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Based on interview and record review, the facility failed to uphold the right of one (1) of 4 sampled discharged patients (Patient ID # 7) to participate in his/her plan of care.

Facility therapist (Staff ID # 7) failed to inform physician of Patient # 7 ' s expression of vulnerability & possible harm to self on date of discharge

Findings include:

TX # 00188756

Record review on 01-30-14 of intake TX 00188756 revealed allegation by complainant that Patient # 7 was discharged too soon " in the midst of a severely depressed Bipolar 2 episode and suicidal state... "

Record review of the clinical record of Patient # 7 revealed she was s 49 years old and admitted involuntarily to the facility on 10-07-12 via law enforcement transport. Patient # 7 voiced Suicidal ideation with plans to have a motor vehicle accident.

Record review of physician orders, dated 10-12-12 (7 a.m.) " Discharge patient home after Family Therapy ... handwritten discharge summary completed... " (Physician /ID #4)

Record review of Patient ID # 7 Family Therapy notes dated 10-12-12 (2:30 p.m.) by Therapist ID # 7 read: " ...labile affect and mood, tearful, poor insight and judgment; anxious; disheveled ... "

Record review of Patient # 7 ' s Group Therapy Notes, dated 10-12-12 (1230) read: " ...Pt. says ' I ' m too vulnerable to go home. ' Pt. said she thinks that if she goes home today she will probably harm herself before the flight on Monday... " This note was co-signed by therapist ID # 7 at 1:00 p.m.

Further review of the Patient # 7 ' s record, including all progress notes, failed to reveal evidence the physician was notified of Patient # 7 ' s expression of being " too vulnerable for discharge and voicing possible harm to self ... " Facility Therapist ID # 8 was unable to locate documentation in the medical record the physician was informed.

Telephone interview on 01-31-14 at 11:45 a.m. with facility therapist ID # 7 she could not recall Patient # 7. She went on to say that if a patient voiced concerns of harming self immediately after discharge, she would either call the doctor herself or make sure the charge nurse called him. This notification would be documented in the progress notes.

Telephone interview with Physician ID # 4 on 01-30-14 at 3:20 p.m. he stated if he had been informed of Patient # 7 ' s expression of vulnerability and possible harm to self-next day, he would have postponed the discharge. H went on to say he would have re-evaluated the patient prior to discharge. He said often he wrote discharge orders in the early morning, but he expected to be informed of any significant patient changes prior to actual discharge.

The facility did not have a policy that addressed informing physician of significant patient information.

Based on interview and record review, an RN failed to supervise and evaluate the care of one (1) of 4 sampled discharged patients (Patient ID # 7).

RN failed to document an assessment or condition status of Patient # 7 upon discharge.

Findings include:

TX # 00188756

Record review on 01-30-14 of intake TX 00188756 revealed allegation by complainant that Patient # 7 was discharged too soon " in the midst of a severely depressed Bipolar 2 episode and suicidal state... "

Record review of the clinical record of Patient # 7 revealed she was s 49 years old and admitted involuntarily to the facility on 10-07-12 via law enforcement transport. Patient # 7 voiced Suicidal ideation with plans to have a motor vehicle accident.

Record review of physician orders, dated 10-12-12 (7 a.m.) " Discharge patient home after Family Therapy ... handwritten discharge summary completed... " (Physician /ID #4)

Record review of Patient # 7 ' s Group Therapy Notes, dated 10-12-12 (1230) read: " ...Pt. says ' I ' m too vulnerable to go home. ' Pt. said she thinks that if she goes home today she will probably harm herself before the flight on Monday... " This note was co-signed by therapist ID # 7 at 1:00 p.m.

Record review of Patient ID # 7 family therapy notes dated 10-12-12 (2:30 p.m.) by Therapist ID # 7 read: " ...labile affect and mood, tearful, poor insight and judgment; anxious; disheveled ... "

Record review of nursing notes for Patient # 7 dated 10-12-13 revealed the last nurses ' note was timed at 7:30 p.m.,: " observation in day room ...D/C (discharge) today.. Ambulating out with tech. verbalizes understanding of orders ... "

Interview on 01-30-14 at 2:15 p.m. with Chief Nursing Officer (CNO/ID # 2) she was unable to locate documentation of the actual time of discharge or nursing assessment of Patient # 7 upon discharge.

Record review of the every 15 minute monitoring record for Patient ID #7 revealed the last observation on the unit was recorded on 10-12-13 at 3:45 p.m.

Record Review of the facility Discharge Census Summary for 10-12-12 revealed Patient # 7 was removed from the facility computer system at 4: 51 p.m.

The CNO stated she " would expect a discharge note and assessment to be documented by nursing on Patient # 7, especially considering the circumstances ... " The CNO acknowledged the time documented on the 10-12-12 nursing notes for Patient # 7 was in error. Patient # 7 was discharged from the hospital around 4:30 p.m.; the nurse ' s note was timed at 7:30 p.m., which was after the patient had left.

Record review of facility policy titled " Nursing Documentation, " revised date 2/2013, read: " ...8. The patient ' s status is documented upon transfer or discharge from the hospital... "