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Based on record review and interview the facility failed to implement policies to inform the patient or representative of the patient's rights for 1 of 20 patients sampled. Failure to provide notification of patient rights has the potential to cause the patient or representative to be unable to make fully informed choices.

Findings:
Review of the nurses notes for patient #1 reveals that the patient was discharged in the care of his / her spouse. The case management notes also reveal that the patient had violent outbursts during admission to the facility that required both physical and chemical restraint to control.

Interview with the spouse of resident on 6/1/2010 at 10:30 AM reveals that the spouse was concerned with why the facility wanted the patient discharged so quickly.

Further review of the medical record reveals that the facility had contacted a psychiatric facility and had been advised that the patient could be seen for evaluation and that the spouse was instructed to take the patient to the psychiatric facility upon discharge.

Review of the case management note dated 4/2/2010 and timed 19:55 reveals that the patient was transported to the psychiatric facility and that the spouse left with the patient prior to admission, the note further indicates that the patient was then taken to another facility and not admitted before finally returning to the subject facility and being readmitted.

Review of the certificate of Professional Initiating Involuntary Examination dated 4/6/2010 at 7:15 AM reveals that the patient was eventually Baker acted and transported to another facility.

Review of the form " An Important Message From Medicare About Your Rights " for the admission ending on 4/2/2010 reveals that it was not signed by the patient or representative and that the form is also not signed by the case manager.

During interview on 6/2/2010 at 2:00 PM with the case manager for this case she stated that the spouse expressed concerns about why the patient was being discharged and that the patient needed to stay at another facility for at least ten days.

The director of case management stated during interview on 6/2/2010 at 3:50 PM that the policy for executing the form " An Important Message From Medicare About Your Rights " had not been carried out.

Review of the facility provided policy/procedure entitled " Delivery Of Important Messages From Medicare To Patients " reveals that:

" 1. Registrars will explain the patient ' s discharge rights to the patient or designee for all Medicare and Medicare Advantage patients including patients who have Medicare as a second payer. Once the patient or designee understands their discharge rights, the signature is obtained on the Important Message (IM) From Medicare form located in the form fast. A copy of the signed IM is to be placed on the chart and the original given to the patient or designee. "

And further

" 2. In the event that a patient or designee is not available at the time of admission, the registrar will be required to go to the floor to explain and issue the Important Message From Medicare within 2 days of admission.

3. Case management will review the patients and discuss care with nursing and physicians. Based on discussions and chart reviews, patients will be identified for upcoming discharges within 48 hours.

4. Case Manager to give a copy of the signed IM after discussing planned discharge date, patient ' s appeal rights and answering all questions. Case manager to sign and date Important Message to demonstrate compliance. "

Based on record review and interview the facility failed to implement policies for discharge planning for appropriate services to meet the patient's needs after discharge for 1 of 20 patients sampled. Failure to provide appropriate discharge planning has the potential to cause delays in treatment and to allow needs to be unmet.

Findings:
Review of the nurses notes for patient #1 reveals that the patient was discharged in the care of his / her spouse. The case management notes also reveal that the patient had violent outbursts during admission to the facility that required both physical and chemical restraint to control.

Interview with the spouse of resident on 6/1/2010 at 10:30 AM reveals that the spouse was concerned with why the facility wanted the patient discharged so quickly.

Further review of the medical record reveals that the facility had contacted a psychiatric facility and had been advised that the patient could be seen for evaluation and that the spouse was instructed to take the patient to the psychiatric facility upon discharge.

Review of the case management note dated 4/2/2010 and timed 19:55 reveals that the patient was transported to the psychiatric facility and that the spouse left with the patient prior to admission, the note further indicates that the patient was then taken to another facility and not admitted before finally returning to the subject facility and being readmitted.

Review of the certificate of Professional Initiating Involuntary Examination dated 4/6/2010 at 7:15 AM reveals that the patient was eventually Baker acted and transported to another facility.

Review of the form " An Important Message From Medicare About Your Rights " for the admission ending on 4/2/2010 reveals that it was not signed by the patient or representative and that the form is also not signed by the case manager.

During interview on 6/2/2010 at 2:00 PM with the case manager for this case she stated that the spouse expressed concerns about why the patient was being discharged and that the patient needed to stay at another facility for at least ten days.

The director of case management stated during interview on 6/2/2010 at 3:50 PM that the policy for executing the form " An Important Message From Medicare About Your Rights " had not been carried out.

Review of the facility provided policy/procedure entitled " Delivery Of Important Messages From Medicare To Patients " reveals that:

" 1. Registrars will explain the patient ' s discharge rights to the patient or designee for all Medicare and Medicare Advantage patients including patients who have Medicare as a second payer. Once the patient or designee understands their discharge rights, the signature is obtained on the Important Message (IM) From Medicare form located in the form fast. A copy of the signed IM is to be placed on the chart and the original given to the patient or designee. "

And further

" 2. In the event that a patient or designee is not available at the time of admission, the registrar will be required to go to the floor to explain and issue the Important Message From Medicare within 2 days of admission.

3. Case management will review the patients and discuss care with nursing and physicians. Based on discussions and chart reviews, patients will be identified for upcoming discharges within 48 hours.

4. Case Manager to give a copy of the signed IM after discussing planned discharge date, patient ' s appeal rights and answering all questions. Case manager to sign and date Important Message to demonstrate compliance. "