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Based on review of medical records and staff interview it was determined the hospital failed to ensure the patent/family was involved in the development and implementation of the plan of care in ten (10) of ten (10) medical records reviewed (#1, 2, 3, 4, 5, 6, 7, 8, 9 and 10). This has the potential to negatively impact patient care by interfering with their right to be involved in their care. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10. The care plan was initiated on admission without documentation of the patient/family involvement.

2. Patient #2 was admitted to the hospital on 2/3/10. The care plan was initiated on admission without documentation of the patient/family involvement.

3. Patient #3 was admitted to the hospital on 2/18/10. The care plan was initiated on admission without documentation of the patient/family involvement.

4. Patient #4 was admitted to the hospital on 4/8/10. The care plan was initiated on admission without documentation of the patient/family involvement.

5. Patient #5 was admitted to the hospital on 4/19/10. The care plan was initiated on admission without documentation of the patient/family involvement.

6. Patient #6 was admitted to the hospital on 5/26/10. The care plan was initiated on admission without documentation of the patient/family involvement.

7. Patient #7 was admitted to the hospital on 6/2/10. The care plan was initiated on admission without documentation of the patient/family involvement.

8. Patient #8 was admitted to the hospital on 5/25/10. The care plan was initiated on admission without documentation of the patient/family involvement.

9. Patient #9 was admitted to the hospital on 5/29/10. The care plan was initiated on admission without documentation of the patient/family involvement.

10. Patient #10 was admitted to the hospital on 5/26/10. The care plan was initiated on admission without documentation of the patient/family involvement.

11. These records were reviewed with the Director of Clinical Services in the afternoons of 6/7/10 and 6/8/10 and she agreed with these findings.

Based on review of records and staff interview, it was determined the facility failed to ensure the Registered Nurse (RN) was supervising and evaluating the care of each patient in five (5) of ten (10) medical records reviewed (#1, 2, 3, 4 and 7) by failing to document repositioning the patient every two (2) hours as indicated on the plan of care. This has the potential to cause more harm to the patient by the development of or worsening of decubitus ulcers. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged on 4/20/10. The plan of care indicated the patient was to be turned every two (2) hours. Nursing failed to document the turning of the patient on 3/11/10 from 1500 to 0600, on 3/13/10 from 1700 to 0600, on 3/14/10 from 1600 to 0600, on 3/16/10 from 0700 to 1500, on 3/20/10 from 1400 to 1900, on 3/20/10 from 1400 to 1900, on 3/23/10 from 2400 to 0600, on 3/28/10 from 1400 to 1900, on 4/1/10 from 1800 to 2400 and 0200 to 0600, on 4/2/10 from 1800 to 0600, on 4/6/10 from 1000 to 1600 and 2000 to 0300, on 4/6/10 from 1000 to 1600 and 2000 to 0300, on 4/8/10 from 1700 to 2200 and 4/10/10 from 1700 to 0600.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged on 3/4/10. The plan of care indicated the patient was to be turned every two (2) hours. Nursing failed to document the turning of the patient on 2/5/10 from 1800 to 0600, on 2/6/10 from 1800 to 0600, on 2/7/10 from 1700 to 0600, on 2/8/10 from 1300 to 2000, on 2/9/10 from 0700 to 1900, on 2/11/10 from 1700 to 0600, on 2/14/10 from 0100 to 0600, on 2/20/10 from 2000 to 0600 and on 2/24/10 from 1600 to 0600.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged on 3/20/10, The plan of care indicated the patient was to be turned every two (2) hours. Nursing failed to document the turning of the patient on 2/25/10 for 24 hours, on 2/27/10 from 1200 to 1600 and from 1700 to 0600, on 2/28/10 from 1700 to 2000, on 3/1/10 from 0700 to 2000, on 3/2/10 from 0700 to 1100, on 3/4/10 from 1600 to 2100 and on 3/8/10 from 2200 to 0600.

4. Patient #4 was admitted to the hospital on 4/8/10 and discharged on 4/30/10. The plan of care indicated the patient was to be turned every two (2) hours. Nursing failed to document the turning of the patient on 4/9/10 from 0100 to 0600, on 4/10/10 from 2400 to 0600, on 4/13/10 from 0100 to 0600, on 4/16/10 from 2400 to 0500 and on 4/17/10 from 1100 to 2000.

