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Based on staff interview and review of medical records, it was determined that the facility did not consistently ensure that patient's rights, comprehensive treatment plans and initial treatment plans were updated. Additionally, the facility did not ensure that each patient participated in the discharge plan.
This deficient was noted in one of two appropriate medical records reviewed (MR #9)
Findings include:
During the tour of the unit (Geriatric psychiatric unit) on 09/28/12 at approximately 12:50 PM, the staff reported that the patient in MR # 9 was scheduled for discharged. The record was reviewed. It was noted that this 82 year old female with diagnosis of schizoaffective disorder was an Involuntary Admission on 8/28/12 at 16:50. It was documented that the patient was a nursing home resident who was admitted because she was spitting out her medication and spitting at people.

The Discharge Summary indicated that treatment goals and objectives were fully achieved. The Multidisciplinary treatment plan was reviewed. It was noted that on 8/31/12, Social Worker goals/objective "The patient will not be verbally abusive and compliant with treatment ". The interventions/ method "to provide 1:1 individual therapy with the patient for three times a week ". This provider's interaction and interventions with the patient, and the patient's responses to this intervention during the treatment was not documented.
The social work staff was interviewed on 9/28/12. The staff reported that the goal above was not appropriate for the patient as the patient was in a wheelchair. There was no documentation in the record that the treatment goal was updated to meet this patient's needs.
It was noted that the Multidisciplinary treatment plan form had documentation dated 8/31/12 & 9/25/12. It was noted that the patient was admitted on 8/28/12. Although, there was a section for the patient to sign this document it was noted that the day for patient or family involvement in the plan was not signed or the reason why this was not necessary.

Based on observation, patient interview, and review of medical records it was determined that the facility did not ensure that all patients needing discharge evaluation have complete and appropriate needs assessment that include an assessment of factors that impacts on the patients' needs after discharge. This deficiency was noted in three of seven applicable medical records reviewed ( MR # 10, MR # 4 & MR # 16)
Findings include:
During the tour of the unit (Telemetry) on 9/27/12 at appropriate 10:00 AM, the unit s census list was reviewed. It was noted that writing next to the patient in MR # 10
" Homeless wants adult home kicked out - D/C to shelter " .
Review of MR # 10 on 9/27/12 , noted that this 33 year old male was admitted to the psych unit for his depression and suicidal ideation. The patient was admitted to medical unit on 9/25/12 after stool was positive for C-diff. The psych evaluation dated 9/24/12 at 14: 14 indicated that the patient was diagnosed with schizoaffective who was homeless since 2009. It was noted that the patient informed the psychiatrist "I am tired of living in the shelter. I want to shoot myself with a gun and end it ".
The discharge planning assessment was reviewed noted that on 9/26/12 the case manager noted that the patient may need placement upon discharge, or ongoing community service. The case manager noted social work to follow up.
On 9/27/12 at 1240, SW noted patient medically cleared for discharge home. The SW noted " patient agrees to be discharged to a shelter patient was provided with a metro card and a list of intake shelter ". This patient did not have a psychosocial assessment or a complete discharge planning evaluation.
It was noted that the patient's statement not wanting to continue to live in a shelter was not explored with the patient prior to discharge. It was noted that the patient was non-compliant with prescribed outpatient program. However, the patient's non-compliant to treatment was not addressed with the patient before discharge.
Review of the Discharge / Transfer form noted that the disposition was to a skilled/sub-acute nursing facility. This patient was discharged with a token and list of shelter. The patient was not provided with an outpatient appointment for continuing of care. The medical follow up for the patient was to follow up with a private MD. This discharge plan was inadequate. There was no documentation that the patient had a private MD or the private MD was contacted while the patient was an inpatient.
During tour of unit (Telemetry 11th floor) on 9/27/12 at approximately 10: 15 AM, it was observed that the patient in room 1124- ( MR # 4) was dressed in street clothes sitting on the bed and she had her belongings packed. The patient was interviewed. The patient reported that she was scheduled for discharged. The patient reported that she resided alone but she was waiting for her son to pick her up. When queried about the discharge papers, the patient reported that the staff will give the discharge papers to her son.
The Nurse Manager interviewed reported that the patient was not medically cleared. This staff also stated that "every day the patient was ready to go".
This staff reported that the patient had bouts of confusion.

