Health inspection·March 15, 2023

F626 -Permitting Residents to Return to Facility Section 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. On 1/11/23 at 10:50 a.m., an unannounced visit was made to the facility to investigate an allegation of a refusal to readmit a resident (Resident 1). This failure resulted in a prolonged hospital admission and had the potential to cause unnecessary emotional distress for Resident 1. Resident 1 was admitted to the facility in 2022 with diagnoses including anxiety and major depression. During an initial tour observation of the facility on 1/11/23 at 10:50 a.m., Resident 1 was not present in the facility. Review of the Progress Notes, dated 12/15/22, indicated Resident 1 had nausea and vomiting, coffee ground colored emesis 5 to 6 times, and was transferred to a general acute care hospital (GACH) for further evaluation. During an interview with the Director of Nursing (DON) on 1/11/23 at 1:07 a.m., the DON could not recall any information regarding Resident 1. During an interview with the Regional Quality Management Consultant (RQMC) on 1/11/23 at 1:13 p.m., the RQMC stated there was no notice of bed hold documentation for the 12/15/22 hospital visit for Resident 1. During an interview with the Medical Record Assistant (MRA) on 1/11/23 at 1:57 p.m., the MRA confirmed there was no physician order to transfer the resident to the hospital on 12/15/22. A review of the facility's census document titled, "Room Roster," dated 12/21/22 to 1/10/23, indicated Resident 1 was not present in the facility and there was an available female bed from 12/21/22 to 1/10/23. During an interview with RQMC on 1/11/23 at 1:53 p.m., the RQMC confirmed there was available bed(s) in the subacute unit and/or in the short-term unit in the facility from 12/21/22 to 1/10/23. During an interview with Clinical and Healthcare Risk Specialist II (CHRS) on 1/12/23 at 3:53 p.m., the CHRS stated Resident 1 had still been at the hospital since 12/15/22 and was waiting for placement at a facility. The CHRS confirmed the resident was cleared to be discharged back to the skilled nursing facility (SNF) on 1/3/23. A review of the GACH physician's progress notes titled, "Progress Notes," dated 1/3/23, stipulated Resident 1 was, "medically cleared for discharge to SNF." A review of the facility's policy titled, "Readmission," dated 10/1/13, indicated, "An individual is a readmit if he or she was readmitted to the facility from a hospital to which he or she was transferred for the purpose of receiving care...Individuals who exercises their bed-hold rights prior to their transfer from the facility...The Facility will allow residents who were previously residents of the facility to be readmitted to the Facility." Therefore, the Department determined the facility failed to readmit Resident 1 after they were stable and cleared by the physician for readmission to the facility from the GACH as of 1/3/23. This violation has a direct or immediate relationship to the health, safety, or security of Long-Term Care patients or residents.