K ennedy Memorial Hospital CA 92201-6739 RIVERSIDE

CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF PUBLIC HEALTH

STATEMENT OF DEFICIENCIES

AND Plf\N OF CORRECTION

(XI ) PROVIDER/SUPPLIER/CL IA

IDENTIFICATION NUMBER

(X2) MULTIPLE CONSTRUCTION

(X3) DATE SURVEY

COMPLETED

A BUIU)I NG

050534

NAME OF PROVIDER OR SUPPLIER

John

F.

STREET ADDRESS. CITY, STATE, ZIP CODE

47111 Monroe St, Indio, CA 92201-6739 RIVERSID E COUNTY

K ennedy Memorial Hospital

(X4) 1D

SUMMARY STATEMENT OF DEFICIENCIES

(EACH DEFICIENCY MUST BE PRECEEDEO BY FULL

REGULATORY OR LSC IDENTIFYING INFORMATION)

PREFIX

TAG

08/2.1 /2012

B W ING

10

PROVIDER'S PLAN OF CORRECTION

(X5)

PREFIX

{EACH CORRECTIVE ACTION SHOULD BE CROSS?

COMPLETE

TAG

REFERENCED TO THE APPROPRIATE D EFICIENCY)

DATE

The plan of correction is prepared in

compliance with federal regulations and is

intended as JFK Memorial Hospital (the

" hospital") credible evidence of compliance..

The submission of the plan of correction is

not an admission by the facility that it agrees

that the citations are correct or that it

violated the law.

T he following reflects the findings of the Department

of Public Health during an inspection visit:

Complaint Intake Number:

CA00286109 - Substantiated

Representing the Department of Public Health:

Surveyor ID# 28294 , HFEN

Organization Minutes:

The confidential and privileged minutes are being

retained at the facility for agency review and

veri fication if required.

The inspection was limited to the specific facility

event investigated and does not represent the

1 findings of a full inspection of the facility.

Exhibits

Health and Safety Code Section 1280. 1(c): For

purposes of this section "immediate jeopard y"

means a

situation

in

which

the

licensee's

noncompliance with one or more requirements of

1licensure has caused, o r is likely to cause, serious

injury or death to the patient.

A ll exhibits including revisio ns to Medical StafT

Bylaws. reviewed/revised or promulgated policies

and procedures. documentation of staff and medical

staff training/education arc retained at the facility

for agency review and verilication upon request.

I

I

Penaltv Number 2500 10926

Abbreviations use d in this document:

RN - Registe red Nurse

& - and

T itle 22 of the Californ ia

section 70717(f)( 1):

Code

of

Regulations

Admission, T ransfer and Discharge Policies.

1

I

No patient shall be transferred or discharged

for the purposes of effecting a transfer from a

' hospital to another health facility unless:

(1) Arrangemen ts have been made in advance for

(f)

j solely

admission to such health fac ility.

Event ID:YXPK11

('. ~

\\I~ .lJ ~

\.~>~

8/ 11/2014

The Governing Body is in rece ipt of the "Request

For Plan of Correction for Immediate Jeopardy (IJ)

Deficiencies" written by California Depa11menl of

Pub lic Health dated August I I. 2014. Th e

?

Governing Body has taken the allegations of

deficiency in the report seriously and continues to

assume full responsibi lity for determining.

implementing and monitoring policies governing

the hospital's total operation and for ensuring that

these policies are administered to protect and

promote patient safety. protect patient rights and

provide quality health care. We have reviewed the

patients chart. discussed thi s event with Case

Management Social Services and the discharging

physician. We have' identificd opportunities to ?

improve our processes as it pertains to a patient

safe discharge. The caregivers responsible for the

care of this patient made every effort to transfer the

3:07:30PM

TITL E .,

t:!. e'()

By signing this document, I am acknowledging receipt of the entire citation packet,

Any deficiency statement ending with an as1erisk (')denotes a deficiency which the instilution may be excused from correcting providing ii 1s determined

that other safeguards provide sufficient protection to the patients Except for nursing homes, the findings above are disclosable 90 days following the date

of survey whether o r not a plan of correction 1s provided For nursing homes , the above hndings and plans o f correction are disclosable 14 days following

th e date these documents are made available to the racllity. If deficiencies are cited. an approved plan of correction is requisite to continued program

pa rt1cipat1on.

State-2567

Page 1 of 9

CALI FORNIA HEAL Tri AND HUMAN SERVICES AGENCY

DEPARTMEN T OF PUBLJC HEAL TH

STATEMENT OF DEFICIENCIES

AND ?lAN o r CORRECTION

(X 1) PROVIDER/SUPPLIER/CU A

(X2) MVlTIPLE CONSiRUCTION

IDENTtFICA flON NUM8ER¡¤

()(3) DATE SURVEY

COMPLETED

A. 8UILO ING

e. WINO

050534

NAME Of PROVIOER OR SUPPLIER

John F. Kennedy Memorial Hospital

(X ~ ) 10

STREET ADDRESS. CITY, STATE. ZIP CODE

47111 Monroe St, Indio, CA 92201 ¡¤6739 RIVERSIDE COUNTY

SUMMARY STATEMENT OF OEFICIENCIES

(EACH DEFICIENCY M J ST BE PRECEEOEO BY FULL

REGULATORY OR LSC IDENTIFYING INFORMATION}

PREFIX

TAG

ID

PREFIJI

TAG

Based on inte rv iew and reco rd review, the facility

(Facility A ) failed to ensure a patient (Patient 6)

was d ischarged fo r the p urpose of effecting a

transfer to another facility without first making

advanced arrangements with that rece iving facili ty

( Facility 8 ). Patient 6 was oischarged from Facility

A and told to go to th e emergency departmen t of

Facility B, via priva te automobile. This placed

Patie nt 6 at risk for increased health deterioration,

harm a nd death. Additionally, Patient S's vehicle

had a mechanica l b reakdown on the way to Facility

B and emergency services had to pick up Patient 6

from the side of tne road In order to complete

Patient 6's tran sfer to Facility B.