5. Patient #7 was admitted to the hospital on 6/2/10 and as of 6/9/10 remains inpatient. The plan of care indicated the patient was to be turned every two (2) hours. Nursing failed to document the turning of the patient on 6/2/10 from 0300 to 0600, on 6/3/10 from 1700 to 0600 and on 6/5/10 from 0100 to 0600.

6. These medical records were reviewed in the afternoons of 6/7/10 and 6/8/10 with the Director of Clinical Services and the Divisional Director of Quality and they agreed with these findings.

Based on review of medical records and staff interview, it was determined the hospital failed to ensure a discharge planning evaluation was being conducted in ten (10) of ten (10) medical records reviewed for a discharge planning evaluation (#1, 2, 3, 4, 5, 6, 7, 8, 9 and 10). This has the potential to negatively impact patient care by not being prepared for the possibility of future needs upon discharge. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged on 4/20/10. There was no documentation of a discharge planning evaluation found in the medical record.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged on 3/4/10. There was no documentation of the discharge planning evaluation found in the medical record.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged on 3/9/10. There was no documentation of a discharge planning evaluation found in the medical record.

4. Patient #4 was admitted to the hospital on 4/8/10 and discharged on 4/30/10. There was no documentation of a discharge planning evaluation found in the medical record.

5. Patient #5 was admitted to the hospital on 4/19/10 and discharged on 5/10/10. There was no documentation of a discharge planning evaluation found in the medical record.

6. Patient #6 was admitted to the hospital on 5/26/10 and remains inpatient as of 6/10/10. There was no documentation of a discharge planning evaluation found in the medical record as of 6/9/10.

7. Patient #7 was admitted to the hospital on 6/2/10 and remains inpatient as of 6/10/10. There was no documentation of a discharge planning evaluation found in the medical record as of 6/9/10.

8. Patient #8 was admitted to the hospital on 5/25/10 and remains inpatient as of 6/10/10. There was no documentation of a discharge planning evaluation found in the medical record as of 6/9/10.

9. Patient #9 was admitted to he hospital on 5/29/10 and remains inpatient as of 6/10/10. There was no documentation of a discharge planning evaluation found in the medical record as of 6/9/10.

10. Patent #10 was admitted to the hospital on 5/26/10 and remains inpatient as of 6/10/10. There was no documentation of a discharge planning evaluation found in the medical record as of 6/10/10.

11. These medical records were reviewed with the Director of Clinical Services and the Case Manager in the afternoons of 6/6/10 and 6/9/10 and they agreed with these findings.

Based on review of documents, medical record review and staff interview, it was determined the hospital failed to include the patient/family in the discussion of the discharge planning evaluation in eight (8) of ten (10) medical records reviewed (#1, 2, 3, 4, 5, 6, 8 and 10). This has the potential to negatively impact patients by interfering with their right to be involved in the discharge planning process. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged on 4/20/10. Interdisciplinary Team Meetings (IDT)/Discharge Planning (DCP) occurred on 3/17/10, 3/24/10, 3/31/10, 4/7/10 and 4/14/10. There was no documentation indicating patient/family involvement.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged on 3/4/10. IDT/DCP occurred on 2/10/10, 2/17/10, 2/24/10 and 3/3/10. There was no documentation indicating patient/family involvement.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged on 3/9/10. IDT/DCP occurred on 2/24/10, 3/3/10, 3/10/10 and 3/18/10. There was no documentation indicating patient/family involvement.

4. Patient #4 was admitted to the hospital on 4/8/10 and discharged on 4/30/10. IDT/DCP occurred on 4/14/10, 4/21/10 and 4/29/10. There was no documentation indicating patient/family involvement.

5. Patient #5 was admitted to the hospital on 4/19/10 and discharged on 5/10/10. IDT/DCP occurred on 4/21, 4/28, and 5/5/10. There was no documentation indicating patient/family involvement.

6. Patient #6 was admitted to the hospital on 5/26/10 and remains inpatient as of 6/10/10. IDT/DCP occurred on 5/26/10 and 6/2/10. There was no documentation patient/family involvement.

7. Patient #8 was admitted to the hospital on 5/25/10 and remains inpatient as of 6/9/10. IDT/DCP occurred on 6/2/10. There was no documentation indicating patient/family involvement.

8. Patient #10 was admitted to the hospital on 5/26/10 and remains inpatient as of 6/9/10. IDT/DCP occurred on 6/2/10. There was no documentation indicating patient/family involvement.

