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Based on observation, staff interview, and review of facility documents, it was determined that the Governing Body failed to demonstrate that it is effective in carrying out the operation and management of the facility. The Governing Body failed to provide necessary oversight and leadership as evidenced by the lack of compliance with the following Conditions of Participation:

482.43 Discharge Planning (Cross refer Tag A-0799)





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Based on medical record review and administrative staff interview, it was determined that the facility failed to ensure all patients are provided with a smooth and safe transition from the hospital to his/her discharge destination.

Findings include:

The facility failed to ensure that all patients who reside in long term care facilities were safely transitioned from the hospital to their discharge destination at the long term care facility. Refer to Tag A-0820.

Based on medical record review and administrative staff interview, it was determined that the facility failed to ensure that all patients who reside in long term care facilities were safely transitioned from the hospital to their discharge destination at the long term care facility.

Findings include:

1. Review of Medical Record #1 revealed the following:

a. On 7/15/17 at 20:30 the patient arrived at the ED (Emergency Department) from the nursing facility.

i. The patient was triaged at 20:33. The triage note indicated, "Patient sent by (name of nursing facility) for psych (psychiatric) evaluation, per EMS (Emergency Medical Service), Patient was seen by (name of hospital) psych today and diagnosed with Dementia. (Name of Nursing Facility) wants a second opinion related to bizarre behavior and being combative with staff."

ii. The patient received a Medical Screening Exam (MSE) at 21:59. The physician note indicated, "Mental Status: ...bizarre ... Consult for psychiatric evaluation. Deferred to SCIP (Screening Crisis Intervention Program)."

iii. The Screening Crisis Intervention Program (SCIP) evaluated the patient at 22:11. The SCIP note states, "...Thought content Rambling ... Disoriented to time ... Judgement impaired ... Impaired insight ... poor impulse control ... SCIP recommendations: Discharge from Emergency Department."

iv. On 7/16/17 at 02:26 the nurses note indicated, "... Patient discharged ..."

v. At 10:31 the nurses note indicated, "Notified by (name of nursing facility) staff at 10:15 AM patient never returned to (name of nursing facility) after ER (Emergency Room) visit. Nursing supervisor made aware and will notify the police."

vi. Staff #2 states, "At 11 PM the nurse who took over was not aware that the patient came from a nursing home. The patient was located and is currently back at the nursing home."

b. The patient was not safely transitioned from the hospital to his/her discharge destination at the long term care facility.

2. Review of Medical Record #2 indicated the following:

a. On 8/14/17 at 17:01 the patient arrived at the ED from the nursing facility

i. The patient was triaged at 17:08. The triage note indicated, "Patient brought by the EMS from the (name of nursing facility) for psychiatric evaluation. Patient attempted suicide by placing a bag over her head, admits to suicidal ideation and as per nursing home paperwork is a behavioral problem."

ii. The patient received a MSE at 18:20. The physician note indicated, "Consult for psychiatric evaluation ordered."

iii. At 21:53 the physician note states, "Patient evaluated by SCIP. Felt safe and appropriate for discharge and outpatient treatment. Diagnosis: Emotional Crisis."

iv. At 22:00 the SCIP note states, "... Disposition: Discharge ... Referred to Nursing Home/Assisted Living ..."

v. At 22:15 the nurses note indicated, "RN (Registered Nurse) assisted patient with getting dressed. Patient states fiancé is picking her up. Patient ambulated with awkward steady gait. ... Patient discharged."

vi. Staff #2 stated, "The patient was discharged to the community but should have been discharged back to the nursing facility. The police were called and the patient was located in Camden City."

b. The patient was not safely transitioned from the hospital to his/her discharge destination at the long term care facility.

3. Review of Medical Record #4 revealed the following:

a. On 3/29/17 at 23:47 the patient arrived at the ED by ambulance. This was the patients third visit to the ED on 3/29/17. The patient had eloped from the ED twice. The patient was initially sent to the ED by ambulance from the nursing facility.

i. The patient was triaged on 3/30/17 at 00:27. The triage note states, "Patient brought in by EMS after being found passed out in the street, patient with slurred speech and smells of ETOH."

ii. The patient received a MSE at 00:01. The physician note states, "Patient presents with Intoxication and Hypothermia. Patient was seen slumped over on a nearby park bench and brought in by EMS."

iii. At 08:39 the nurses note indicated, "Patient awaiting transport to go back to (name of nursing facility). At 9:47 (name of ambulance company) arrives to take patient to (name of nursing facility). At 09:47 Discharged."

iv. At 10:07 the nurses note indicated, "After being discharged and placed into ambulance by ambulance crew, (name of nursing facility) calls and states, "we cannot have him back in our facility." Patient brought back to ambulance bay and refuses to come back to the ED. Patient states, "Man I'm not staying here." Patient is alert and oriented x 3 and wants to leave. Patient seen walking out of ambulance bay with steady gait."

v. Staff #5 stated, "The process to send a patient to a nursing facility from the ED is to call the nursing facility and discuss the patient's Plan of Care with the nursing staff. This conversation would be documented in the medical record."

vi. There is no documented evidence that the Plan of Care was discussed with staff at the nursing home prior to Patient #4 being discharged.

b. The patient was not safely transitioned from the hospital to his/her discharge destination at the long term care facility.

4. The above findings were confirmed with Staff #2.

Based on staff interview, it was determined that the facility failed to ensure that a list of home health agencies was available and presented to all patients requiring home health care upon discharge.

Findings include:

1. Upon request on 8/18/17, Staff #6 and Staff #9, were unable to produce a list of home health agencies that are given to patients who require home health agency services.

2. The above finding was confirmed with Staff #17.