The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

LARKIN COMMUNITY HOSPITAL 7031 SW 62ND AVE SOUTH MIAMI, FL 33143 Oct. 27, 2016
VIOLATION: DOCUMENTATION OF EVALUATIONS Tag No: A0811
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review the facility failed to discuss the results of the discharge planning evaluation with the patient or individual acting on his or her behalf for 1 of 11 sampled patients (SP) #1.
The findings:
Record review showed that Sample Patient (SP) #1, the subject of this investigation was admitted on [DATE]. He was brought to this facility ' s Emergency Department (ED) from the Police Department after being called by his brother for psychosis and disorganized behavior- jumping out of his brother ' s car while it was in motion. He has multiple admissions to this facility. Record showed patient was admitted to inpatient psychiatry unit, the Behavioral Health. Discharge instructions showed: Patient will be discharged to ALF (Assisted Living Facility).
Interview with Registered Nurse (RN - B) on 10/27/2016 at 11:10 AM revealed that he took report from the outgoing nurse on that afternoon when pt. ran away. He further stated: that the brother is super involved in the care of his brother; that he talked to the brother, explained to him the situation. Brother showed up and stated pt. has done this before. The brother called the Police himself since he knows patient ' s inclinations. His brother is more concerned of locking his brother up; he does not care where his brother goes. RN - B also stated he talked to the Nursing Supervisor and the Doctor. According to RN - B when he spoke to the doctor, his concern was family be notified and he left it at that. What to tell the Police if I called them is what pt. was wearing to identify patient. The patient has a voluntary status and not BA (Baker Act). He has own free will; not a threat to himself or to others.
Record review of SP #1 regarding Patient Assessment Report: Case Management - Discharge Disposition dated 9/14/2016, time 9:30 AM for the first admission. Case Manager (CM-A) documentation showed: has a list of placement provided to the patient (Assisted Living Facility)? Answer NO. Please list all options that were provided to the patient (Minimum of 5 choices need to be listed below). Answer NO.
Record review of the Registration Admission showed SP #1 was re-admitted on [DATE] at 14:59 PM.
Record review of BH-ED Assessment: History Present Illness (HPI) dated 9/14/2016 on second admission showed, patient stated he: doesn't want to go back to the ALF and that is the reason he left yesterday.
Interview with CM - A on 10/27/2016 at 9:40 AM confirmed the above findings.
Record review of policy number CMGT-764-013(review date 10/2016) subject: "Patient Initial Assessment and Re- Assessment", showed the focus of these assessments are to provide patients and significant others with a continuous plan of care in order to prepare the patient and facility for discharge home or to an alternate care facility. It further reads the Case Manager encourages the participation of the patient and significant other in the patient's plan of care and discharge plan. Arrangements are made by CM for appropriate disposition upon discharge, including referrals to community agencies.
VIOLATION: REASSESSMENT OF A DISCHARGE PLAN Tag No: A0821
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review the facility failed reassess the patient's discharge plan for factors that affected the appropriateness of the discharge plan for 1 out of 11 SP (# 1).

The findings:
Record review showed that Sample Patient (SP) #1, the subject of this investigation was admitted on [DATE]. He was brought to this facility ' s Emergency Department (ED) from the Police Department after being called by his brother for psychosis and disorganized behavior- jumping out of his brother ' s car while it was in motion. He has multiple admissions to this facility. Record showed patient was admitted to inpatient psychiatry unit, the Behavioral Health. Discharge instructions showed: Patient will be discharged to ALF (Assisted Living Facility).
Interview with Registered Nurse (RN - B) on 10/27/2016 at 11:10 AM revealed that he took report from the outgoing nurse on that afternoon when pt. ran away. He further stated: that the brother is super involved in the care of his brother; that he talked to the brother, explained to him the situation. Brother showed up and stated pt. has done this before. The brother called the Police himself since he knows patient ' s inclinations. His brother is more concerned of locking his brother up; he does not care where his brother goes. RN - B also stated he talked to the Nursing Supervisor and the Doctor. According to RN - B when he spoke to the doctor, his concern was family be notified and he left it at that. What to tell the Police if I called them is what pt. was wearing to identify patient. The patient has a voluntary status and not BA (Baker Act). He has own free will; not a threat to himself or to others.
Record review of Registration Admission showed SP #1 was re-admitted on [DATE] at 14:59 PM.
On 09/14/2016 at 11:36 AM (less than 24 hour later), SP #1 was baker act by police. The police report showed that he suffers from paranoid delusions, he ran away from a medical transport wagon, has not taken his medication and can otherwise not care for himself without supervision. According to the physician chart dated 09/14/2016 at 12:07 PM SP #1 presents to the emergency department with complaints of psyche problem-bizarre behavior. Onset: the symptoms/ episode began/ occurred yesterday. The Behavioral Health ED assessment the patient is grossly psychotic; responding to internal stimuli. It is difficult to have patient respond to questions because he is internally preoccupied and speaking to himself. SP #1 was medically cleared and readmitted to inpatient psychiatry unit. Patient was then discharged on [DATE] to another Assisted Living Facility.
Record review of Behavioral Health (BH)-ED Assessment: History Present Illness (HPI) dated 9/14/2016 on second admission showed, patient stated he: "doesn't want to go back to the ALF and that is the reason he left yesterday."
Interview with Case Manager (CM)-A on 10/27/2016 at 9:40 AM confirmed the above findings.
Record review of Policy Number CMGT-764-013(review date 10/2016) subject: "Patient Initial Assessment and Re-Assessment" showed the focus of these assessments are to provide patients and significant others with a continuous plan of care in order to prepare the patient and facility for discharge home or to an alternate care facility. It further reads the CM encourages the participation of the patient and significant other in the patient's plan of care and discharge plan. Arrangements are made by CM for appropriate disposition upon discharge, including referrals to community agencies.