HospitalInspections.org

Based on record review and interview, the facility failed to ensure effective discharge planning and coordination of care for one (#1) of 11 patients reviewed for discharge planning, resulting in the potential for harm (inclement and freezing weather conditions and homelessness) for patient #1 being discharged to a shelter that did not accept single males and the potential for serious harm for all homeless patients (9) served by the facility.
Findings include:

(See A-813) -The facility failed to implement an effective discharge plan for a homeless single male patient (#1) who was discharged to a shelter that did not provide shelter for homeless single males.

Based on record review and interview, the facility failed to implement an effective discharge plan for one (#1) of 11 patients whose records were reviewed for discharge planning, resulting in the potential for serious harm (inclement and freezing weather conditions and homelessness) for patient #1 being discharged to a shelter that did not accept single males and the potential for serious harm for all homeless patients (9) served by the facility.

Findings include:
Record review on 2/18/2021 at 1130 revealed patient #1 was a 19-year-old male admitted to the facility on 1/31/2021. Review of the admission face sheet documented the patient's address as "Homeless." The patient's admission was involuntary. His admitting diagnosis was listed as unspecified psychosis not due to substance abuse.

Further record review revealed an "Interdisciplinary Master Treatment Plan" dated 2/4/2021 that documented the patient (#1's) Initial Discharge Disposition would be to return "Home." However, the patient was "Homeless" on admission.
Additionally, there were no further updates to the patient's "Interdisciplinary Master Treatment Plan" dated 2/4/2021, for the patient's discharge that addressed his living arrangements (housing) post discharge plans, nor in the medical record.

Review of a form titled, "Transition of Care: Discharge Plan Part II" that was completed by Social Worker Staff E on 2/11/2021 at 1351 documented:
Admit date: 1/31/21, Discharge Date 2/11/21.
Discharge Status: Scheduled
Discharge to/Name: Shelter A
Address and Phone Number listed
Mode of Transport: Taxi
Follow-up appointment in the community for Case Management and Community Mental Health (CMH) services.
Family involvement: 2/9/21 at 1230.

However, there was no evidence on the "Transition of Care: Discharge Plan Part II" dated 2/11/2021 or in the medical record that documented facility Staff had contacted the shelter in advance of the patient's discharge to confirm whether they had a bed available for a single male who was being discharged from their facility.

During an interview with Social Worker Staff E on 2/18/2021 at 1230, he explained that he had contacted a third-party liaison for CMH who advised him that the patient of concern #1 could be discharged to "Shelter A." Staff E said he did not contact "Shelter A" in advance to confirm the patient would be discharged to a safe environment. Staff E said, "most shelters are walk-ins."

Review of the facility's "Discharge Planning Protocol Policy" dated, last revised on 10/2020 documented:
IV: Procedures:
B. The Social Worker will:
1. Coordinate the establishment of a discharge plan at the time of admission (or by the first treatment team conference)
2. Be responsible, to do the following:
a. schedule discharge conferences
b. obtain release of information authorization
c. arrange for vocational rehabilitation
d. notify probate court
e. refer for outpatient treatment and transmit discharge information to the next provider.
f. assists with living arrangements/long-term placement

However, there was no evidence in the medical record that documented the facility had arranged and/or confirmed living arrangements with the shelter that patient #1, who was homeless, prior to being discharged.