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.


A. Based on Facility policy review, clinical record review and staff interview, it was determined for 1 of 10 clinical records reviewed (Pt #1), the Facility failed to ensure supervision of the discharge planning process.

Findings include:

1. On 8/2/11 at approximately 10:00AM, Facility policy #1300.85 titled, "Case Management: Discharge Planning" was reviewed. The Policy included, " The Case Manager and Social Worker play a unique role in the discharge planning process ...any member of the team may make a referral to Social Service when case complexity is high or psychosocial needs present."

2. On 8/1/11 at approximately 11:00AM, the clinical record for Pt. #1 was reviewed. Pt. #1, a [AGE] year old male, was admitted through the emergency department (ED) on 6/24/11 at 3:15PM for a psychiatric evaluation. The ED physician's medical screening exam on 6/24/11 at 3:40PM included information that Pt. #1 had a history of schizophrenia. While at home the Pt. became violent, agitated and was abusing alcohol. After medical clearance, Pt. #1 was admitted to a closed psychiatric unit (4West) with diagnoses of Mood Disorder and Alcohol Abuse. Admission orders, dated 6/24/11 included: close observation and assault precautions. Antipsychotic medication, Prolixin, 5mg daily was also ordered. The initial psychiatric evaluation, dated 6/25/11 (no time) contained the Axis I diagnoses of Mood Disorder and Alcohol Abuse Disorder. No psychiatric diagnosis was made during the initial psychiatric evaluation to qualify Pt. #1 for a nursing home placement. The clinical record contained three discharge progress notes. On 7/6/11, the Hospital Discharge Planner (E#1) identified the need for care in an Intermediate Care Facility (ICF). On 7/10/11, a referral packet was faxed to the pre-admission screener (PAS) for admission to a nursing home. On 7/12/11, the DP documented that the psychiatrist was notified that the axis I diagnosis of Mood Disorder/Alcohol Abuse did not meet PAS admission criteria for severe mental illness. The psychiatrist was notified by E#1 and the discharge summary, dated 7/12/11, listed the final diagnosis as Chronic Schizophrenia with acute exacerbation and Alcohol Abuse. On 7/14/11 Pt. #1 was discharged to Southview Manor nursing home by ambulance in stable condition, according to documentation on the transfer form.

3. The DP (E#1) was interview on 8/1/11 at approximately 10:30AM. The DP explained that Pt #1 needed an Intermediate Care Facility. E#1 contacted the pre-admission screener (PAS) who subsequently denied admission to a nursing home because the axis I diagnosis of Mood Disorder/Alcohol Abuse done on 6/25/11 did not meet the definition of sever mental illness. The psychiatrist was informed, and the psychiatrist wrote the discharge summary final diagnosis as Schizophrenia. According to E#1, the PAS worker failed to come to the Hospital to evaluate Pt. #1 and refused accept the diagnosis of Schizophrenia from a "discharge summary sheet " E#1 stated that rather than deal with the PAS worker, he bypassed the process and called the owner of Southview Manor nursing home who accepted the patient for admission without the required PAS screening. E#1 failed to follow Hospital policy which required notifying a Social Worker when a case is complex.

4. The Nurse Manager, who supervises E#1, was interviewed on 8/1/11 at approximately 10:45AM. The Manager was not aware of any placement problems regarding Pt. #1 or that E#1 independently called a nursing home owner to bypass the PAS process.

5. The Chief Nursing Officer (CNO) was interviewed on 8/2/11 at approximately 9:30AM. The CNO was not aware of any issues related to discharge planning for Pt. #1.

6. The above findings were discussed with the CNO, Interim Chief Executive Officer and Chief Operating officer during an interview on 8/2/11 at approximately 3:00PM.