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Based upon record review and interview, the facility failed to ensure 1 of 1 (#1) patient's legal guardian was provided written information related to patient's rights for patient #1.

Review of patient #1's medical record revealed patient was a 79 year old male involuntarily admitted on 3/19/11 with a diagnosis of major depression with suicidal ideation, Alzheimer's Disease, and bi-polar disorder. Review of the admission paperwork in the medical record revealed 1.) Authorization and Assignments Consent, 2.)Joint Notice of Privacy Practices Acknowledgment Form., 3.) Patient's Responsibility Form, 4.) An Important Message From Medicare About Your Rights, 5.) Password Program Authorization Form, 6.) Acknowledgement of Receipt of Patient Rights Pamphlet. All of these forms had "Refused to Sign" on the signature line and was signed by two staff as witnesses.

Review of the Patient Bill of Rights Pamphlet revealed a section titled "Your Right To Know Your Rights" that contained the following information: " You have the right, under the rules by which this hospital is licensed, to be given a copy of these rights before you are admitted to the hospital as a patient. If you so desire, a copy should also be given to the person of your choice. If a guardian has been appointed for you or you are under 18 years of age, a copy will also be given to your guardian, parent, or conservator.

Review of the patient's medical record revealed a copy of the patient's guardianship documents. The guardianship documents revealed patient's daughter had been appointed full guardianship of the patient and the patient shall be declared totally incapacitated without the authority to exercise any rights or powers for himself.

Further review of the medical record revealed no documentation that patient's guardian was given the admission, rights, password, or privacy information to review and sign on the patient's behalf.

An interview was conducted with the Director of Senior Care on 5/24/11 at 2:30 pm in the board room. The Director of Senior Care reviewed the record and confirmed there was no documents signed by the guardian.

Based upon record review and interview, the facility failed to ensure patient #1's guardian participated in the development and implementation of the treatment plan of patient #1.

Review of the treatment plan for patient #1 revealed a section on page 2 of the Treatment Plan Problem List that contained the following statements to be signed and dated: " I, ( a signature line for patient's signature)a patient at Baptist Hospital of Southeast Texas-Behavioral Health Center (along with appropriate family members or significant others), participated in the development of my treatment and discharge plans. This information has been discussed with me in a fashion I understand. I hereby agree to participate in and cooperate with my treatment and discharge plan. I, (a signature line for healthcare provider's signature), have explained this plan of treatment to the patient and/or family member or significant other in terms he/she/they understand, to the best of my ability." These statements were left blank on patient #1's treatment plan.

Review of physician progress notes revealed a note written by the Discharge Planner on 3/23/11 that stated "Daughter will attend treatment team this Friday". Further review of the medical record revealed no evidence that patient's daughter attended treatment team meeting at any time. No documentation was found in the medical record that patient's daughter was given notification of date and time of treatment team meetings.

An interview was conducted on 5/24/11 at 11:30 am with the Director of Senior Care. The Director confirmed there was no evidence that patient's daughter was notified of date and time of treatment team meetings as well as no evidence that patient's daughter participated in treatment planning.

Based upon record review and interview, the facility failed to ensure the discharge plan for 1 of 1 (#1) patients was reassessed for changes in care needs and appropriateness of the discharge placement.

REFER TO TAG A-843

Based upon record review and interview, the facility failed to document in the medical record that a list of post-hospital care services was provided to the guardian of 1of 1(#1) patients.

Review of the medical record for patient #1 revealed no documentation that the patient's guardian (daughter) was provided a list of post hospital placement options.

An interview was conducted with the Discharge Planner on 5/24/11 at approximately 2:00 pm. The Discharge Planner reported she had numerous conversations with the patient's guardian (daughter) about placement alternatives but failed to document those discussions in the medical record or maintain notes about those contacts.

Based upon record review and interview, the facility failed to follow its own policy for reassessment of the discharge plans and documenting each contact with or on behalf of the patient for 1 of 1(#1) patients reviewed.

Review of the policy and procedure #ADM.7.1.0007 titled Discharge Planning revealed the following: "Section D. Documentation - The discharge planning and social services provided are documented in the designated area of the patient's medical record following each contact with or on behalf of the patient. Documentation should be brief and concise and should include dates of services, source of referral, plan of service and outcome. Each contact with patient or family should be noted. If contacts are very extensive they may be summarized periodically. If for some reason a requested service cannot be provided, this should be indicated. The discharge plan itself will be documented and will include an evaluation of the availability of appropriate services to meet the patient's identified needs. discharge documentation should include discharge date, discharge destination and arrangements made."

Review of patient's medical record revealed two documents related to Discharge Planning. A form titled "Master Treatment Plan-Discharge Planning" revealed a form completed by the Director of Social Services dated 3/21/11(2 days after admission). The form was divided into sections with a checklist and a place for comments under each section. The sections were completed as follows: LIVING ARRANGEMENTS/PLACEMENT - Nursing Home was checked and comments added were "Not sure if patient to return to a previous nursing home or a new placement." REFERRALS/RECOMMENDATIONS: Psychiatrist and Primary Care Physician were checked and no comments written. CRITERIA FOR DISCHARGE: No imminent risk of harm to self/others. ASSISTANCE WITH MEDICATIONS/TRANSPORTATION: Hospital staff will arrange or assist. This was the only documentation of any discharge planning found in the chart prior to the day of discharge (5/4/11). The other document found was the discharge instructions dated 5/4/11. The Discharge Instruction form had documentation that patient was to go by ambulance to a local nursing home. The form also had documentation that all instructions were given to the receiving nursing home and report had been called to the nursing home.

Review of physician's progress notes revealed a note written by the discharge planner dated 3/23/11 (4 days after admission) that included the following statements: "Sent packet to Lufkin nursing home. Staff called back and doubts they will accept patient. Also received call back from Veterans Administration Hospital in Houston. Doctor is refusing the patient @ this time." Further review of medical record revealed no other documentation that discharge planning assessment and reassessment was done.

An interview was conducted with the Discharge Planner on 5/24/11 at approximately 2:00 pm. The Discharge Planner reported she made contact with many facilities to arrange placement but she did not document those contacts in the medical record. The Discharge Planner also reported she did not keep notes of the calls and contacts she made.