Other·March 9, 2022

F 626 §483.15(e)(1)(i)(A)(B) §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. The facility failed to follow the aforementioned regulation by failing to follow their Bed Hold Policy by refusing to permit one of one sampled resident (Resident 1) to return to the facility after hospitalization on 2/22/22. This deficient practice resulted in an unnecessary stay at the hospital and not being permitted to return to the facility. During a review of Resident 1's Admission Record, printed on 2/23/22, the Admission Record indicated, Resident 1 was admitted to the facility on 2/17/22 with diagnoses that included Acute Osteomyelitis (a bone infection) and was eligible for Medicaid. Review of the Progress Notes dated 2/17/22, indicated Resident 1 was admitted to the facility for Physical Therapy, Occupational Therapy, and wound care. The note further indicated Resident 1 has Osteomyelitis at the fifth metatarsal (long bones in the foot that connects the ankle to the toes) of his left foot, and a wound at the inner fifth toe of his left foot and was receiving antibiotics for the wound. During a review of Resident 1's Minimum Data Set (MDS, a comprehensive health assessment), it indicated, Resident 1 required total dependence on staff for transfers, extensive assistance for dressing and toilet use, and partial physical help in bathing. The MDS also indicated Resident 1 was unable to walk around his bed or along the corridor. Resident 1 used a wheelchair but was unable to propel himself while he was in his wheelchair. During a review of the Order Summary Report, it indicated on 2/17/22, Resident 1's physician ordered daily wound treatment for Resident 1's fifth metatarsal and inner fifth toe wound on the left foot and Metronidazole (medication used to treat infection) tablet 500 milligrams (mg, unit of measurement) by mouth three times a day for Osteomyelitis. Further review indicated an order dated 2/17/22 for Resident 1 to received Occupational Therapy five times a week for four weeks to address lack of coordination and Physical Therapy five times a week for four weeks to address generalized muscle weakness. Review of the Progress Notes dated 2/22/22 at 9:09 a.m., indicated Resident 1 was found on the floor, unresponsive with shallow breathing. Resident 1 was transferred to Acute Care Hospital 1 (ACH 1). During a review of Resident 1's history and physical (H&P) from ACH 1 titled, "Internal Medicine H&P [History & Physical]," dated 2/23/22, the H&P indicated Resident 1 presented to ACH 1 with altered mental status in setting of likely opioid overdose. The H&P further indicated, Resident 1 was less responsive in the Emergency Department and became apneic. Resident 1 was given Narcan (medicine to reverse an opioid overdose) with good response. Resident had stable mentation and was awake at beside for many hours, ate dinner and asked to go back to SNF. The H&P indicated the facility would not accept Resident 1 back due to overdose and stated, 'he needs rehab'. Further review of the H&P indicated Resident 1's opioid overdose was resolved and "now pending safe discharge plan." The plan included for Resident 1 to continue antibiotic therapy and for wound consult to address the left foot wounds. During a review of Resident 1's ACH 1's Progress Notes, dated 2/22/22, indicated, the ACH 1 social worker called and provided the facility Admissions Coordinator a brief update on Resident 1's cleared medical condition and plan of care to transfer back to the facility. The document further indicated, the DON and ADM declined to accept Resident 1 back to the facility due to safety concerns, illicit substance use on site, insufficient staff to monitor resident and danger to self. During a telephone interview with the Nurse Manager (NM) from ACH 1 on 2/23/22, at 9:35 a.m., NM stated, she called the facility on 2/22/22 to inform the facility that Resident 1 was ready for discharge. The facility told NM they were not going to readmit Resident 1. During an interview with the Administrator (ADM) and the Director of Nursing (DON) on 2/23/22, at 11:50 a.m., they both stated the facility will not readmit Resident 1 due to his drug seeking behavior. The DON further stated, Resident 1 could be a threat to his own safety and the safety of the other residents in the facility. During a concurrent interview and record review of Resident 1's medical records with the DON, on 2/23/22, at 12:25 p.m., the DON stated the facility did not attempt to assess Resident 1's condition after NM informed the facility that Resident 1 was ready to return to the facility. During a phone interview on 3/7/22, at 11:07 a.m., with the NM, the NM stated Resident 1 was still at ACH 1 and was ready for discharge, but the facility continued to refuse to readmit Resident 1. During a review of the facility policy and procedure titled, "Discharge and Transfer of Resident," dated Feb 2018, the P&P indicated, "Upon transfer to the acute hospital the resident/resident representative will be given an opportunity to execute a Bed Hold." According to Resident 1's Bed Hold Agreement dated 2/17/22 he had been informed of the facility's bed hold policy to hold the bed for up to seven days if transferred to a general acute care hospital or goes on a therapeutic leave. During a review of the policy and procedure titled, "Bed Hold Policy," dated July 2017, it indicated, "... in the event that the resident is in the hospital for more than seven (7) days, meets the standards for skilled nursing care... the facility will re admit the resident to his/her previous room or the first available bed in a semi-private room..." Therefore, the facility failed to follow the aforementioned regulation by failing to follow their Bed Hold Policy by refusing to permit one of one sampled resident (Resident 1) to return to the facility after hospitalization on 2/22/22.