HospitalInspections.org

Based on interview and record review it was determined that the Governing Body was not effective in its oversight of the hospital.

A) 1 of 10 patients (Patient #5) had a compression fracture to the spine, fractured bilateral feet, a fractured wrist of his dominant hand, and was none-weight bearing (NWB). (Patient #5) was discharged to a homeless shelter where his NWB status could not be ensured.

B) 1 of 10 patients (Patient #5's) psychological needs were not evaluated while an inpatient and/or evaluated prior to discharge to a homeless shelter even though the above injuries were sustained due to a suicide. (Patient #5) was subsequently discharged to a homeless shelter.

C) The hospital failed to ensure a list of skilled nursing facilities (SNF) was provided to and/or documented in the medical record for (Patient #5) prior to discharge on 07/21/14.

Findings Included:

A) (Patient #5), with multiple fractures, was discharged to a homeless shelter and was to care for himself medically. The homeless shelter that (Patient #5) was discharged to did not have wheelchair accessible transportation to and from the main shelter. (Patient #5) would be expected to be independent and able to care for all of his needs. (Cross refer to A821)

B) (Patient #5) demonstrated inappropriate behavior during his hospital stay. (Patient #5) did not receive a psychological evaluation while an inpatient and/or evaluated prior to discharge to the homeless shelter.The above injuries were sustained due to a suicide attempt. (Cross refer to A821)

C) A list of skilled nursing facilities was not documented and/or provided to (Patient #5). (Cross refer to 823)

Based on interview and record review the Governing Body failed to ensure 1 of 10 patients (Patient #5's) discharge plan was appropriate to meet his medical and psychological needs in that,

1) (Patient #5) had a compression fracture to the spine, fractured bilateral feet, a fractured wrist of his dominant hand, and was none-weight bearing (NWB). (Patient #5) was discharged to a homeless shelter where his NWB status could not be ensured, supported or maintained.

2) (Patient #5's) psychological needs were not evaluated while an inpatient and/or evaluated prior to discharge to a homeless shelter even though the above injuries were sustained due to a suicide attempt. (Patient #5) was subsequently discharged to a homeless shelter.

3) A SNF (skilled nursing facilities) list was not provided and/or documented as provided to (Patient #5) prior to discharge.

Findings Included:

1) The ED Note dated 07/18/14, timed at 1600, reflected, "Patient arrived to ED via EMS (emergency medical services) after discharge from (another hospital)...patient presents with splints to bilateral ankles, back brace, and right arm splint placed by (another hospital)..."

The Care Management note (Social Work) dated 07/18/14, timed at 1713, reflected "SW requested wheelchair accessible housing ...patient able to clothe himself, can transfer from the wheelchair to the toilet, however he needs assistance with bathing ...patient is interested in nursing home placement...it was determined by the team that nursing home was not a good fit at this time...SW to send group home referral..."

The physician discharge instructions dated 07/19/14, timed at 0932, reflected "No strenuous activity...do not put weight on either leg or lift anything with your right arm...splint must not get wet, splint must remain dry, do not take off the splint, the splint must remain on until follow-up appointment ...continue to use brace for your spine fracture..."

The ED Note dated 07/19/14, timed at 1200, reflected "Patient is aware of POC (plan of care) that he is to be admitted to ortho service and is NWB (non-weight bearing) to BLE (bilateral lower extremities) and RUE (right upper extremity)..."

The Care Management note (Social Work) dated 07/19/14, timed at 1620, reflected, "SW contacted (outside agency) caseworker to determine if any boarding homes had been found...SW contacted PT (physical therapy)...stated patient is able to dress and bathe self independently...PT stated patient is non-weight bearing but able to transfer himself out of his wheelchair...contacted weekend surgery SW and requested SW contact the homeless shelters and notify them of patient's condition and determine if one of the shelters will take the patient..."

The nursing note dated 07/20/14, timed at 1149, reflected "Dr...says if the patient refuses shelter and transportation, that we can call the police...patient informed he has been officially discharged...van transport was offered again and refused...stated he was not leaving...stated he wanted to file an appeal on his discharge...police called." It was noted the patient left the floor and was discharged.