Findings¡¤

On Oc tob er 12, 2011. the record for Patient 6 was

reviewed. Patient 6 w as admitted to the faciUy

(Facility A) on 2011, with diagnoses

including jaundice (yellow coloring of the sk in which

comes from bilirubin. a byproduct of old red blood

cells) and liver failure (occu rs when large parts of

the liver become damaged beyond rep air and the

liver is no longer able to perform its physiologica l

functions) Patient 6 did not have health insurance.

I

The "History and Physical," dated

2011,

indicated:

"Social

Services

has

oeen

consulted for her issues and fo r discharge

1, planning."

On

2011. a! 10¡¤40 a.m. ,

"Hematology" and "Chemistry" resu lts indicated

Event ID:YXPK11

State-2567

08/21 / 201 2

the

811112014

PROVIDER"S PLAN OF CORRECTION

(EACH CORRECTIVE ACT ON SHOULD BE CROSS?

REFERE2'CED TO THE APPROPRIATE DEFICIENCY}

(XS}

COMPLETE

DATE

patient to a tertiary care center for further care.

Social Services and Case Management made every

effort to find a receiving facility to no avail. The

discharging physician recogn ized that the patient

was very sick, continuing to decline and refusing

hospice as an alternative for cure. The required

level of care was determined to be outside the

scope provided by the hospital. After exhausting all

resources to have this patient transferred to a

higher level of care, and after di scussion with the

famil y, it was decided and agreed by the famil y to

discharge the patient to the son :;o he could take his

mother directly to Riverside County H ospital for

continuation ofcare. The dischargin g physician

contacted the hospital the patient was admitted to

and was informed of the patient's status during her

hospitalization th ere. At the time of this event, the

physician felt i t was the right cou rse ofaction to

take based on the patient's wishes to recei ve a

higher level of care an d the refusal to be placed on

hospice.

Policv & Procedures:

The Chief N ur sing O fficer (CNO), Interim Case

Managemem Direc1or (ICM) and the Director of

8120112

Clinical Quality I mprovement (DCQI) reviewed the 8/20/1 4

Policy and Procedure " Discharge of a Patient"

effective revi sion date of 8/20112. CNO, ICM and

DCQJ all agreed that a m ore comprehensive policy

and proced ure should be developed to re flect

Condi1ions of Participati on Guidelines 42 CFR

482.43, Discharge Planning. The revised policy and

procedure will be placed on the next Medical

Executi ve Com miuec and Govern ing Board

Committee's agenda in September 20 14 for final

revi ew and approval.

The Chief Nursing Officer, Interim Case

Management D irector and the Director of Clinical

816112

Qu ality Improvement reviewed the Policy and

8/20/1 2

Procedure ..Chain ofCommand" with effective date

8/6/I 2. There are no revisions required .

3:07:30PM

Page 2 of 9

CALIFORNIA HEALTH AND HUMAN SERVICES AG ENCY

DEPA RTMENT OF PUBLIC HEALTH

STATEME NT OF DEFICIENC IE S

ANO PLAN OF CORRE CTION

(X21MV'.TIPLE CONSTRUCTION

(XI) PROVIOERISUPP LIERICLIA

(X 31OATE SURVEY

COMPLETED

IOENTIFICA TION NJMSER

A BUILDING

050534

NAME Of' PROVIDER OR SUPPLIER

J oh n f .

STREET ADDRESS, CITY, STA TE, ZIP CODE

Kennedy Memorial Hospital

47111 Monroe St, Indio, CA 92201-6739 RIVER SIDE COUNTY

SUMMARY ST ATEM ENT OF DEFICIEl'IC IES

(EACH o = FICLENCY MUST BE PRECEEOEO BY FULL

(X4) 10

PREF IX

TAG

10

PREFIX

TAG

iIG INF ORMATION)

2011, at 5:30 a .m.. Patient 6's

count increased to 9.8 1Oe9/l and Bilirubin

Total increased to 14 1 mg/d L

The reference range for WBC coum wa s 4.2

through 10.8 10e9/ L (elevated WBC count occurs

with infection. systemic iUness). and the refere nce

range for Bilirubin Total was 0.0 through 1.0 mgldl

1

(elevated Bilirub in Total occurs with liver damage,

di seas e or failure).

On

2011 , at 7 :15 p.m., tne " Nursing

Note" indicated Patient 6 w as ready for discharge

but that Pati ent 6 was "very weak; nauseated and

started to vomit: her blood pressure wa s 88/42; HR

(heart ra1e) 100". The physician was calfed and the

physician requested lo reverse the discharge and I

retam Patient 6 until she was more stable to send

home.

I

On

201 1, at 9: 17 a m. . the Case

Managemen t1Soc1c.1 Services notes indicated Case

Management assisted with discharge planning for

Patient 6.

On

201 1, at 5:06 a.m , Pauent 6's

WBC count increased to 16.3 1Oe9/L and Bilirubin

Total

increased

to

15.7 mgldl,

which

was

considered a "critical value."

Event ID:YXPr ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download