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Based on record review and staff interview, it was determined that the facility failed to notify the patient's representative of date and time of discharge and transfer to a skilled nursing facility for 1 (#1) of 11 sampled patients.


Findings include:


Review of the medical record of patient #1 revealed that the patient was admitted to the facility on 10/24/11 per the facesheet. The plan of care, dated 10/29/11, documented that the patient had dementia and that information was obtained from the daughter. The daughter signed the consent for treatment and was contacted regarding the patient's do not resuscitate status. The patient was a resident at a Skilled Nursing Facility (SNF) prior to being admitted to the facility. A note written by the social worker on 10/27/11 revealed that she had spoken to the daughter to verify the appropriate placement back to the SNF where he had been a resident. There was no documentation of the anticipated discharge date. The patient was transferred back to the SNF on 10/28/11. There was no documentation that the daughter was informed as to when the patient would be transferred or that he had been transferred. The Director of Clinical Resource Management confirmed there was no evidence that the daughter was notified of the discharge and transfer during interview on 12/14/11 at approximately 2:00 p.m.

Based on record review and staff interview, it was determined the facility failed to ensure Pre-Admission Screening and Resident Review (PASRR) screening was performed prior to transfer to a skilled nursing facility for 2 (#3,#4) of 11 sampled patients. This practice does not ensure appropriate placement.


Findings include:

42 CFR 483.100 requires that the facility transferring a patient to a Skilled Nursing Facility (SNF) ensures that a level 1 PASRR screening is completed prior to the patient's being transferred to the SNF to ensure appropriate placement.
Review of the medical records of patients #3 (Social Services SOAP note 12/9/11) and #4 (CMS -R- 193, dated 12/8/11) revealed that they were transferred to skilled nursing facilities for continued care. Review of the medical records revealed no evidence of the completion of the level I PASRR screen which is required prior to admission to a skilled nursing facility. The Director of Clinical Resource Management was interviewed on 12/14/11. She confirmed that the facility is not performing the required screens as yet.