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.

LIFESTREAM BEHAVIORAL CENTER 2020 TALLY RD LEESBURG, FL Feb. 21, 2011
VIOLATION: REASSESSMENT OF A DISCHARGE PLAN Tag No: A0821
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview the facility failed to reassess Discharge Plans for 1 of 3 patients (#3).

Findings:

Review of patient #3's record revealed the patient was admitted on [DATE] with a diagnosis of psychosis not otherwise specified and dementia. The patient was Baker acted on 1/4/11 with hallucinations and physical violence along with death threats to family members. On page 4, of the Access Center Evaluation, the Evaluator for admittance to the facility and the psychiatrist determined the patient was to be admitted for further evaluation, observation, and stabilization with a referral to an assisted living facility. On the Inpatient Discharge Summary, dated 1/7/11, page 2 it states "[Patient's family member] reports [other named family member] is afraid of the [individual] and he can not take care of [patient #3]". On page 4 it states under #4., [patient] does not understand he is diagnosed with dementia. On page 6 of 6 pages, of the Inpatient Discharge Summary dated 1/7/11, it notes under Discharge Instructions "Discharge to: own home", "Special Activity needs: N/A".

Further review revealed the Shift Notes for 1/6/11 state "individual's [family member] supportive of discharge if appropriate supportive services in place". It states "[patient] unaware of his mental condition, limited insight to treatment needs, dementia, individual reported stressors in the home since his [sibling] is presently in the hospital. The Shift Notes for 1/7/11 at 1:53 PM stated "Individual's [child] does not want [patient #3] to return to [parent's sibling's] home or his own home". "[Child] reported [patient #3] as not having a home". The next paragraph states "[Patient #3's child] and [other family member] were advised the discharge will remain scheduled for today". Under Plan, it states "Individual will be discharged with medication management and home health nurse". The Shift Notes for 1/7/11 at 3:17 PM state the patient was discharged at 16:45. "He was given all of his belongings with a copy of his Continued Care Summary with a prescription for home medications." The Contact Shift Notes for the date of discharge 1/7/11 4:36 PM, state "Individual's family [child and family member] have failed to comply with discharge planning. Family have been provided multiple opportunities to schedule a pick up time and appropriate place emtn assistance, but have failed to comply. [State agency] abuse hotline notified about failure to pick up [patient]. [Patient #3] was to be transported to the [sibling's] home by transport vehicle.

Review of the facility Policy for Discharge #VI, Individuals with unresolved housing issues at the time when discharge is clinically indicated shall be offered a listing of local shelters-emergency and homeless, to assist in making a decision for placement if other housing cannot be secured through the efforts of the clinical specialist and the individual. If a shelter is selected the discharge planner will contact the shelter and transportation will be arranged by the facility for the individual.

During an interview on 2/21/11 at 9:20 AM, the Recovery Specialist (Discharge Specialist) confirmed the staff should have ongoing engagement with the family if the patients are going home. She confirmed the patients should be properly evaluated for their ability to understand their condition if they are to be able to make decisions about their own discharge.

During a telephone interview with patient #3's sibling (owner of the home the other family member is presently living in) on 2/21/11 at 10:30 AM, the sibling stated patient #3 was not supposed to come back to her home after being discharged from the facility.

During an interview with the Director of Social Services on 2/21/11 at 11:45 AM, she confirmed patient #3's assigned staff member called a state agency hotline because the family did not show up for transporting him home. She confirmed they knew the family did not want the patient to return to the home before he left the facility. She stated they knew the patient had a diagnosis of psychosis and dementia which limited his capability to understand the situation and protect self. She had no information why the staff was concerned enough to call a state agency to go to the home, but sent the patient into that situation anyway.
VIOLATION: TRANSFER OR REFERRAL Tag No: A0837
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview the facility failed to refer patients to appropriate agencies and outpatient services for 1 of 3 patients (#1).

Findings:

During an interview with Patient #1 on 2/21/11 at 8:45 AM, he stated no facility staff had talked to him about a discharge plan. Patient #1 thought he would be discharged today. According to Patient #1 he had no transportation to the county he lived in when prior to being Baker Acted last week. The patient indicated having lost his "green card". The patient indicated calling the proper government agency and they told him that he needed to fill out an application and pay $291.00. He stated he lives in a Recreational Village and works 2 days doing odd jobs so he can stay there. According to Patient #1, he has no money. Patient #1 stated he lost his Social Security card and cannot apply for a replacement without the green card. Without those he states he cannot get a state identification card and apply for better jobs. He stated he told the staff he was depressed because he could not get a better job. He stated he told them he had thought about suicide. According to Patient #1, within minutes the police were there and he was Baker Acted. He stated he feels much better now and appreciates the help the hospital has given him with his medications. He states he has no discharge plan, but he can walk to the park, approximately 40 miles away. He is worried about getting medication because he has no money. He is not aware of any way to get help with his medications. He stated he is not aware of any staff contacting anyone on his behalf to assist with discharge.

Review of Patient #1's record revealed a "Continued Care Summary " which is what the facility has entitled it's Discharge Plan dated 2/21/11, he was admitted on [DATE]. Under "Case Management Services Needed?", the facility answered No. There was no documentation provided regarding any services the facility was going to provide Patient#1 on discharge.

Review of the Facility policy on Discharges revised 4/09 states under III . " The Clinical Specialist is responsible for securing placement, setting up discharge appointments and other non-medical referrals as appropriate."

An interview with the Director of Social Services on 2/21/11 at 11:00 AM confirmed the Continued Care Summary was the Discharge Plan. She confirmed the staff had answered "No" to the question which would trigger Case Management Services for Patient #1. She stated Case Management is the department of the facility which would ensure assistance for the patient with transportation, appointments, medications and other agency referrals for needed services.