Health inspection·October 8, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to readmit one of one sampled resident (Resident 1) from General Acute Care Hospital (GACH) 1 after Resident 1 was cleared by GACH 1 to return to the facility on [DATE]. This deficient practice had the potential to result in the denial of Resident 1's rights to return to the facility. Findings: During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted to facility on 9/5/2024, with diagnoses including respiratory failure (when the lungs cannot get enough oxygen into the blood), quadriplegia (the condition in which both the arms and legs are paralyzed [unable to move]), and type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar). During a review of Resident 1's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 9/25/2024, the MDS indicated the resident had severely impaired (never/rarely made decisions) cognitive skills (ability to make daily decisions). Resident 1 was dependent (helper does all the effort) on staff for dressing, personal hygiene, and toilet use. During an interview on 10/8/2024 at 9:46 a.m. with the Administrator (ADM), the ADM stated Resident 1 was admitted to the facility on [DATE]. The ADM stated the resident had Medi-Cal (a public health insurance program). The ADM stated Resident 1 was sent to GACH 1 on 9/26/2024. The ADM stated when Resident was ready to be discharged from GACH 1 and return to the facility (on 10/2/2024), Resident 1 was no longer eligible for Medi-Cal. During a telephone interview on 10/8/2024 at 10:08 a.m. with the GACH 1's Social Worker (GACH 1 SW), the GACH 1 SW stated Resident 1 was admitted to GACH 1 on 9/25/2024. The GACH 1 SW stated Resident 1 was ready to return to the facility on [DATE]. The GACH 1 SW stated the facility informed GACH 1 the facility could not accept Resident 1 back to the facility until Resident 1's Medi-Cal was active again. The GACH 1 SW stated Resident 1's Medi-Cal eligibility was not showing up on the Medi-Cal system that Resident 1 was eligible for Medi-Cal. The GACH 1 SW stated GACH 1 had received a verbal confirmation from Medi-Cal that Resident 1 was eligible. The GACH 1 SW stated the facility was provided the new and active Medi-Cal number for Resident 1. During an interview on 10/8/2024 at 10:28 a.m. with the facility's Admissions Coordinator (AC), the AC stated on 10/1/2024, someone (the AC could not remember who she spoke with) from GACH 1 called Page 1 of 2 055449 055449 10/08/2024 Covina Rehabilitation Center 261 W. Badillo Street Covina, CA 91723

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the AC and informed the AC that Resident 1 no longer had eligibility for Medi-Cal. The AC stated GACH 1 called back the next day (10/2/2024) with a new Medi-Cal number for Resident 1. The AC stated Resident 1's new Medi-Cal number still did not show eligibility when the AC checked on the Medi-Cal portal (website to check Medi-Cal eligibility). During a follow-up interview on 10/8/2024 at 11 a.m. with the facility's AC, the AC stated GACH 1 notified the facility on 10/2/2024, that Resident 1 was ready to return to the facility from GACH 1. The AC stated the facility had a bed available for Resident 1 (on 10/2/2024) but that the facility would not accept Resident 1 because Resident 1's Medi-Cal number did not show that Resident 1 was eligible for Medi-Cal on the Medi-Cal portal. The AC stated when AC checked Resident 1's eligibility again on 10/8/2024, Resident 1 was eligible for Medi-Cal. The AC stated the facility no longer had a bed available for Resident 1 (on 10/8/2024). The AC stated another resident was admitted to Resident 1's previous bed on 10/4/2024. During a review of the facility's policy and procedure (P&P) titled, Bed-Holds and Returns, revised March 2022, the P&P indicated, Medicaid residents who exceed the state's bed-hold limit and/or non-Medicaid residents who request a bed-hold are responsible for the facility's basic per diem rate while his or her bed is held. The P&P indicated, If a Medicaid resident exceeds the state bed-hold period, he or she will be permitted to return to the facility, to his or her previous room (if available) or immediately upon the first availability of a bed in a semi-private room provided that the resident requires the services of the facility and is eligible for Medicare skilled nursing services or Medicaid nursing services. 055449 Page 2 of 2