Review of MR # 4 on 9/27/12, noted that this 79 year old female with history of DVT, HTN, Hypercholesteremia, and PE, walked into the facility's Emergency Department ( ED) on 9/22/12 with chief complaint of chest pain.
It was documented that the patient had not taken her Coumadin x 3 days. After evaluation, it was discovered that the patient was on Coumadin but the Coumadin was not therapeutic. It was documented that the patient was alert, and oriented x 3. There was no documentation in the record that this patient was confused or disoriented while in the hospital.
It was noted that on 9/24/ 12, the MD noted chest pain resolved; discharge after therapeutic INR. It was noted on 09/26/12, that the MD noted the patient's son was contacted x 2 voice mail left in mailbox. There was no documentation in the record that the discharge plan was discussed with the patient or the reason why this was not necessary.
The discharge planning assessment for this patient was not located in the record.

Similar findings of lack of psychosocial assessments for patient in MR #16, 56 year old with medical history of CVA admitted on 9/24/12 and discharged on 9/27/12 .
It was noted that the only SW assessment, dated on 9/27/12 at 0100 documented "Pt medically cleared for D/C to NH".

Based on observation and review of medical record, it was determined that the facility did not effectively ensure that all patients needing discharge plan have a complete discharge evaluation. This deficiency was noted in two of ten applicable medical records reviewed
( MR # 11 & MR # 12)
Findings include:
Review of MR #11, on 9/27/12 at approximately 11:50 AM, noted that this 87 year old male history of MI, CHF, HTN, and Alzheimer Disease presented in the ED with chest pain on 9/17/12 and was admitted from home . On 9/19/12, the Case manager noted management assessment done. The Case manager noted "patient admitted from home may need SNF placement " . On 9/27/12 at 12:40 PM, the Medicine Attending noted discharge to chronic care facility. On 9/27/12, Case manager noted informed by MD that patient is cleared for discharge. PRI done SW to follow up.
On 9/27/12 at 0100, SW noted -spoke to patient's daughter "daughter states that homecare referral is not necessary at this time and that patient does not need NH placement. Patient's family to continue to care for patient at home. Patient has out of state insurance and is in the process of enrollment with Elder care plan. Daughter to F/U with community homecare referral if need.
Plan is for patient to discharge home with family daughter will pick up patient at about 11 PM. No other social work f/u need " .
The discharge planning evaluation was incomplete as it did not include if the patient's caregiver understood the patient's discharge needs. The patient's continuing care needs after discharge was not listed. The SW noted that the daughter will follow up in the community home care referral if need. A list of such community resources and the resources appropriate for this patient's needs was not provided.
It was noted that patient's MD ordered long care placement after discharge. The SW documented that the patient's daughter indicated that nursing home placement was not necessary. The discharge evaluation did not include if this was a safe and appropriate discharge for this patient.
During the unit tour of on 9/27/12 at approximately 10:45 AM, MR #12 was reviewed. It noted that the patient, 95 year old Russian speaking with history of HTN, CHF, Afib, DM, was admitted with syncope. The patient was admitted on 9/25/12.
On 9/27/12, the MD ordered DC home with home care today. Discharge/Transfer form dated 9/27/12 was located in the record. This document indicated the patient was to be discharged to home with HHA.
The discharge planning evaluation for this patient was reviewed. It was noted on 09/26/12, that the case manager noted "Comments: Pt., 95 year old from home lives with care taker, admitted to Tele s/p syncope episode. Initial case management review completed, will follow to ensure a safe care. Plan at this time is for patient to return home with home care services, SW to follow that Pt. /family are in agreement with the above plan and to provide options of home care services available ".
There was no documentation if the home care services were reinstated prior to discharge.
The social work assessment was not located in the record.