The Care Management note (Social Work) dated 07/20/14, timed at 1508, reflected "The patient stated he did not feel safe going to the shelter with three casts on...SW explained that placement had been discussed earlier and SW had secured a shelter that will accept him with the cast and wheelchair...reiterated that placement was found and transportation made...SW consulted with supervisor and supervisor stated if patient does not accept the safe placement made..he will have to be escorted off the floor by the police..."

The Care Management note (Social Work) dated 07/20/14, timed at 1546, reflected "SW informed that (Patient #5's) (family) wanted to speak with SW...SW called (family) and explained she put a safe discharge plan in place with transportation to get to the location of the (homeless shelter)..."

The Allied Health Services Progress Note dated 07/20/14, timed at 2116, reflected "Social worker spoke to...who reports he received a call from the...(Nurse Administrator) and she said she wanted the patient re-admitted for placement tomorrow...updated ER (emergency room) RN (Registered Nurse)..."

The PT progress note dated 07/21/14, timed at 1144, reflected, "Re-evaluation of mobility assessment due to re-admit ...refused sliding board...patient demonstrated wheelchair transfers independently with bilateral LE's and RUE (right upper extremity) NWB status without sliding board...able to get on and off the toilet safely..."

(Patient #5's) outside Physician Office visit dated 07/22/14, reflected "Sustained bilateral calcaneal fractures, right wrist fracture...presents for follow-up three weeks later...despite swelling ...there is minor ecchymosis over bilateral heels...patient was transitioned into short arm cast, well-padded for the right wrist...avoid any pulling, pushing...lifting or any weight bearing on the right upper extremity...patient transitioned into removable fracture boots, however the patient is to maintain strict no weight bearing for both lower extremities..."

On 07/25/14, at 1610 Personnel #18, was interviewed. Personnel #18 stated she was familiar with (Patient #5). Personnel #18 was asked about the homeless shelters being used for discharge and asked the criteria of individuals the homeless shelter takes and/or does not take. Personnel #18 stated she has been to the (homeless shelters) but did not answer the surveyor's question.

On 07/25/14, at approximately 1640, Personnel #7 was interviewed. Personnel #7 stated she was familiar with (Patient #5). Personnel #7 stated her first encounter with (Patient #5) was on a Saturday when he was resting in bed. Personnel #7 stated she watched (Patient #5) transfer from the wheelchair to the bed. Personnel #7 stated (Patient #5) transferred to the wheelchair by sliding in from the side. Personnel #7 stated (Patient #5) propelled the wheelchair with one arm. Personnel #7 stated the physician told her there was callus formation on his heels and it was ok for (Patient #5) to steer with his feet. Personnel #7 stated she trained (Patient #5) to be NWB but was not able to assure he was NWB. Personnel #7 stated she did not follow-up as to how (Patient #5) was doing his transfers and/or actually watch him on the unit propelling his wheelchair.

On 07/29/14, at 1245, Personnel #15 was interviewed. Personnel #15 stated (Patient #5) was frustrated with the discharge plan to send him to the homeless shelter. Personnel #15 stated (Patient #5) could use the good arm and stated he spoke with Personnel #20 and she told him it was ok for (Patient #5) to propel himself with his feet because he was three weeks out from his injuries and it was highly unlikely any further harm could be done.

On 07/30/14, at 0853, Non-Hospital Staff #27 was interviewed by telephone. Non-Hospital Staff #27 stated the (homeless shelter) stated a resident would have to be triaged and then based on the triage outcome it would be determined if the resident could be housed at the homeless shelter. Non-Hospital Staff #27 was asked whether a wheelchair patient with bilateral fractured feet, fracture to the spine and a hand fracture would qualify for the shelter. Non-Hospital Staff #27 stated the individual would have to be independent and able to care for themselves as the facility did not provide any physical assistance. Non-Hospital Staff #27 stated all the residents have to leave their assigned shelters and get on the bus and are then taken to the (main shelter) for the rest of the day until the evening when the residents are bused back to their assigned shelter. Non-Hospital Staff #27 stated the buses are old buses and are not wheelchair accessible so the resident would have to get out of their wheelchair and board the bus walking up and down the steps. Non-Hospital Staff #27 stated based on the surveyor's description of the potential resident the shelter would not be able to house the individual.

