Health inspection·November 22, 2022

The following reflects the findings of the California Department of Public Health during the investigation of: Complaint #CA00782592. Survey Event ID: Y4D511 Representing the California Department of Public Health: #39792, Health Facilities Evaluator Nurse. State Class B citation was written. Citation number: 11-39792-110018082-S F 622 Transfer and Discharge Requirements 483.15(c)(1)(i)(ii)(2)(i)-(iii) 483.15(c) Transfer and discharge- 483.15(c)(1) Facility requirements- (i) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless- (A) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; (B) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; (C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident; (D) The health of individuals in the facility would otherwise be endangered; (E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or (F) The facility ceases to operate. (ii) The facility may not transfer or discharge the resident while the appeal is pending, pursuant to  431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to  431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose. 483.15(c)(2) Documentation. When the facility transfers or discharges a resident under any of the circumstances specified in paragraphs (c)(1)(i)(A) through (F) of this section, the facility must ensure that the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider. (i) Documentation in the resident's medical record must include: (A) The basis for the transfer per paragraph (c)(1)(i) of this section. (B) In the case of paragraph (c)(1)(i)(A) of this section, the specific resident need(s) that cannot be met, facility attempts to meet the resident needs, and the service available at the receiving facility to meet the need(s). (ii) The documentation required by paragraph (c)(2)(i) of this section must be made by- (A) The resident's physician when transfer or discharge is necessary under paragraph (c) (1) (A) or (B) of this section; and (B) A physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section. (iii) Information provided to the receiving provider must include a minimum of the following: (A) Contact information of the practitioner responsible for the care of the resident. (B) Resident representative information including contact information (C) Advance Directive information (D) All special instructions or precautions for ongoing care, as appropriate. (E) Comprehensive care plan goals; (F) All other necessary information, including a copy of the resident's discharge summary, consistent with 483.21(c)(2) as applicable, and any other documentation, as applicable, to ensure a safe and effective transition of care. The facility failed to ensure a safe discharge plan for one of one sampled resident (Resident 26) when 1) the facility did not discuss Resident 26's facility-initiated discharge plan with the resident's daughter or obtained the daughter's agreement to care for Resident 26, and 2) the facility-initiated discharge plan to discharge Resident 26 to a location that was not determined by the choice or the best interests of Resident 26. This failure resulted in Resident 26 feeling very upset and had to go through an appeal process. The intake information sheet dated 4/28/22 indicated that the Department (the California Department of Public Health) received an anonymous complaint on 4/28/22 regarding an involuntarily discharge of a resident. The complaint information included that the resident had gone through an appeal process with the Office of Administrative Hearing and Appeals. The resident was granted to be remained in the facility due to the facility did not provide the resident with sufficient preparation and orientation to ensure a safe and orderly discharge from the facility. The complaint information also included that the facility did not obtain the daughter's agreement to allow her mother to reside with her in another state. On 4/28/22, an unannounced visit was conducted at the facility to investigate a complaint of involuntary discharge. During a review of Resident 26's "Admission Record", dated 3/15/18, indicated she had been admitted to the facility on 3/15/18 originally and had been readmitted to the facility on 1/10/19 with a history of right artificial knee replacement and difficulty walking. During a concurrent interview and record review on 4/28/22 at 2:00 p.m., with the Social Services Director (SSD), Resident 26's "Facility-Initiated Discharge Notice", dated 3/1/22 was reviewed with the SSD. The SSD stated Resident 26's daughter would provide care to Resident 26 in her home. The SSD stated Resident 26 was no longer eligible for covered skilled nursing services and neither Resident 26 nor her family were able to pay privately to remain at the facility. During a review of Resident 26's "Social Services Progress Notes", dating from 2/2/22 to 3/29/22 indicated there were no documented encounters where Resident 26's daughter had agreed to provide care and housing for Resident 26. The SSD could not explain how Resident 26's daughter was indicated to be agreeable to providing housing and care to Resident 26. The SSD stated, there was nothing else to be done and did not know what to do since Resident 26 was unable to pay for her stay at the facility and other measures for housing and care were not available. During an interview on 4/28/22 at 4:11 p.m., with Resident 26, she stated she was very upset when she received a paper from the SSD and the paper indicated Resident 26 would be living with her daughter out of state. Resident 26 stated both of her daughters did not have the space nor the time to care for her and she did not want to be a burden to her daughters. Resident 26 stated, she felt comfortable and safe living at the facility. During a review of the facility's policy and procedure titled, "Transfer or Discharge Notice", dated 2016, the P&P indicated, "3. The resident and/or representative (sponsor) will be notified in writing of the following information: ...c. The location to which the resident is being transferred or discharged; ...10. At the time of notification, the facility will provide each resident and responsible party with the following information: a. The plan for the transfer and adequate relocation of resident. B. The date by which the transfer/relocation of the resident will be completed; and c. Assurances that the resident will be transferred to the most appropriate facility or setting to meet his or her needs in terms of quality, services, and location. 11: In determining the transfer location for a resident, the decision to transfer to a particular location will be determined by the needs, choices and best interests of that resident." In violation of the above cited standards, the facility failed to comply with the Transfer and Discharge Requirements, including but not limited to: The facility failed to ensure a safe discharge plan for one of one sampled resident (Resident 26) when 1) the facility did not discuss Resident 26's facility-initiated discharge plan with the resident's daughter or obtained the daughter's agreement to care for Resident 26, and 2) the facility-initiated discharge plan to discharge Resident 26 to a location that was not determined by the choice or the best interests of Resident 26. This failure resulted in Resident 26 feeling very upset and had to go through an appeal process. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents.