HospitalInspections.org

Based on interview and document review, the facility failed to provide a Director of Social Work who monitors and oversees the clinical work of the Licensed Professional Counselors (LPC's), Licensed Marriage and Family Therapists (LMFT), Licensed Social Workers (LSW), Case Managers, and Discharge Planners, who are responsible for the psychosocial assessments, discharge plans, and therapeutic interventions. This deficiency results in patients not having access to the clinical expertise of the social work discipline.

Findings are:

Interviews:

1. In an interview on 4-21-14 at 9:45 a.m., LPC 2 stated, "The therapists are responsible for writing the psychosocial assessments. I am supervised by the nurse manager of the unit and do not receive supervision from the Director of Social Work."

2. In an interview on 4-22-14 at 10:00 a.m., the Supervisor of Operational Performance and the Director of Nursing(DON) stated that the Case Managers on each unit are supervised by their respective Nurse Managers.

3. In an interview on 4-22-14 at 10:30 a.m., the Manager of Human Resources stated, "There is no Department of Social Work. The hospital does not have a job description for a Director of Social Work. The Director of Social Work has that role by circumstance, but in the organizational table he is considered the Director of the Eating Disorder Unit."

4. In an interview on 4-22-14 at 11:30 a.m., the facility's consulting psychologist stated that she offers clinical supervision to the case managers on the Adult Unit. Furthermore she stated that on the Senior Unit, the Nurse Manager leads the monthly therapist staff meetings.

5. In an interview on 4-22-14 at 3:30 p.m., LPC 3 stated that during the past year that she had worked at the facility, she had never had any clinical supervision from the Director of Social Work. She stated that she receives her supervision from the nurse manager.

6. In an interview on 4-22-14 at 4:00 p.m. the Director of Social Work stated that he audits patient records for specific social work standards, but that he does not review psychosocial assessments for overall quality. "I am looking at specific elements required, not at overall quality." He stated that he is not responsible for the clinical work of the social service staff, but instead that the nurse managers on the units are responsible for the clinical work of these staff members.

7. In an interview on 4-23-14 at 9:15 a.m., the case manager who is responsible for discharge planning stated that she reports to the unit manager who is a registered nurse. She stated that during her time of employment, she has never consulted with the Director of Social Work about a clinical issue.

8. In an interview on 4-23-14 at 9:30 a.m., LPC 4 stated that her work is supervised by the Nurse Manager of the unit.

9. In an interview on 4-23-14 at 9:30 p.m., SW1 stated that her work is supervised by the Nurse Manager of the unit. Furthermore, she stated that if she needed additional clinical consultation, she would consult with other therapists on her unit. SW1 stated that she has had no clinical supervision from the Director of Social Work during her 5-year tenure at the hospital.

10. In an interview on 4-23-14 at 9:25 a.m., the DON stated that the Director of Social Work role is primarily one of auditing social work benchmarks in the medical records and that he does not do any direct clinical supervision with the social work staff.

11. In an interview on 4-23-14 at 10:40 a.m., Nurse Manager 1 stated that the collaboration between nurse managers and the Director of Social Work is that of monthly audits and "reports on score cards." She stated that the collaboration is limited to determining if the unit met particular social service benchmarks, and that the focus is not clinical. Furthermore, she stated that she does not routinely review psychosocial assessments, nor does the Director of Social Work, other than for specific benchmarks.

Document Review:

1. The facility's Table of Organization does not reflect that Social Work is a discipline within the facility. There is no place in the Table of Organization that reflects that there is a Director of Social Work.

2. The most recent evaluation and reappointment letter (10-2-13) for the individual identified to the surveyor as the Director of Social Work, states that his job title is "Licensed Clinical Social Worker." There is no mention in the reappointment letter of this staff person being a Director of Social Work.

3. The job description, for the individual identified to the surveyor as the Director of Social Work, is entitled: "Director, Eating Disorders Operations." The job description and summary (09-27-10) does not include directing the Department of Social Work.

4. Hospital Policy entitled Social Service Program (6-16-11) states, "Day-to-day supervision of service provision is provided by management level clinicians supervising their respective work areas. The individuals collaborate with the Director of Social Services to ensure quality of care provided."