Failure to Initiate Discharge Planning Upon Resident Request
Penalty
Summary
The facility failed to initiate and follow through with discharge planning upon a resident's request, resulting in a deficiency. The resident, who was cognitively intact with a BIMS score of 15 and was at the facility for therapy, expressed a desire to either return home or transfer to another facility closer to family. Despite multiple requests made to different social workers, the resident did not receive any updates or assistance regarding his discharge or transfer options. The resident was capable of private pay for 24-hour nursing care at home and had a home environment suitable for his needs, but no progress was made toward facilitating his discharge or transfer. Documentation shows that a social worker met with the resident and acknowledged his request, but only provided supportive listening and did not take further action or make referrals to other facilities. The social worker documented the conversation but did not follow up or initiate the discharge process. The Social Service Director confirmed that no referrals had been made for the resident, and discharge planning had not started as required by facility policy, which mandates that discharge planning begin at admission and be reevaluated regularly. This lack of action resulted in the resident's needs and preferences for discharge not being addressed.