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Based on record review and interview, the facility failed to ensure the medical record contained a medical history and physical for one of 22 Swing Bed patients (Patient 14). This deficient practice places patients at risk for unmet health care needs and services.

Findings Include:

Review of Patient 14's electronic medical record (EMR) showed an admission date of 11/16/18 after a total knee arthroplasty (knee joint replacement), and the patient was discharged on 11/19/18.

Review of Patient 14's EMR did not show a history and physical (H & P).

During an interview on 12/06/18 at 2:01 PM, the Swing Bed Coordinator (SBC) confirmed Patient 14's record did not contain a history and physical.

During an interview on 12/06/18 at 3:15 PM, the Chief Nursing Officer (CNO) stated an expectation that each patient record has an H & P within 24 hours of admission.

A request was made to the CNO on 12/06/18 for a facility policy regarding the inclusion of an H & P in a patient's medical record, however, no policy was provided prior to exiting the survey.

Based on interview and document review, the facility failed to ensure the activities program was directed by a qualified individual. This deficient practice places swing bed patients at risk of being isolated, bored, and having a lack of activities in which to participate.

Findings Include:

During an interview on 12/04/18 at 11:52 AM, the Social Worker (SW) stated she had been working there for seven years and had been the Activities Director (AD) since she started her employment. The training certificates provided for review were for continuing education (CE) for social work. The SW stated her primary duties are discharge planning and social services.

During an interview on 12/05/18 at 9:49 AM, the Human Resources (HR) Manager confirmed the CE's in the SW/AD's personnel file was social work related, and she was under the impression that a SW was qualified to serve as AD. At 10:08 AM, the HR Manager confirmed the [SW] did not have the proper/adequate training for the AD role in a Swing Bed Unit."

A review of the 04/17/13 "Subject: Swing Bed Activities and Recreation" showed: " ... At a minimum, the activities in the hospital will include the following: Be directed by a person who is qualified under applicable law or regulation to do so ..."

Based on record review the facility failed to ensure a comprehensive care plan with measurable goals and time frames was developed for one of 22 patients reviewed (Patient 4). This deficient practice places all patients at risk for unmeasurable goals and timelines to evaluate the progress toward their goals.

Findings Include:

Review of Patient 4's electronic medical record (EMR) documented an admission to the facility swing bed unit on 11/20/18, after a surgical wound closure and osteomyelitis (bone infection).

The 11/20/18 "History and Physical" showed:

"Assessment/Plan: ...
1. Stage 4 sacral (region at the base of the spine that is a large, triangular bone that forms by the fusing of vertebrae) ulcer, status post flap closure with known osteomyelitis. Patient is having good wound healing being turned every 2 hours, is on an immersive mattress, has close supervision by Dr. [name], his surgeon and the wound care team. He will need to remain on IV [intravenous] antibiotics for a total of 6 weeks, given his positive osteomyelitis and its anticipated that he will stay in swing bed during that time.
2. Small bowel obstruction, resolved. Patient appears to have resolved to [sic] small bowel obstruction but given his significant history, we are advancing diet very slowly and will continue with a full liquid diet today.
3. Weakness. Patient had significant weakness due to his weight, age and debility. He will require extensive physical therapy and is unable to be upright at this time due to his wound.
4. Diabetes. Patient's blood sugars are rising and will reinstitute his meal time insulin.
5. Hypertension. Patient's blood pressures are trending improved and will restart his blood pressure medication when systolic (the force that creates pressure on those blood vessels, top number of the blood pressure) are greater than 120. ..."

A review of Patient 4's "Patient Plan of Care" showed two sections, one for "Weakness" and one for "Additional Problems/Interventions." The care plan included interventions related to the resident's diagnoses but failed to include measurable goals and timelines to evaluate the resident's progress toward his/her goal(s).

Based on record review and interview, the facility failed to ensure patient medical records contained a discharge summary that included a summary of the stay and post-discharge plan of care, for one of 22 Swing bed patients reviewed (Patient 14). Failure to ensure a discharge summary was completed and in the medical record places patients at risk for unmet needs for continuation of care after discharge.

Findings Include:

Review of Patient 14's electronic medical record (EMR) showed an admission date of 11/16/18 following a total knee arthroplasty (knee joint replacement). Patient 14 was discharged on 11/19/18.

A continued review of Patient 14's EMR did not show a discharge summary that recapitulated (summarized) Patient 14's stay and/or a plan of care for Patient 14 after discharge.

During an interview on 12/06/18 at 2:01 PM, the Swing Bed Coordinator (SBC) stated she was unable to find a discharge summary for Patient 14.

During an interview on 12/06/18 at 3:16 PM, in response to the question of what a discharge summary included, the Chief Nursing Officer (CNO) stated as far as she knew, the course of treatment, the diagnosis, and where the patient was discharged to. The CNO stated "I looked at the regulations, and the discharge summary with recapitulation is in there."

A review of the facility policy dated 05/15/13 and titled "Subject: swing bed Discharge Plan" showed:
"The discharge planning process shall culminate in a discharge summary
completed by the physician which, at a minimum:
1. Details a recapitulation of the patient's stay
2. Presents a final summary of the patient's status pertaining to each point
in the Comprehensive Assessment.
3. Is available for release to persons and agencies authorized by the patient
or legal representative to receive such information.
4. Details a post discharge plan of care that has been developed with the
participation of the patient and the patient's family, which will assist the
patient to adjust appropriately to his or her new living environment."