Failure to Ensure Proper Notification and Discharge Planning
Penalty
Summary
The facility failed to meet regulatory requirements during the discharge of a resident with schizoaffective disorder, generalized anxiety disorder, opioid dependence, and diabetes mellitus. The resident was discharged after an incident involving aggressive behavior, specifically throwing coffee on the Assistant Director of Nursing, which led to his arrest. Documentation showed that the Medical Director determined the resident was no longer safe to remain in the facility, and the Administrator documented the resident's discharge while he was in jail. However, the facility did not ensure proper notification was given to the resident, did not confirm the resident's receipt of the discharge notice, and failed to conduct appropriate discharge planning. Interviews with facility staff revealed that the discharge paperwork was hand-delivered to the jail but there was no confirmation that the resident actually received it. When the resident returned to the facility, he reported not having received any paperwork while in jail, and only then was a copy of the discharge papers provided. The Director of Nursing and Regional Nurse Consultant both confirmed that discharge planning was not completed and that the resident did not receive his medications upon discharge. The facility also denied the resident reentry due to safety concerns, but failed to follow required procedures for safe and appropriate discharge, including proper notification and planning.