Other·September 16, 2022

§ 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 4/29/22, at 1:05 p.m., an unannounced visit was conducted at the facility to investigate a complaint regarding the facility's process for planning one resident's (Resident 1) discharge to the community. Resident 1 did not receive an effective post-discharge plan. The facility planned to discharge Resident 1 to a location where Resident 1 was not qualified to live. This resulted in Resident 1 receiving a discharge plan that could not produce a safe and orderly discharge, or prevent avoidable complications to Resident 1's recovery and overall health. The facility failed to develop and implement an effective discharge plan, when the facility staff did not, including but not limited to: 1. Plan for Resident 1 to discharge to a safe, appropriate discharge location; 2. Follow the facility's policy and procedure for Discharge and Post-Discharge Plans Resident 1's Face sheet, dated 4/29/22, indicated the resident had a history of cancer, muscle weakness, kidney disease, as well as cognitive communication deficits. Resident 1's Minimum Data Set (MDS, an assessment tool) dated 3/24/22, indicated Resident 1 used a wheelchair and walker for mobility. The MDS indicated Resident 1 exhibited no impairments in either her upper or lower extremities and had "steady" balance "at all times" when moving, walking, or transferring between surfaces (e.g., transfer between bed and chair/wheelchair). Resident 1 required "supervision" as well as "setup help" for assistance when undertaking activities of daily living. During an interview on 4/29/22 at 12:15 p.m., Resident 1 stated the facility wanted to discharge her to her husband's hotel room. Resident 1 stated the room was small and was already filled with the resident's husband's wheelchair and commode. Resident 1 stated "I lived there before, and it is too small." Resident 1 also stated she did not possess the required voucher to finance her staying there. Resident 1 verbalized concern for her ability to safely move around at the location. Resident 1 stated she felt unsteady when turning around (while standing) and did not feel safe arranging her own transportation for "multiple appointments." During an interview on 4/29/22 at 2:25 p.m., Social Services stated she was tasked to arrange a discharge for Resident 1 based on the resident's health having improved significantly. Social Services stated Resident 1 no longer required services of the facility and the resident had also failed after reasonable and appropriate notice to pay her share of costs. Social services stated that the plan was to reunite her with her husband at his shelter and she could receive services there. Social Services stated this option was approved by the facility management. During a review of Resident 1's medical record, the "Progress Notes," dated 2/24/22, indicated the facility conducted a "Discharge Planning Conference" with the resident's family members, at 11:07 a.m. on the date of the note. The note was authored by "Social Services." The note indicated the facility "offered [Resident 1]" three options of discharge, including to "Move into [a veteran's homeless shelter] with [the resident's husband]." The note indicated Resident 1's husband stated his "social worker" had informed him, "[Resident 1] can't be added to the housing voucher," required to reside at the veteran's shelter. During a review of Resident 1's medical record, the "Progress Notes," dated 3/7/22, at 1:28 p.m., indicated the SSD contacted Resident 1's husband's social worker at the veteran's shelter, who informed SSD the prospective accommodation at the veteran's shelter did not provide enough space for both husband and wife, as the room's dimensions were "roughly" 10 feet by 10 feet. During a review of Resident 1's medical record, the "Progress Notes," dated 3/23/22 at 4:38 p.m., indicated Resident 1 appealed discharge on 3/22/22, for which the facility received notice the following day, or 3/23/22. The note indicated, "[the veteran's homeless shelter] remains discharge location. ... During zoom meeting previously[,] Administrator was able to view the room and deemed it had enough room for both people." The facility policy and procedure titled, "Discharge and Post Discharge Plan," Issued 11/2017, indicated: "The [SSD] shall: ... Assist ... in discharging the resident at the most suitable time and the most suitable placement to ensure a safe and orderly ... discharge from the facility[, and] ... Obtain resident resources in terms of living outside the facility and the resident's options for discharge arrangements ... . ... A post-discharge plan of care means ... developing a plan designed to ensure the resident's needs will be met after discharge from the facility." In violation of the above cited standards, the facility failed to comply with the federal requirements for planning a resident's discharge, when it did not plan to discharge Resident 1 to a safe and appropriate location discharge location. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents.