HospitalInspections.org

Based on record review and interview, discharge planning staff failed to assess and document a comprehensive initial discharge planning evaluation in 2 of 5 (#1 and 3) patients requiring a discharge planning initial assessment. This deficient practice has the potential to affect all patients receiving discharge planning services, including 172 inpatients at the time of this survey.

Findings include:

Pt #1's Social Services initial assessment dated 9/18/15 at 9:14 AM, does not include assessment of Pt #1's pt's post discharge care needs being met in the environment from which Pt #1 entered hospital, activities of daily living, caregivers availability to provide care, whether the patient will require specialized medical equipment, or an assessment of the patient's insurance coverage or potential financial needs.

Pt #3's Social Services Initial Assessment dated 10/13/15 at 12:03 PM, does not include assessment of Pt #3's post discharge needs being met in the environment from which Pt #3 entered hospital, activities of daily living, caregivers availability to provide care, whether the patient will require specialized medical equipment, or an assessment of the patient's insurance coverage or potential financial needs.

Conducted interview Per Interim Director of Nursing O on 10/1/15 at 10:45 AM. Per Interim Director of Nursing the facility does not have a policy addressing the content of the initial discharge evaluation.

Based on record review and interview, the facility failed to have a policy for 2 of 2 components of the assessment process (initial and ongoing assessment) in their discharge planning policy. This deficient practice has the potential to affect all patients receiving discharge planning services, including 172 inpatients at the time of this survey.



Findings include:

During interview with Interim Director of Nursing O on 11/30/15 at 12:45 PM, Interim Director of Nursing O stated the facility does not have any policies describing the expectations of a complete initial discharge planning assessment or subsequent follow up assessments relating to timeliness or content. Interim Director of Nursing O stated the facility could only find two polices relating to the discharge planning department and provided copies of both.

Review of facility policy "Discharge to a Skilled Nursing Facility" GL-6168, undated, does not address the initial and ongoing assessment expectations or procedures related to the discharge planning process.

Review of facility policy "Discharge planning" GL-3019, undated, does not address the initial and ongoing assessment expectations or procedures related to the discharge planning process.