2) The PT progress note dated 07/21/14, timed at 1144, reflected "At the end of the PT assessment when patient returned supine into bed, patient jumped out of bed onto both feet stating, "see what you made me do are you happy now." Patient returned to bed screaming for therapist to leave the room ...patient does not require additional skilled PT services at this time..."

No documentation was found which addressed interventions provided for (Patient #5's) inappropriate behavior which had the potential to cause further injury to his lower extremities and/or that his mental status was evaluated for safe decision making.

(Patient #5's) outside Physician Office visit dated 07/22/14, reflected "Sustained bilateral calcaneal fractures, right wrist fracture...presents for follow-up three weeks later...despite swelling ...there is minor ecchymosis over bilateral heels...patient was transitioned into short arm cast, well-padded for the right wrist...avoid any pulling, pushing...lifting or any weight bearing on the right upper extremity...patient transitioned into removable fracture boots, however the patient is to maintain strict no weight bearing for both lower extremities...discussed findings with patient...compliance could be a factor..."

On 07/25/14, at 1610, Personnel #18 was interviewed. Personnel #18 was asked by the surveyor why (Patient #5) did not have a psychiatric evaluation. Personnel #18 stated (Personnel #15) did not think he needed one. Personnel #18 was asked who determined the discharge was safe after (Patient #5) jumped off the bed on his fractured feet. Personnel #18 insisted the (homeless shelter) was safe.

On 07/25/14, at approximately 1640, Personnel #7 was interviewed. Personnel #7 stated she was aware of (Patient #5's) attempted suicide but was not aware of a psychiatric diagnosis. Personnel #7 was asked by the surveyor if PT thought (Patient #5's) behavior was appropriate when he jumped off the bed on his fractured feet when he got upset with her. Personnel #7 did not reply. Personnel #7 stated on 07/21/14, PT reassessed (Patient #5) and stated (Patient #5) was physically mobile with his feet and hand and he was steering with his feet. Personnel #7 was asked how (Patient #5) was assessed due to his psychiatric issues and non-compliance with NWB. Personnel #7 stated (Patient #5) knew what he should do NWB but his psychiatric disorder keeps him from doing what he should.

On 07/29/14, at 1215, MD Personnel #9 was interviewed. Personnel #9 stated he was not aware of (Patient #5's) specific psychiatric issues. MD Personnel #9 stated if he had known it may have changed his orders. MD Personnel #9 was asked if (Patient #5) had a psychiatric evaluation before being discharged to a homeless shelter. MD Personnel #9 stated not that he was aware of. MD Personnel #9 stated (Patient #5) seemed to be safe to get around and PT cleared him. MD Personnel #9 was asked if he ever saw (Patient #5) transfer and propel himself in his wheelchair. MD Personnel #9 stated he had not.

On 07/29/14, at 1245, Personnel #15 was asked if (Patient #5) had a a psychiatric evaluation prior to discharge given his depression and previous serious suicide attempt. Personnel #15 stated (Patient #5) did not have a psychological evaluation prior to discharge.

On 07/29/14, at 1445, RN Personnel #8 was interviewed. RN Personnel #8 stated (Patient #5) could not use the slide board and she RN Personnel #8 assisted (Patient #5) to the bathroom. RN Personnel #8 stated (Patient #5) had mood swings and she (RN Personnel #8) felt it was not safe for (Patient #5) to be discharged to a homeless shelter with his medical conditions.

