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SOUTHERN WINDS 4225 W 20TH AVE HIALEAH, FL 33012 Nov. 9, 2016

Based on interview and record review the facility failed to reassess the patient's discharge plan for the appropriateness of the discharge to an unlicensed Assisted Living Facility (ALF) for 1 of 10 sampled patients (SP) #1.

The Findings:
Review of the record of sampled patient (SP) #1 revealed the pt. was admitted to the facility on [DATE] under Baker Act. Pt (patient) came from an ALF (Assisted Living Facility). Pt continued treatment for stabilization through continued medications and therapies. SP#1 condition improved and has reached maximum benefits from the treatment. Pt was discharged voluntary to the ALF.
Review of the CM (Case Manager) "Psycho Social Assessment"on admission revealed that SP#1 came from an ALF. It is noted that the plan includes possible discharge back to the ALF.
The "Physician's Orders" dated 9/22/2016 showed an order to discharge to another named ALF.
Interview with Risk Manager (RM) on 11/9/16 at 10:15 am who stated that facility ensures that placements to facilities requiring license have indeed a license. She called ALF#1 and ensure that they are licensed as an ALF. Spoke with the son of the owner of ALF#1 and faxed the license which showed there is an active license to operate as an ALF. SP#1 did not want to pay and the facility tried to assist the pt . by looking for ALFs. RM further stated her role include going to the community and reaching out to providers such as ALF, ILF (Independent Living Facility) and SNF (Skilled Nursing Facility). Collaborate with other state agency such as DCF (Department of Children's and Families) if necessary to find placement for the pts.

Review of the copy of the license certificate provided by RM and CM of ALF#1 showed that ALF#1 has a license to operate as an ALF and with limited mental health and limited nursing services. License # effective 9/15/15 to 4/4/2017.
Review of the showed no current license for named ALF #1 provider at the address SP #1 was discharged to.
The named ALF #1 license # closed in 2007.
Review of the Policy Subject: "Hospital-Wide Discharge Planning Program" revealed that the discharge process includes education of pt., collaboration with physician, and assisting with the appropriate placement and transfer of patients. The facility did not follow their policy.