Health inspection·February 3, 2021

483.15(e)(1) Permitting residents to return to facility. A facility must establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave. The policy must provide for the following. (i) A resident, whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, returns to the facility to their previous room if available or immediately upon the first availability of a bed in a semi-private room if the resident- (A) Requires the services provided by the facility; and (B) Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. (ii) If the facility that determines that a resident who was transferred with an expectation of returning to the facility, cannot return to the facility, the facility must comply with the requirements of paragraph (c) as they apply to discharges. The facility failed to follow their admission/discharge policy for one of three sampled residents (Resident 1), when the facility did not re-admit Resident 1 after hospital discharge. This failure resulted in Resident 1 remaining in an acute care hospital 46 days longer than necessary. During Resident 1's extended hospitalization he was exposed to potential hospital acquired infections, contagious diseases, and the potential distress of not being surrounded by his home like environment. On 4/9/19, an onsite investigation was conducted to investigate the complaint regarding denial of re-admission after hospitalization. A review of the Resident 1's "Admission Record," dated 2/20/18, indicated Resident 1 had been a male nonverbal patient dependent on caregivers for assistance and custodial care. Resident 1 had been admitted as a long-term resident living fulltime at the facility, which became his home. A review of nursing "Progress Notes," dated 1/17/19, indicated the facility transferred Resident 1 to a hospital after Resident 1 visited a podiatrist for an infection (osteomyelitis), an infection of the bone, in Resident 1's left heel. The facility held Resident 1's room for 7 days, per facility protocol. A review of hospital records titled "Discharge Summary", dated 4/8/19, indicated the following: 1. Resident 1 had been admitted to the hospital on 1/17/19 at 9:43 p.m., with a diagnosed left heel ulcer that had exposed bone. 2. The hospital treated Resident 1 for infection with intravenous (IV) antibiotics and topical wound care. 3. The hospital planned Resident 1's discharge back to his home at the facility on 2/21/19 (35 days after hospital admission) 4. The hospital's "Case Manager Notes," dated 1/31/19, indicated the facility confirmed that Resident 1 would be re-admitted to the facility with wound care and IV antibiotics. 5. The hospital's "Case Manager Notes," dated 2/21/19, (the date Resident 1 was ready for discharge) indicated the facility refused to re-admit Resident 1 because he would require hospice services. The "Case Manager" notes dated 3/5/19, indicated the facility refused to re-admit Resident 1 because he had been hospitalized greater than seven days. 6. On 3/19/19, the hospitals "Case Manager Notes" stated an appeal was made to the Department of Healthcare Service (DHCS) for Resident 1's re-admission to the facility. 7. The hospital's "Case Manager Notes," dated 4/8/19, indicated the facility re-admitted Resident 1. During an interview with the facility's Director of Nursing (DON) on 6/17/19, at 12:20 p.m., the DON stated she had spoken with the hospital's Case Manager once and told them the facility could not re-admit Resident 1 because of a contagious infection at their facility which prevented them from admitting him. When asked for documentation, dates, and names, the DON denied having documentation. A review of the facility's "Admit/Discharge Report," dated between 2/26 to 3/30/19, indicated the facility had admitted eight male residents during the period they denied Resident 1's re-admission. A review of the facility's policy, "Readmission to the Facility," revised 9/19/02, indicated "A Medicaid resident whose hospitalization exceeds the bed hold period allowed by the state will be readmitted to the facility upon the first availability of a bed." The facility failed to follow their admission/discharge policy for one of three sampled residents (Resident 1), when the facility did not re-admit Resident 1 after hospital discharge. This failure resulted in Resident 1 remaining in an acute care hospital 46 days longer than necessary. During Resident 1's extended hospitalization he was exposed to potential hospital acquired infections, contagious diseases, and the potential distress of not being surrounded by his home like environment. The violation of the regulation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to patients.