3) The Hospital referral list for SNF/Rehabilitation Centers dated 07/25/14 to 07/31/14: revealed 18 referrals with 1 of the 18 referrals interested in placement and under review. The rest of the referrals did not accept (Patient #5). It was noted no documentation was found which indicated the case management department independently inquired about SNF/Rehabilitation Centers without requests made by (Patient #5's) family. The referrals were made after (Patient #5's) discharge on 07/21/14. No documentation was found which indicated (Patient #5) was given a list of SNF/Rehab Centers.

On 08/08/14, at 1400, Personnel #1 was interviewed by telephone. Personnel #1 stated all the SNF/Rehab Centers were contacted after (Patient #5) was discharged and she could not find evidence that a list of SNF/Rehabilitation Centers was documented as given to (Patient #5).

The Care Management Manual procedure entitled, "Discharge Planning" with a revision date of 03/13 reflected, "Discharge planning process with a hospital-wide system of interdisciplinary accountability that fosters quality, continuity of care and appropriate utilization of health care resources...patient's needs pertaining to post-discharge...will develop a plan to meet discharge planning needs...implementation of a discharge plan that is safe and comprehensive..."

The policy and procedure entitled, "Inpatient Discharge Planning" with a revision date of 06/11 reflected, "Procedure...patients who are likely to suffer adverse health consequences upon discharge...the goal will be to plan a timely course of action to meet the patient's clinical, medical...psychological needs post discharge."

Based on inteviews and records review, the hospital failed to ensure 1 of 10 patients (Patient #5's) discharge plan was appropriate to meet his medical and psychological needs as evidenced by:

1) (Patient #5) had a compression fracture to the spine, fractured bilateral feet, a fractured wrist of his dominant hand, and was none-weight bearing (NWB). (Patient #5) was discharged to a homeless shelter where his NWB status could not be ensured, supported or maintained.

2) (Patient #5's) psychological needs were not evaluated while an inpatient and/or evaluated prior to discharge to a homeless shelter even though the above injuries were sustained due to a suicide attempt. (Patient #5) was discharged to a homeless shelter on 07/21/14.

3) The hospital failed to ensure a list of SNF (skilled nursing facilities) was provided to and/or documented in the medical record for (Patient #5) prior to discharge on 07/21/14.

(Cross refer to A821 and A823)

Based on interviews and records review, the hospital failed to ensure 1 of 10 patients (Patient #5's) discharge plan was appropriate to meet his medical and psychological needs in that,

1) (Patient #5) had a compression fracture to the spine, fractured bilateral feet, a fractured wrist of his dominant hand, and was none-weight bearing (NWB). (Patient #5) was discharged to a homeless shelter where his NWB status could not be ensured, supported or maintained.

2) (Patient #5's) psychological needs were not evaluated while inpatient and/or evaluated prior to discharge to a homeless shelter even though the above injuries were sustained due to a suicide attempt.

Findings Included:

The Care Management Manual procedure entitled, "Discharge Planning" with a revision date of 03/13 reflected, "Discharge planning process with a hospital-wide system of interdisciplinary accountability that fosters quality, continuity of care and appropriate utilization of health care resources...patient's needs pertaining to post-discharge...will develop a plan to meet discharge planning needs...implementation of a discharge plan that is safe and comprehensive..."

The policy and procedure entitled, "Inpatient Discharge Planning" with a revision date of 06/11 reflected, "Procedure...patients who are likely to suffer adverse health consequences upon discharge...the goal will be to plan a timely course of action to meet the patient's clinical, medical...psychological needs post discharge."

1) The ED Note dated 07/18/14, timed at 1600, reflected "Patient arrived to ED via EMS (emergency medical services) after discharge from (another hospital)...patient presents with splints to bilateral ankles, back brace, and right arm splint placed by (another hospital)..."

The Care Management note (Social Work) dated 07/18/14, timed at 1713, reflected "SW requested wheelchair accessible housing ...patient able to clothe himself, can transfer from the wheelchair to the toilet, however he needs assistance with bathing ...patient is interested in nursing home placement...it was determined by the team that nursing home was not a good fit at this time...SW to send group home referral..."

