HospitalInspections.org

Based on interview and record review the facility failed to transfer (1) of 10 sampled patients (SP) #1 to the appropriate facilities for ancillary care .

Findings include:
Clinical record review revealed that SP # 1 had past medical history that included hypertension, stroke, vascular dementia, and schizophrenia. He was brought to the hospital on February 2nd 2013 by rescue from a nursing home with multiple decubitus ulcers Stage III and IV . SP # 1 was admitted to the facility with a diagnosis of Altered Mental Status.


Clinical records review revealed that on 4/12/2013 the Social Worker /Case Manager noted that SP # 1 was cleared for discharged to Assisted Living Facility (ALF) on April 12, 2013.


Interview with Social Worker on South Wing 5 conducted July 2, 2013 at 14:40 revealed that SP #1 came from a nursing home . She also stated that the ALF was told that the patient had wounds and was told that an RN would take care of it.

Interview with Director of Social Work and the Director of Case Management conducted on 7/3/2013 at 10:45am revealed that all social workers and case managers are aware of policies regarding discharging patients to an ALF. They also stated that they will re-educate all social workers and case managers to make sure that they know the criteria for discharge to ALF ' s. They stated that Stage III and IV ' s pressure ulcers cannot go to an ALF. They also stated that they will look at their policy and that they will make sure that they follow up on all ALF ' s placement.

Interview with Social Worker on the Rehabilitation Unit conducted on 7/3/2013 at 11:22am revealed that the criteria has to be met in order for patient to be discharged to an ALF, for example patient needs to be ambulatory, need to require supervision for ADL ' s and medication management. She also stated " we cannot send a patient that requires skill care (nursing) for example tube feed, IV med (Intravenous medication) or decubitus ulcer to an ALF " . She also stated that a Stage II, III and Stage IV pressure ulcers cannot go to an ALF. She also stated that even if a patient can walk or eat but has a decubitus ulcer - stage IV, they cannot go to an ALF because they will need nursing care. She also stated that depending on where patient is located, patient may need a hospital bed and they cannot get that at an ALF. She also stated that if a placement cannot be found for patient for example a nursing home and the patient cannot go to an ALF then the patient has to stay in the hospital until appropriate and safe placement is found for discharge. She also stated that they can look for family if none is present. She also stated that if family cannot take care of patient we cannot force them to, we have to keep the patient.


Review of the policy:" Boarding Home/ Assisted Living Facility/Foster" states that the following types of individuals cannot reside in an ALF-persons with stage 2,3, and 4 decubitus ulcers; and other persons who require complex twenty four hour nursing supervision.