9. These medical records were reviewed with the Director of Clinical Services and Case Management in the afternoons of 6/6/10 and 6/8/10 and they agreed with these findings.

Based on review of medical records and staff interview it was determined the hospital failed to include a list of Skilled Nursing Facilities (SNF)/Home Health Agencies(HHA)/Hospices available to the patients, participating in the Medicare program in five (5) of five (5)) closed medical records reviewed (#1, 2, 3, 4 and 5). This has the potential to negatively impact patient care by interfering with their right of the freedom of choice. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged to a SNF on 4/20/10. There was no list of SNF's made available to the patient/family or documented in the medical record.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged to a SNF on 3/4/10. There was no list of SNF's made available to the patient/family or documented in the medical record.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged to a SNF on 3/9/10. There was no list of SNF's made available to the patient/family or documented in the medical record.

4. Patient #4 was admitted to the hospital on 4/8/10 and discharged to a Hospice on 4/30/10. There was no list of Hospices made available to the patient/family or documented in the medical record.

5. Patient #5 was admitted to the hospital on 4/19/10 and discharged to a SNF on 5/10/10. There was no list of SNF's made available to the patient/family or documented in the medical record.

6. These medical records were reviewed/discussed with the Case Manager in the afternoon of 6/7/10 and he agreed with these findings, stating he was unaware of this regulation.

Based on review of medical records and staff interview it was determined the hospital failed to ensure patients enrolled in managed care were given a list with the choices available for post-hospital extended care services in one (1) of one (1) medical records reviewed with a managed care organization (#1). This has the potential to negatively impact patient care financially by patients not being given a choice of services available through their managed care organization. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged to a SNF on 4/20/10. The patient/family was not made aware of services offered through their managed care organization.

2. This medical record was reviewed with the case manager in the afternoon of 6/7/10. He agreed with this finding and stated he was unaware of this regulation.

Based on review of medical records and staff interview it was determined the hospital failed to ensure documentation in the patient's medical record of a list of post hospital care services was presented to the patient in five (5) of five (5) closed medical records reviewed (#1, 2, 3, 4 and 5). This has the potential to negatively impact patient care by interfering with their right of freedom of choice. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged to a Skilled Nursing Facility (SNF) on 4/20/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged to a SNF on 3/4/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged to a SNF on 3/10/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

4. Patent #4 was admitted to the hospital on 4/8/10 and discharged to Hospice care on 4/30/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

5. Patient #5 was admitted to the hospital on 4/19/10 and discharged to a SNF on 5/10/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

6. These medical records were reviewed in the afternoon of 6/7/10 with the case manager and he stated he was unaware of this regulation.

Based on review of medical records and staff interview, it was determined the hospital failed to ensure during the discharge planning process, patient's were informed of their freedom to choose a provider of post hospital care services in five (5) of five (5) closed medical records reviewed. This has the potential to negatively impact patient care by interfering with their rights of freedom of choice. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged to a Skilled Nursing Facility (SNF) on 4/20/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged to a SNF on 3/4/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged to a SNF on 3/10/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

4. Patent #4 was admitted to the hospital on 4/8/10 and discharged to Hospice care on 4/30/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

5. Patient #5 was admitted to the hospital on 4/19/10 and discharged to a SNF on 5/10/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

6. These medical records were reviewed in the afternoon of 6/7/10 with the case manager and he stated he was unaware of this regulation.

Based on review of medical records and staff interview, it was determined the hospital failed to ensure during the discharge planning process, patient's were informed of their freedom to choose a provider of post hospital care services in five (5) of five (5) closed medical records reviewed. This has the potential to negatively impact patient care by interfering with their rights of freedom of choice. Findings include:

1. Patient #1 was admitted to the hospital on 3/10/10 and discharged to a Skilled Nursing Facility (SNF) on 4/20/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

2. Patient #2 was admitted to the hospital on 2/3/10 and discharged to a SNF on 3/4/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

3. Patient #3 was admitted to the hospital on 2/18/10 and discharged to a SNF on 3/10/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

4. Patent #4 was admitted to the hospital on 4/8/10 and discharged to Hospice care on 4/30/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

5. Patient #5 was admitted to the hospital on 4/19/10 and discharged to a SNF on 5/10/10. There was no documentation in the medical record indicating a list of post hospital services was presented to the patient/family.

6. These medical records were reviewed in the afternoon of 6/7/10 with the case manager and he stated he was unaware of this regulation.