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OCEANS BEHAVIORAL HOSPITAL OF PERMIAN BASIN 3300 S FM 1788 MIDLAND, TX 79706 Oct. 11, 2017
VIOLATION: QUALIFIED PERSONNEL Tag No: A0818
Based on a review of clinical records, a personnel file and facility documentation, the discharge plan was not developed or supervised by appropriately qualified personnel.

Findings were:

5 closed, clinical records were reviewed (patients #1 through #5). 1 of the 5 patients (patient #1) did not have a discharge plan developed or supervised by appropriately qualified personnel.

Discharge planning documentation (performed by staff #4) consisted of the following:
"8-3-17 at 4:50 pm - "Called Prairie Acres NH [nursing home], spoke to charge nurse, [name given], DON [director of nursing] was already gone for the day. To her understanding facility will not be taking patient back. (806) 250-3922."

"8-4-17 at 3:52 pm - "Called patient's sister, [name given], gave update on patient. She would like for him to return to Prairie Acres, however, his belongings have been moved out of prairie Acres Nursing Home. She said he does not want to be at the nursing home, instead wants to be out in the streets. The only relative he has is his sister, but she cannot take him home with her."

"8-9-17 at 12:11 pm - "Spoke to administrator at Clarendon Nursing home, he will be coming to assess patient thursday(sic) afternoon so he will see the patient that evening or friday(sic) morning, He is leaning toward taking patient but would like to lay eyes on the patient first. [name given] (806) 874-2273."

"8-11-17 at 10:43 am - "Met with administrator with Clarendon, [name given], he assessed patient for possible admission. Patient refuses to go to a nursing home, there he cannot accept patient."

"8-11-17 at 12:04 pm - "Called [name given], patient's sister, (806) 341-7307, notified patient will pick up belongings at Prairie Acres, she was able to confirm his belongings are there. Met with patient and let him know we can transport him Monday and he has agreed."

No further discharge planning notes were found and no indication was given as to where the patient would be living following his discharge from OBH (Oceans Behavioral Health).

A written statement requested by the surveyor and supplied by staff #4 stated the following:
"When [patient #1] was inpatient, patient refused to go to a nursing home. Patient [#1] came from Prairie Acres Nursing Home in Friona, Tx. Facility was contacted and they were not willing to take him back nor was he willing to go to back to the nursing home. Patient [#1] was assessed by Clarendon nursing Home when he began to clear up but when he was assessed by [name given], administrator at Clarendon, he refused to go. Clarendon then denied him because of his refusal. When patient [#1] was asked where he wanted to go he said he would like to just be released back to Amarillo, but would first need to get his belongings from Prairie Acres Nursing Home. Prairie Acres was then informed that the patient [#1] would be released and would be transported to their facility for the patient to just pick up his things, they agreed and said it would be fine. Patient [#1] was then given an MHMR appointment in Amarillo. Oceans Healthcare Transportation then drove him to Friona and when they arrived the facility became upset. Patient [#1] mentioned that he wanted to get a taxi from there which we followed his wishes but then realized that Friona is a small town. There are no taxis that run there and the closest town would be Hereford, Tx. [Patient #1] then got in the van with the drive and took the patient to Hereford. Patient [#1] stated that he wanted to buy a bus ticket in Hereford and would get to Amarillo by himself. He mentioned he did not want to burden the driver any more. The driver took him to the bus station where [patient #1] purchased the ticket. There were no tickets available that same day so he purchased one for the next day. After he purchased that ticket, he was taken to the nearest hotel, the Budget Motor Inn, and the driver helped him get settled into his hotel room."

A review of the personnel file for staff #4 revealed a job description for "Discharge Planner/Case Manager". The job description listed the following requirement:

"Education/Experience
Associate's Degree with emphasis on healthcare or Bachelor's degree is social services field preferred. At least one year psychiatric/chemical dependence experience with good working psychiatric/medical knowledge". The job description stated that staff #4 had held the position of Discharge Planner/Case Manager since 7-8-16.

An employment application completed by staff #4 stated "hire date 7-6-15". Staff #4 stated that she had an Associate's degree but no field of study was specified. She listed restaurant and food service positions as her prior employment. No psychiatric or medical knowledge/experience was documented. Documentation stated that staff #4 was hired at OBH and worked 1st as a cook in the dietary department and then as a medical records clerk before being promoted to the position of Discharge Planner/Case Manager in July 2016.

A document within staff #4's personnel filed titled "Competency Skill Checklist" (dated 10-31-16) stated the following experience:
"Adult Psych 3M [months]
Child Psych N/A [not applicable]
Geriatric Psych 3M
Adolescent Psych 3M
Adult CD [chemical dependency] 3M
Geriatric CD 3M"

The above was confirmed in an interview with the CEO and other administrative staff on the afternoon of 10-11-17.