Health inspection·August 24, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on interview and record review, the facility failed to ensure an appropriate discharge for one of two sampled residents (Resident 1), when the facility issued a 30-day advance notice of discharge to Resident 1 and did not specify a location to which the resident would be discharged . This failure had the potential to result in an unsafe discharge and resulted in Resident 1 experiencing anxiety. Findings: During an interview on 7/27/21 at 4:20 p.m. with the Director of Nursing (DON), the DON stated the facility issued a 30-day discharge notice to Resident 1 because Resident one was not compliant with the facility's smoking policy. During an interview on 7/28/21 at 10:55 a.m. with the social worker (SW), the SW stated a 30-day discharge notice was issued by the IDT (interdisciplinary team) on 6/29/21 after a staff member stated she observed Resident 1 outside smoking without supervision. During an interview on 7/28/21 at 11:45 a.m. with Resident 1, Resident 1 stated she had been a resident at the facility since 2018. Resident 1 stated she is a smoker and for three years she did not have any problems with the facility's smoking policy. Resident 1 stated she had independent smoking privileges and had previously kept her smoking supplies with her. Resident 1 stated the rules changed recently. Resident 1 stated when she received the 30-day discharge notice she felt intimidated. Resident 1 stated she did not have another place to go and had to submit an appeal to court. During a review of Resident 1's Care Plan, dated 7/28/21, the Care Plan indicated, Resident is non-compliant with smoking policy, schedule .refused to turn in her smoking materials for safe keeping .30-day notice was issued by IDT on 6/29/21, Resident filed appeal .7/1/21-SSD will find appropriate placement for Resident . During a review of Resident 1's admission Record (AR- a document that provides resident contact details, a brief medical history, level of functioning, preferences, and wishes), dated 7/28/21, the AR indicated, . Original admission Date 8/23/18 .Diagnosis Information .Multiple Sclerosis .Hypertension .Generalized Anxiety Disorder, Major Depressive Disorder . During a review of Resident 1's Minimum Data Set Section C Cognitive Patterns (MDS-comprehensive, standardized assessment of residents' functional capabilities and health needs), dated 6/29/21, the MDS indicated, .BIMS (Brief Interview for Mental Status) Summary Score .15 [indicating full Page 1 of 2 055475 055475 08/24/2023 Main West Postacute Care 812 West Main Street Turlock, CA 95380

F 0623 cognition] . Level of Harm - Minimal harm or potential for actual harm During a review of Resident 1's MDS Section G Functional Status, dated 6/29/21, the MDS indicated, . Mobility Devices- wheelchair .Activities of Daily Living [ADL]- self-sufficient in wheelchair in room and outside of room; one-person physical assistance required for bathing and dressing . Residents Affected - Few During a review of the document titled Decision and Order from the Office of Administrative Hearings and Appeals of the Department of Health Care Services, dated 7/21/21, the document indicated, . Facts Regarding Notice of discharge: Facility did not include a discharge location on Notice .Summary: The appeal is GRANTED. Facility has not complied with the legal requirements to involuntarily discharge [Name of Resident] in that it did not issue a legally compliant notice of transfer/discharge. Therefore, the discharge is improper, and Resident shall be permitted to remain in the Facility (42 U.S.C.19 § 1396r(c)(2)(B); 42 C.F.R. §483.15(c)(3), (5).) . Decision and Order: The appeal is GRANTED. Facility may not conduct an involuntary discharge of Resident. Resident shall be permitted to remain in Facility . During a review of the facility's policy and procedure (P&P) titled, Transfer or Discharge, Preparing a Resident, dated January 2018, the P&P indicated, .3. The resident and/or representative will be notified in writing of the following information: The reason for the transfer or discharge, the effective date of the transfer or discharge, the location to which the resident is being transferred or discharged . 055475 Page 2 of 2