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Based on record review and interview, the facility failed to provide a discharge plan that described the services and supports that are appropriate to the patient's needs at the time of discharge in five (5) of five (5) records reviewed (#D1, D2, D3, D4, and D5). Information for dates, times, names and/or phone contacts were not documented in the aftercare plan, compromising efforts to assure appropriate and timely follow-up care to the patient.

Findings Include:

A. Record Review

1. Patient D1 was admitted on 3/16/17 and discharged on 8/14/17. The Discharge Summary, dated 8/18/17, did not address any follow-up care for the patient.

2. Patient D2 was admitted on 3/1/17 and discharged on 7/24/17. The Discharge Summary dated, 7/25/17, did not address any follow-up care for the patient.

3. Patient D3 was admitted on 5/16/17 and discharged on 7/5/17. The Discharge Summary dated, 7/7/17, did not address any follow-up care for the patient.

4. Patient D4 was admitted on 4/25/17 and discharged on 6/15/17. The Discharge Summary, dated 6/26/17, did not address any follow-up care for the patient.

5. Patient D5 was admitted on 5/9/17 and discharged on 6/5/17. The Discharge Summary dated, 6/13/17, did not address any follow-up care for the patient.

B. Interview

1. During interview on 8/30/17 at 9:40 a.m., the Director of Social Work stated that discharge follow-up appointments were included in the Social Work Discharge Summary which was not a part of the discharge summary.

2. During interview on 8/30/17 at 12:15 p.m., the Medical Director stated that the physicians did not include follow-up appointment information in their discharge summaries.