The physician discharge instructions dated 07/19/14, timed at 0932, reflected "No strenuous activity...do not put weight on either leg or lift anything with your right arm...splint must not get wet, splint must remain dry, do not take off the splint, the splint must remain on until follow-up appointment ...continue to use brace for your spine fracture..."

The ED Note dated 07/19/14, timed at 1200, reflected "Patient is aware of POC (plan of care) that he is to be admitted to ortho service and is NWB (non-weight bearing) to BLE (bilateral lower extremities) and RUE (right upper extremity)..."

The Care Management note (Social Work) dated 07/19/14, timed at 1620, reflected "SW contacted (outside agency) caseworker to determine if any boarding homes had been found...SW contacted PT (physical therapy)...stated patient is able to dress and bathe self independently...PT stated patient is non-weight bearing but able to transfer himself out of his wheelchair...contacted weekend surgery SW and requested SW contact the homeless shelters and notify them of patient's condition and determine if one of the shelters will take the patient..."

The nursing note dated 07/20/14, timed at 1149, reflected "Dr...says if the patient refuses shelter and transportation, that we can call the police...patient informed he has been officially discharged...van transport was offered again and refused...stated he was not leaving...stated he wanted to file an appeal on his discharge...police called." It was noted the patient left the floor and was discharged.

The Care Management note (Social Work) dated 07/20/14, timed at 1508, reflected "The patient stated he did not feel safe going to the shelter with three casts on...SW explained that placement had been discussed earlier and SW had secured a shelter that will accept him with the cast and wheelchair...reiterated that placement was found and transportation made...SW consulted with supervisor and supervisor stated if patient does not accept the safe placement made..he will have to be escorted off the floor by the police..."

The Care Management note (Social Work) dated 07/20/14, timed at 1546, reflected "SW informed that (Patient #5's) (family) wanted to speak with SW...SW called (family) and explained she put a safe discharge plan in place with transportation to get to the location of the (homeless shelter)..."

The Allied Health Services Progress Note dated 07/20/14, timed at 2116 PM, reflected "Social worker spoke to...who reports he received a call from the...(Nurse Administrator) and she said she wanted the patient re-admitted for placement tomorrow...updated ER (emergency room) RN (Registered Nurse)..."

The PT progress note dated 07/21/14, timed at 1144, reflected "Re-evaluation of mobility assessment due to re-admit ...refused sliding board...patient demonstrated wheelchair transfers independently with bilateral LE's and RUE (right upper extremity) NWB status without sliding board...able to get on and off the toilet safely..."

(Patient #5's) outside Physician Office visit dated 07/22/14, reflected "Sustained bilateral calcaneal fractures, right wrist fracture...presents for follow-up three weeks later...despite swelling ...there is minor ecchymosis over bilateral heels...patient was transitioned into short arm cast, well-padded for the right wrist...avoid any pulling, pushing...lifting or any weight bearing on the right upper extremity...patient transitioned into removable fracture boots, however the patient is to maintain strict no weight bearing for both lower extremities..."

On 07/25/14, at 1610, Personnel #18 was interviewed. Personnel #18 stated she was familiar with (Patient #5). Personnel #18 was asked about the homeless shelters being used for discharge and asked the criteria of individuals the homeless shelter takes and/or does not take. Personnel #18 stated she has been to the (homeless shelters) but did not answer the surveyor's question.

On 07/25/14, at approximately 1640, Personnel #7 was interviewed. Personnel #7 stated she was familiar with (Patient #5). Personnel #7 stated her first encounter with (Patient #5) was on a Saturday when he was resting in bed. Personnel #7 stated she watched (Patient #5) transfer from the wheelchair to the bed. Personnel #7 stated (Patient #5) transferred to the wheelchair by sliding in from the side. Personnel #7 stated (Patient #5) propelled the wheelchair with one arm. Personnel #7 stated the physician told her there was callus formation on his heels and it was ok for (Patient #5) to steer with his feet. Personnel #7 stated she trained (Patient #5) to be NWB but was not able to assure he was NWB. Personnel #7 stated she did not follow-up as to how (Patient #5) was doing his transfers and/or actually watch him on the unit propelling his wheelchair.

