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.

SAMARITAN MEDICAL CENTER 830 WASHINGTON STREET WATERTOWN, NY 13601 June 10, 2015
VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN Tag No: A0820
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on findings from medical record (MR) review and interview, in 1 of 5 MRs reviewed, written discharge instructions were not provided to a patient's (Patient A's) representative upon discharge to an assisted living facility.

Findings include:

-- Per MR review, Patient A was admitted on [DATE]. He/she had a court appointed legal guardian. On 4/10/15 Patient A was discharged to an assisted living facility. There is no documentation in Patient A's MR indicating that written discharge instructions were completed and/or provided to the patient's legal guardian at discharge.

-- During interview with Clinical Discharge Planner #1, on 6/24/15 at 2:30 pm, he/she acknowledged lack of discharge instructions in Patient A's MR and agreed that the discharge instructions should have been completed.
VIOLATION: LIST OF HOME HEALTH AGENCIES Tag No: A0823
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on findings from facility document review, medical record (MR) review and interview, in 1 of 5 MRs reviewed, the hospital did not provide a patient (Patient B) with a list of Medicare participating home health agencies (HHAs) available to meet the needs of the patient after discharge. The hospital's discharge planning policy and procedure (P&P) did not describe the process for providing a list of Medicare participating HHAs and skilled nursing facilities (SNFs) to patients identified as needing those services.

Findings include:

-- The hospital's policy and procedure titled "Discharge Planning," last revised 6/2014, indicated that the discharge planning process should include options available to patients for post acute durable equipment, nursing care needs, transportation, emergency systems, etc.

-- Per MR review, Patient B was admitted on [DATE] with fever. Patient B was treated with antibiotic therapy and on 6/8/15 Patient B was discharged from the hospital with home care nursing services and home infusion services. There is no documentation in Patient B's MR indicating that a list of Medicare participating HHAs was provided to the patient during the discharge planning process.