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Based on observation, record review and interview, the facility was not in compliance with 42 CFR §489.20(1), and §489.24. The facility failed to post the required right to treatment sign in a common area for all individuals to view. The facility failed to maintain a complete emergency room log, and failed to provide stabilizing treatment before one patient was discharged.

Based on observation and interview, the facility failed to post conspicuously the required sign informing all individuals who enter the emergency room department their specified rights for an examination and treatment. This practice could affect all individuals entering the emergency room department. Findings include:

During an observation on 2/24/15 at 2:00 p.m., with staff member B, CNO, a tour was completed of the emergency room department. The required sign informing all individuals who enter the emergency department (ED) of their specific rights to an examination and treatment was not posted in a common area.

In an interview on 2/24/15 at 2:00 p.m., staff member B, CNO, stated she was not aware the sign had to be posted so all individuals entering the ED could see the sign.

Based on record review and interview, the facility failed to maintain a complete ED log. This practice could affect all patients who present to the emergency room department. Findings include:

Review of the ED log for the last year reflected multiple blank spots each day in the log for patients who presented to the ED. The spots left blank were: time in, time out, medical symptoms, and disposition.

In an interview on 2/25/15 at 2:30 p.m., staff member C, RN/ED manager, stated the ED log was to be completed entirely.

Based on record review and interview, the facility failed to provide stabilizing treatment for one patient (#1) of 20 medical records reviewed. Findings include:

On 1/29/15 at 6:04 p.m., patient #1 was brought to the emergency room by an ambulance. Patient #1 was on a gurney and could not walk. The medical symptoms documented on the ER report were unable to care for self at home and dehydration. The patient was discharged home at 9:15 p.m.

During an interview on 2/25/15 at 10:50 a.m., staff member D, medical doctor, stated patient #1 was on gurney and he completed a quick MSE which included blood pressure, pulse, and questions for cognition. Staff member D stated the patient wanted to go home so he was discharged home. The medical record did not reflect any concern or medical treatment for the patient's inability to walk and care for himself.

Review of the ambulance report dated 1/29/15 reflected patient #1 was unable to walk and was loaded into the ambulance. The patient was lifted onto a kitchen stool and a phone was placed next to him because the patient was unable to stand.

The patient was seen at another hospital later in the day on 1/29/15. He was then transported to another hospital where he expired the following day.