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Based on document review and interview, it was determined that in 2 (patient #1 & 9) of 25 medical records (MR) reviewed of patients who presented to the hospital requesting emergency services, the facility failed to ensure compliance with 489.24 in that the facility failed to provide a medical screening exam.

Findings include:

1. See findings cited at 42 CFR 489.24(1), A2406.

Based on observation & interview, the facility failed to post conspicuously in any emergency department or in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment in areas other than traditional emergency departments (that is, entrance, admitting area, waiting room, treatment area) a sign (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously (in a form specified by the Secretary) information indicating whether or not the hospital participates in the Medicaid program under a State plan approved under Title XIX for 1 of 1 outpatient psychiatric offsite where unscheduled individuals may present for evaluation.

Findings include:

1. During the facility tour of the Crisis offsite on 05-23-16 at 0935 hours there was no signage posted in the ambulatory entrance, waiting room or the ambulance entrance specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously (in a form specified by the Secretary) information indicating whether or not the hospital participates in the Medicaid program under a State plan approved under Title XIX.

2. On 05-23-16 at 0935 hours staff #41 confirmed the signage was not present in the ambulatory entrance, waiting room or the ambulance entrance.

Based on document review & interview, the facility failed to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 of 25 patients presenting to the facility. (Patient #1)

Findings include:

1. Review of facility documentation dated 5-10-16 indicated that patient #1 came to the Crisis offsite on 05-07-16.

2. On 05-23-16 at 1100 hours staff #43 confirmed that patient #1 was seen at the Crisis offsite on 05-07-16.

3. On 05-23-16 at 1010 hours review of the Crisis Patient Log lacked documentation that patient #1 presented to the facility on 05-07-16.

Based on document review & interview, the facility failed to ensure that written policies and procedures governing an appropriate medical screening examination of all patients presenting to the facility was conducted by an individual(s) who was determined qualified by hospital policies and procedures was followed for 2 of 10 Crisis medical records (MR) reviewed. (Patient #1 & 9)

Findings include:

1. Review of policy/procedure CLN #2031, EMTALA: Emergency Medical Screening, Stabilization and Transfer, indicated the following;
At CHNw (Community Health Network), individuals that are qualified to perform a medical screening exam (MSE) at a Hospital are members of the Hospital's medical staff (physician, resident or allied health professional members) with the appropriate clinical privileges, or the employees designated in this Policy. Specifically, those individuals who may perform the MSE are as follows:
iii. MSEs for mental health issues:
2. Those individuals presenting to the Behavioral Health pavilion may receive the MSE by licensed Crisis Department clinical staff in consultation with a physician, or by a physician or allied health professional member of the medical staff with appropriate clinical privileges.
This policy/procedure was last reviewed/revised on 8/7/15.

2. Review of facility documentation dated 5-10-16 indicated that patient #1 came to the Crisis offsite on 05-07-16.

3. Review of patient #1's MR the Call Documentation Note dated 05-21-16 at 7:39 AM indicated that the patient presented to Crisis and staff #55 (triage specialist) staffed the case with MD #1.

4. Review of patient #9's MR indicated the patient presented to Crisis on 5/6/16 and the Crisis Clinical Triage Note dated 5/6/16 at 6:26 AM indicated that staff #56 (triage specialist) staffed the case with MD #2.

5. On 05-23-16 at 0950 hours staff #43 confirmed that licensed clinical staff can to do assessments on patients presenting to Crisis and then are to staff with a physician for disposition. The triage specialists are not licensed clinical staff, but are usually 4 year degree individuals that are not licensed.