Failure to Provide Timely 30-Day Written Discharge Notice and Ombudsman Notification
Penalty
Summary
The deficiency involves the facility’s failure to provide proper written notice of a proposed transfer and discharge to a resident, the resident’s responsible party, and the state long-term care ombudsman at least 30 days prior to the proposed discharge date. The resident, who had type 2 diabetes mellitus and end-stage renal disease and was documented as having decision-making capacity with no cognitive impairment, was initially given a Notice of Proposed Transfer and Discharge dated early in the month stating that discharge was appropriate because the resident’s health had improved sufficiently. The notice in the record lacked the resident or representative’s signature and was not faxed to the ombudsman. The facility’s policy required that a copy of the notice be placed in the medical record and faxed to the ombudsman, and that when a transfer or discharge is initiated by the facility, notice be provided to the resident, responsible party, and ombudsman 30 days prior to discharge unless specific exceptions applied. Despite this, the facility representative did not sign the notice until late in the month, and the physician’s order to discharge the resident with home health and DME was entered the following day. The resident reported not recalling receiving the proposed discharge documents within the prior four weeks and stated feeling rushed and harassed to sign a document and be discharged the same day. The ombudsman confirmed the facility did not fax the notice of proposed discharge until the day after the resident interview and had previously reminded social services about the 30-day notice and record-keeping requirements. An LVN involved in discharge planning stated he usually received at least a week’s notice for discharges but was only given the resident’s discharge plan and notification the day before the planned discharge and was told the discharge had been moved up without further details. The social services director acknowledged that when the resident declined to sign the notice earlier in the month, it was not faxed to the ombudsman, and the administrator stated the notice did not need to be faxed because it was not considered a facility-initiated or involuntary discharge, contrary to the facility’s written policies.
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