Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 530033 (X3) Date Survey Completed 10/23/2013
Name of Provider or Supplier Mountain View Regional Hospital Street Address, City, State 6550 East 2nd Street, Casper, 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)
A0799 DISCHARGE PLANNING
CFR(s): 482.43

The hospital must have in effect a discharge planning process that applies to all patients. The hospital's policies and procedures must be specified in writing.


This CONDITION is not met as evidenced by:
Based on staff interview, review of medical records, and review of the nursing facility death records, it was determined the hospital failed to ensure an effective discharge planning process was in place for 1 of 7 sample patients (#3) in regard to reassessment (A821). This lack of effective planning may have contributed to the death of 1 sample patient (#3) who expired in less than 24 hours after discharge. The combined results of these systems failures resulted in the inability of the hospital to meet all of the necessary requirements for the discharge planning services Condition of Participation.