| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 530025 | (X3) Date Survey Completed 11/03/2011 |
| Name of Provider or Supplier Ivinson Memorial Hospital | Street Address, City, State 255 N 30th, Laramie, WY | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| A0827 | DISCHARGE PLANNING DOCUMENT CFR(s): 482.43(c)(6)(iii) The hospital must document in the patient's medical record that the list was presented to the patient or to the individual acting on the patient's behalf. This STANDARD is not met as evidenced by: Based on medical record review and staff interview, the facility failed to include documentation in the medical record that a list of home health agencies (HHAs) and/or SNFs was given to 2 of 2 sample patients (#11, #24) who required home health or SNF services. The findings were: Review of medical records showed patient #11 was admitted on 10/26/11 and patient #24 was admitted on 10/12/11. Further review showed patient #11 would require home health services on discharge, and patient #24 was transferred to a SNF on 10/18/11. However, there was no documentation in either record that the patient had been given a list of the HHAs and SNFs. During an interview on 11/3/11 at 9:00 AM, the discharge planner stated that, although she had a list of HHAs and SNFs, she never documented in any patient's record that the patient had been given the list. |