On 07/29/14, at 1245, Personnel #15 was interviewed. Personnel #15 stated (Patient #5) was frustrated with the discharge plan to send him to the homeless shelter. Personnel #15 stated (Patient #5) could use the good arm and stated he spoke with Personnel #20 and she told him it was ok for (Patient #5) to propel himself with his feet because he was three weeks out from his injuries and it was highly unlikely any further harm could be done.

On 07/30/14, at 0853, Non-Hospital Staff #27 was interviewed by telephone. Non-Hospital Staff #27 stated the (homeless shelter) stated a resident would have to be triaged and then based on the triage outcome it would be determined if the resident could be housed at the homeless shelter. Non-Hospital Staff #27 was asked whether a wheelchair patient with bilateral fractured feet, fracture to the spine and a hand fracture would qualify for the shelter. Non-Hospital Staff #27 stated the individual would have to be independent and able to care for themselves as the facility did not provide any physical assistance. Non-Hospital Staff #27 stated all the residents have to leave their assigned shelters and get on the bus and are then taken to the (main shelter) for the rest of the day until the evening when the residents are bused back to their assigned shelter. Non-Hospital Staff #27 stated the buses are old buses and are not wheelchair accessible so the resident would have to get out of their wheelchair and board the bus walking up and down the steps. Non-Hospital Staff #27 stated based on the surveyor's description of the potential resident the shelter would not be able to house the individual.


2) The PT progress note dated 07/21/14, timed at 1144, reflected, "At the end of the PT assessment when patient returned supine into bed, patient jumped out of bed onto both feet stating, "see what you made me do are you happy now." Patient returned to bed screaming for therapist to leave the room ...patient does not require additional skilled PT services at this time..."

No documentation was found which addressed interventions provided for (Patient #5's) inappropriate behavior which had the potential to cause further injury to his lower extremities and/or that his mental status was evaluated for safe decision making.

(Patient #5's) outside Physician Office visit dated 07/22/14, reflected "Sustained bilateral calcaneal fractures, right wrist fracture...presents for follow-up three weeks later...despite swelling ...there is minor ecchymosis over bilateral heels...patient was transitioned into short arm cast, well-padded for the right wrist...avoid any pulling, pushing...lifting or any weight bearing on the right upper extremity...patient transitioned into removable fracture boots, however the patient is to maintain strict no weight bearing for both lower extremities...discussed findings with patient...compliance could be a factor..."

On 07/25/14, at 1610, Personnel #18 was interviewed. Personnel #18 was asked by the surveyor why (Patient #5) did not have a psychiatric evaluation. Personnel #18 stated (Personnel #15) did not think he needed one. Personnel #18 was asked who determined the discharge was safe after (Patient #5) jumped off the bed on his fractured feet. Personnel #18 insisted the (homeless shelter) was safe.

On 07/25/14, at approximately 1640, Personnel #7 was interviewed. Personnel #7 stated she was aware of (Patient #5's) attempted suicide but was not aware of a psychiatric diagnosis. Personnel #7 was asked by the surveyor if PT thought (Patient #5's) behavior was appropriate when he jumped off the bed on his fractured feet when he got upset with her. Personnel #7 did not reply. Personnel #7 stated on 07/21/14 PT reassessed (Patient #5) and stated (Patient #5) was physically mobile with his feet and hand and he was steering with his feet. Personnel #7 was asked how (Patient #5) was assessed due to his psychiatric issues and non-compliance with NWB. Personnel #7 stated (Patient #5) knew what he should do NWB but his psychiatric disorder keeps him from doing what he should.

On 07/29/14, at 1215, MD Personnel #9 was interviewed. MD Personnel #9 stated he was not aware of (Patient #5's) specific psychiatric issues. Personnel #9 stated if he had known it may have changed his orders. MD Personnel #9 was asked if (Patient #5) had a psychiatric evaluation before being discharged to a homeless shelter. MD Personnel #9 stated not that he was aware of. MD Personnel #9 stated (Patient #5) seemed to be safe to get around and PT cleared him. Personnel #9 was asked if he ever saw (Patient #5) transfer and propel himself in his wheelchair. MD Personnel #9 stated he had not.

