Failure to Confirm Acceptance Prior to Resident Discharge
Penalty
Summary
The facility failed to ensure a safe and orderly transfer or discharge for a resident diagnosed with Guillain-Barre Syndrome and hypertension, who required partial assistance with activities of daily living and had no cognitive impairment. The resident was initially admitted and later readmitted to the facility, with discharge planning indicating a return to recuperative care upon discharge. However, the facility discharged the resident to recuperative care without obtaining written confirmation that the receiving facility would accept the resident. On the day of discharge, the resident left the facility with all medications and belongings, but shortly after, the outside social service worker (OSSW) notified the facility that recuperative care would not accept the resident due to their medical condition. The resident returned to the facility parking lot and requested assistance, after which the assistant social worker (ASSW) accompanied the resident to a hospital and left the resident in the hospital parking lot. The resident then walked into the emergency room independently. Interviews with facility staff, including the ASSW, social service worker, administrator, and director of nursing, confirmed that there was no written or official confirmation from recuperative care regarding acceptance of the resident. The facility relied on verbal and email communication from the OSSW and did not have documentation of acceptance. Facility policy required sufficient preparation and orientation to ensure safe and orderly transfer or discharge, which was not followed in this instance.