HospitalInspections.org

Based on interview and record review the facility failed to ensure the patient's legal guardian was informed and prepared for the discharge plans of one sampled patient (SP) #6 of ten sampled patients.

The findings:



Review for sampled patient #6 "Admission History and Physical", notes showed that he was admitted on 04/26/2016 with a past psychiatric history of schizophrenia, diabetes, and hypertension. The note also showed that the patient has a legal guardian. The notes further showed that he was to be "baker act", and that he is a danger to self and others. The "Case Management Initial Patient Assessment", report dated 04/26/2016 showed he was a part of the guardianship program of [named] county. His current living situation is at an ALF (Assisted Living Facility).

On 06/03/16 at 13:10 PM, sampled patient #6 record showed , a call was placed to the guardian to inform that the ALF [named, and address, zip] accepted the patient. The next note at 13:16 PM showed that the legal guardian was called and she did not answer, voicemail was left. Transportation was arranged with an ambulance the ETA (estimated time of arrival) was 2:30 PM. On 06/03/2016 at 15:07 PM the patient was discharged at this time to the ALF. Paperwork given to patient. Pt left with ambulance on a stretcher. The "Transportation Log" also showed SP #6 was transferred to the [named] ALF on 06/03/2016. At 16:13 PM the notes from the case manager then showed a call was received from the guardianship program and was informed someone provided wrong information to the ALF owner whom does not have a mental health license and did not focus on patient psych problems. The case manager instructed [named] person from the ambulance to go back and send an ambulance and return the patient back to the hospital. On 06/03/2016 at 19:29 PM, the nursing notes showed SP #6 returned from the ALF and report given to oncoming nurse.


Review of the "Exit-Care Patient Information", dated 06/03/2016 showed that SP #6 needed to follow up with the pulmonologist within 2 weeks, and the primary physician in 14 days. There were no signatures from the patient's guardian showing that the guardian acknowledged or had received the instructions and understood them.


There was no notes or consent from SP #6 legal guardian to discharge the him to this particular accepting ALF.
The Case Manager CM-B on 07/19 2016 at 12:20 PM stated the Case Manager on the case spoke with me and then I called the ambulance to bring the pt. back to the hospital. I just called the ambulance to bring the pt. back. If to send a pt. to an ALF/skilled nursing facility (SNF), I would not release a pt. unless there is approval from the legal guardian to discharge the pt. to that ALF/SNF.
Review of the Policy # 764-004 (review date 7/2015); Subject:"Discharge Planning Process" state that the Case Management Department as part of the discharge planning process must inform the patient or patient' s family of their freedom to choose the provider for post hospital care services and respect the preferences when expressed. The policy also state under "Family Representative/Guardian", to meet with or by phone with the Case Management Department and discuss the discharge plans.