Observations
Based on a review of client records, the client handbook and interviews with facility staff, including the facility director, the facility failed to comply with the Department approved written facility plan for the management of treatment services when client #1 was administratively discharged and taken from the facility by staff to Route 15 without being given an opportunity to call home.
The finding includes:
An onsite complaint investigation was conducted on Friday, April 26, 2013. Two client records were reviewed. Client # 1 was administratively discharged and client #2 was involved in the events leading up to the discharge.
Client record #1 - The client was admitted on February 4, 2013 and administratively discharged on February 21, 2013, subsequent to an alleged behavioral outburst on her unit. The client was taken by staff to Route 15 in Allenwood and dropped off along the highway on February 21, 2013. Documentation in the client record did not support that the client was given the opportunity to make a phone call home. There was no indication that the client had any personal funds.
A prior incident addressed by the Department in November, 2011 resulted in a Department approved plan of correction which stated:
"Effective December 19, 2011 an addition was made to the patient handbook through which clients are provided documentation on admission stating that they will be able to make a phone call to arrange personal transportation if he or she elects to leave against medical advice. If personal transportation is not available and the patient has available funds, he or she will be provided transportation by safety staff to the bus station during first shift. If personal transportation is not available and that patient has no funds, the patient can be transported to Route 15 where a motel, restaurant, and a gas station /convenience store are located which offers the availability of shelter, telephone and food until personal transportation can be secured. The patient may elect to stay in treatment until a continuing care plan can be developed and scheduled for transportation by White Deer Run staff. This will be the responsibility of the unit supervisors in conjunction with the Director of Safety and the Risk Management"
The client handbook was reviewed as part of this investigation and the revision stated above, which was a component of the Department approved plan of correction, was not documented. The current copy of the client handbook states on page 11, #4(a)(f) and page 12, #6 (e) that:
"Each client shall receive individualized treatment, including at least the following:
a. Providing adequate and humane services regardless of the source(s) of financial support.
f. Actively involving the family...where applicable
e. Clients are permitted, in accordance with facility policy, to conduct telephone conversations with family...unless clinically contraindicated"
There was no documentation demonstrating that client # 1 was offered these services as part of her discharge episode. The finding was reviewed with the facility director, who confirmed that the changes had not been made to the client handbook. The Facility Director did not dispute the findings.
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Plan of Correction
QI Coordinator and Administrative assistant will update patient handbook to reflect statement from 2011 POC as well as update patient rights. Handbook will be submitted for print by 5/31/13.
WDR Staff will inform patients of the decision to terminate them from treatment. Staff will ask patient to sign termination form which will outline the purpose of termination from treatment. If patient refuses to acknowledge this or sign the form, staff will mail a copy of the form/letter informing them of their discharge/termination from treatment to the client with a copy of the appeal process and form. Staff will write on communication sheet whether they gave client a copy of the form or whether it was mailed and when to the client.
Medical records and supervisor will audit charts to track that these forms are being utilized and that the letters are being documented on the communication log.
Adolescent patients will be transported home via facility transportation and/or a call will be placed to request that family come to the facility to transport their adolescent home.
During the risk assessment if a patientis assessed as being a harm to self or others, they will be referred to and transported to an appropriate level of care to address suicidal/homocidal ideations/intentions. If they are a low risk of harm they may be transportated home either through facility transportation or by public transportation. Any client that is at risk will be given a 1 day supply of their medication and will be asked to confirm the address they will be returning to so that the remaining medications can be mailed to their residence. All cases will be assessed individually for clinical/medical concerns/needs and discharge results may vary utilizing the outline of the AMA/AD policies based on the individual needs of the patients.
QI Coordinator revised AD, AMA, Medication, patient rights policies on 4/17/13 to preclude dropping patients off on route 15. QI Coordinator will revise and enforce policies by conducting training/supervision with supervisory staff, who will address it with their staff. QI Coordinator will track administrative discharges from the program and document whether this form was used and sent to clients.
QI coordinator met with supervisors to inform them of new policies, supervisors will meet with staff for supervision reflecting new policies by 6/7/13. QI Coordinator will host mandatory staff training to review patient rights on 5/16/13, 5/23/13, 5/30/13.
QI Coordinator will track administrative discharges from the program and document whether this form was used and sent to clients. |