Failure to Provide Required Transfer/Discharge Notices and Accurate Appeal Information
Penalty
Summary
The deficiency involves the facility’s failure to provide required transfer/discharge notifications and accurate appeal information for a cognitively intact resident who was admitted with orthopedic aftercare following surgical amputation, anemia, adjustment disorder, muscle weakness, and dysphagia. The resident’s admission MDS showed a BIMS score of 15 and documented receipt of PT, OT, and speech therapy. A physician order and nursing Discharge Summary dated several days prior to discharge identified a planned discharge to an assisted living group home, and the nursing note stated that discharge instructions and ombudsman contact information were provided to the resident or representative. However, the note did not document that a copy of the discharge notification itself was provided to the ombudsman. On the day of discharge, the Discharge Summary and Post-Discharge Plan of Care documented that the resident’s health had improved sufficiently and that facility services were no longer needed. A Notice of Proposed Transfer/Discharge completed that day indicated the resident was transferred to an assisted living group home and that the notice was provided the same day. The notice incorrectly listed the State Agency as the appeals authority for transfer/discharge issues. Review of the clinical record and facility documentation did not show that a copy of the proposed transfer/discharge notice was provided to the ombudsman. Case management notes from the same day documented that an insurance denial letter was received and given to the resident with appeal instructions, that the resident could not provide information to convert to private pay, and that case management discussed the discharge plan with the resident, who agreed to discharge to a group home that day. Interviews with the ombudsman and facility staff further described the facility’s practices. The ombudsman reported receiving only a monthly list of discharges and stated she had not received copies of discharge notices, despite having informed the facility that regulations require such notices. The case manager stated that the proposed transfer/discharge notice is given to nursing to hand to the resident on the day of discharge and that copies are not routinely sent to outside agencies, except sometimes to insurers. The SS Director and DON both stated that ombudsman notification is sent monthly as a list of admissions, discharges, and hospitalizations, and the SS Director confirmed she does not send copies of the proposed transfer/discharge notices because she had never been told this was required and does not receive the forms. The facility’s written discharge/transfer policy did not address required transfer/discharge notification content for residents, resident representatives, or the ombudsman.
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