On 07/29/14, at 1245, Personnel #15 was asked if (Patient #5) had a a psychiatric evaluation prior to discharge given his depression and serious suicide attempt. Personnel #15 stated (Patient #5) did not have a psychological evaluation prior to discharge.

On 07/29/14, at 1445, RN Personnel #8 was interviewed. RN Personnel #8 stated (Patient #5) could not use the slide board and she RN Personnel #8 assisted (Patient #5) to the bathroom. RN Personnel #8 stated (Patient #5) had mood swings and she (RN Personnel #8) felt it was not safe for (Patient #5) to be discharged to a homeless shelter with his medical conditions.

Based on interviews and records review, the hospital failed to ensure a list of SNF (skilled nursing facilities) was provided to and/or documented in the medical record for 1 of 10 inpatients (Patient #5) prior to discharge on 07/21/14.

Findings Included:

The ED Note dated 07/18/14, timed at 1600, reflected "Patient arrived to ED via EMS (emergency medical services) after discharge from (another hospital)...patient presents with splints to bilateral ankles, back brace, and right arm splint placed by (another hospital)..."

The physician discharge instructions dated 07/19/14,, timed at 0932, reflected "No strenuous activity...do not put weight on either leg or lift anything with your right arm...splint must not get wet, splint must remain dry, do not take off the splint, the splint must remain on until follow-up appointment ...continue to use brace for your spine fracture..."

(Patient #5's) outside Physician Office visit dated 07/22/14, reflected "Sustained bilateral calcaneal fractures, right wrist fracture...presents for follow-up three weeks later...despite swelling ...there is minor ecchymosis over bilateral heels...patient was transitioned into short arm cast, well-padded for the right wrist...avoid any pulling, pushing...lifting or any weight bearing on the right upper extremity...patient transitioned into removable fracture boots, however the patient is to maintain strict no weight bearing for both lower extremities discussed findings with the patient ...compliance could be a factor."

The Hospital referral list for SNF/Rehabilitation Centers dated 07/25/14 to 07/31/14: revealed 18 referrals with 1 of the 18 referrals interested in placement and under review. The rest of the referrals did not accept (Patient #5). It was noted no documentation was found which indicated the case management department independently inquired about SNF/Rehabilitation Centers without requests made by (Patient #5's) family. The referrals were made after (Patient #5's) discharge on 07/21/14. No documentation was found which indicated (Patient #5) was given a list of SNF/Rehab Centers.

On 07/29/14, at 1445, RN Personnel #8 was interviewed. RN Personnel #8 stated (Patient #5) could not use the slide board and she (RN Personnel #8) assisted (Patient #5) to the bathroom. RN Personnel #8 stated (Patient #5) had mood swings and she (RN Personnel #8) felt it was not safe for (Patient #5) to be discharged to a homeless shelter with his medical conditions.

On 08/08/14, at 1400, Personnel #1 was interviewed by telephone. Personnel #1 stated all the SNF/Rehab Centers were contacted after (Patient #5) was discharged and she could not find evidence that a list of SNF/Rehabilitation Centers was documented as given to (Patient #5).

The Care Management Manual procedure entitled, "Discharge Planning" with a revision date of 03/13 reflected, "Discharge planning process with a hospital-wide system of interdisciplinary accountability that fosters quality, continuity of care and appropriate utilization of health care resources ...patient's needs pertaining to post-discharge ...will develop a plan to meet discharge planning needs ...implementation of a discharge plan that is safe and comprehensive ..."

The policy and procedure entitled, "Inpatient Discharge Planning" with a revision date of 06/11 reflected, "Procedure ...patients who are likely to suffer adverse health consequences upon discharge ...the goal will be to plan a timely course of action to meet the patient's clinical, medical ...psychological needs post discharge."