HospitalInspections.org

Based on interview, record review and a review of facility documentation, the facility failed to ensure that a patient was transferred to an appropriate facility which had the authority to provide nursing supervision for patient care for 1 of 4 sampled patients (#1).

Findings:

A review of the medical record of patient #1 was performed. The patient was admitted to the facility on 8/17/18.
A Case Management note of 8/17/18 at 3:36 PM read, "Bilateral BKA (below knee amputation), DM (diabetes mellitus), insulin dependent....hx (history) multiple SNF (skilled nursing facility)/ALF (assisted living facility) denials." Physician orders of 8/21/18 at 1:07 PM read, "Discharge by attending....Routine."

A Case Management note of 8/21/18 at 4:41 PM read, "CM (case manager) requested Sunshine [Medicaid Insurance] to review for SPA (service provider agreement) with Blessing Family Care Home for placement....Referral to ProPlacement/Blessing Family Care Home pending SPA agreement with Sunshine review....3110 and 1823 to be signed." Regarding "Sunshine", during an interview of the Director of Care Management on 9/18/18 at 5:01 PM, she stated that this refers to Sunshine Medicaid, a contractor for Medicaid in the State of Florida. She also stated that ProPlacement refers to a company which is available to assist with hard-to-place patients.

The "AHCA (Agency for Health Care Administration) Form 3110-1023" signed by the physician on 8/23/18, read, "Nursing/treatment/therapy service requirements: Assistance w/bed to wheelchair or chair transfers." It indicated that the patient "needs total help" with ambulation, bathing, and dressing. It indicated that the patient "needs assistance" with toileting, grooming, and transferring. It also had "daily oversight" checked in response to the question: "To what extent does the individual need general oversight?" It also had "yes" checked in response to the question: "Does the individual need help with medications?" It stated in this regard that the patient was "insulin dependent." The form also read, "Needs assistance with transfers....Needs RN oversight."

A Case Management note of 8/23/18 at 10:43 AM read, "Discharge location/Services, D/C (discharge) plan: Group home. ... CM (case manager) notified by..../Sunshine LTC (long term care) CM that she has contacted Blessing Family Care Home and reviewed case as well and they are in agreement with caring for pt (patient) and SPA (service provider agreement)...." A Case Management note of 8/23/18 at 1 PM read, "per....Blessing Family Care Home who reports understanding and willingness to accept level at level of cares and needs." A Case Management note of 8/23/18 at 4 PM read, "Transportation arranged....for 7 PM. 3110, med list and follow up appts placed in chart copy." The patient was discharged on 8/23/18 to Blessing Family Care, a group home.

Regarding Blessing Family Care, it is not a licensed ALF, it is a Group Home. As such, it is not licensed to provide care to the extent as indicated in the AHCA Form 3110-1023.

A review of facility policy "Discharge Planning - Inpatient" revealed the following: "The discharge plan provides appropriate and effective use of health care resources, matching patient needs to the most appropriate level of care within the continuum....Coordinate care under the direction of the medical provider in collaboration with the patient and health care team to support individualized health care needs."

Since the patient was not discharged to a facility that was authorized to provide the services as outlined in the AHCA Form 3110-1023, as signed by the physician, the facility was not in compliance with this policy's expectation of providing appropriate health care resources at an appropriate level of care for the patient upon discharge. In addition, the facility did not fulfill the policy expectation for post-discharge services which would support the patient's health needs.

During an interview of the Risk Manager at approximately 5:15 PM on 9/18/18, she confirmed the findings.