/20 at 1:30 p.m., the surveyor conducted a phone interview with SM #32, the CM assigned to Patient #9. Also present via phone for that interview was SM #3, the Director of Quality. The surveyor asked SM #32 why Patient #9's discharge involved security or police, and why Patient #9 was discharged on that day, when the discharge plan in place at the time was for a discharge to a rehab hospital when a bed was available. SM #32 stated he/she recalled Patient #9, but did not recall seeing the patient on the day of discharge. SM #32 stated he/she was not involved in security being called to the unit or patient's room related to the discharge, and was not aware that security or police were involved or that the discharge occurred until the day after the patient's discharge. SM #32 stated the patient "wanted us to keep trying [the local rehab hospital that declined]" and "our energy went into that." SM #32 acknowledged "a question was warranted regarding the discharge" and that a new discharge plan should have been developed. The surveyor asked, considering the patient had orders for a discharge to a rehab facility, what prompted a seemingly sudden change to a security and police assisted discharge, when there was still no rehab facility to discharge to? Both SM #32 and SM #3 stated it seemed there was something missing in the story.
· On 09/17/20 at 12:15 p.m., the surveyor conducted a phone interview with SM #34, the Director of Case Management. Also present via phone for that interview was SM #3, the Director of Quality and SM #37, the Quality Coordinator. SM #34 stated he/she recalled Patient #9's case after reviewing the patient's record. SM #34 confirmed the surveyor had been given copies of all of the CM notes. Regarding the above described discharge of Patient #9, SM #34 acknowledged that after the charity bed for rehab placement was declined, he/she would expect that discharge planning would continue for the patient and would be documented in the patient's record. When asked by the surveyor, what was the revised plan, SM #34 stated, "I'm not seeing that in the record." SM #34 stated that on the 5th day after admission, the day the patient was discharged with security and police involved, he/she (SM#34) would have expected that CM/Discharge Planning would be continuing with documentation of such by identifying other options for discharge, since the charity bed option was seemingly no longer a possibility.
· On 09/17/20 at 1:00 p.m., the surveyor conducted a phone interview with SM #35 (the NP treating the patient). The NP stated the original discharge plan was for the patient to be admitted to the aforementioned rehab hospital, but when they declined to take the patient it was his/her understanding that the Case Manager was working on other safe discharge options. The NP stated he/she saw the patient on the morning of [the day that turned out to be the discharge] and informed the patient the CM was still working on the discharge plan and once that was established the patient could be discharged. The NP stated he/she was relying on the CM to update him/her when they came up with a new discharge plan but that did not happen. The NP stated he/she did not know what prompted the discharge for the patient on the day it took place, and was not aware the patient had been discharged with the involvement of security and police until the day after it occurred. The NP stated the patient was medically cleared but did have ongoing needs for rehabilitation (therapy services) which could have been met with either inpatient or outpatient rehab services.

The surveyor's review of other facility documents provided the following evidence:

· A Security Incident Report documented that on the 5th day after admission for Patient #9 at 15:45 (3:45 p.m.), the Security Department was asked by the Manager of Security (SM #36) to check out a situation on the 5th floor. A Security Officer (SM #30) responded to the 5th floor and the Security Report's narrative read as follows: "Upon arrival [SM #30] was briefed by [the Nurse Manager and the RN assigned to Patient #9] that the patient in room 568 [Patient #9's medical record #-withheld] had been discharged since 1000hrs [sic] this morning but [the patient] refused to leave the property. [The patient] had been explained to that [the patient] was well enough to be discharged but [the patient] still refused. [Security Officer/SM #30] spoke with the patient to explain further that [the patient] had been discharged and to see if there were any real issues as to why [the patient] did not want to leave. The patient made excuses like [he/she] didn't understand and that [he/she] were [sic] paralyzed. After several attempts by Security the patient still did not want to leave so the decision was made to call Petersburg Police. The Police arrived at 1620hrs [sic] and spoke with the patient. Ultimately the patient got dressed and was placed in a wheelchair and escorted off the property by the police at 1650hrs [sic]. The patient was not arrested. END OF REPORT."
· The facility's Policy titled, "Rights and Responsibilities of Patients" with "Original Effective Date: 2/1/2003" and "Revision Date: 2/1/2019" was reviewed by the surveyor. Under the heading of "PATIENT RIGHTS" the policy included in part, "Patients have the right to: ... Participate in the creation and implementation of one's care plan to include discharge and pain management plans."
· The "Notice of Patient Rights and Responsibilities" document that was provided to patients upon admission was reviewed. That document included, in part, "You have the right to: ...Participate in decisions about your care, including developing your treatment plan, discharge planning and having your family and personal physician promptly notified of your admission. Have the hospital provide you or your surrogate decision-maker with the information about the outcomes of care, treatment, and services that you need in order to participate in current and future health care decisions."
· When the patient questioned the discharge and stated he/she did not understand, there was no evidence provided by the facility that nursing staff, including direct care nursing staff and Case Management nursing staff, intervened or made attempts to clarify if the discharge was an appropriate discharge, with an appropriate order that would allow the patient to be discharged regardless of the fact that a rehab bed was not available at that time.

This was a complaint related deficiency.