Health inspection·February 28, 2024

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to inform one of two sampled residents (Resident 1) of the applicable Medicaid items and services, specifically bed availability, when Resident 1 became Medicaid eligible. Residents Affected - Few The failure to provide Resident 1 and Resident 1 ' s Representative 1 (RR 1) with accurate information about potential charges resulted in Resident 1 ' s premature discharge home with the need for hospitalization two days after discharge. Findings: During a review of Resident 1's Face Sheet, the Face Sheet indicated Resident 1 was admitted to the facility in September 2023 with diagnoses that included end stage kidney disease (the final stage of long-term kidney disease when the kidneys are no longer sufficiently able to remove waste products and excess water to support the body ' s needs.), pneumocystosis (an infection of the lungs caused by the microorganism Pneumocystis carinii), congestive heart failure (serious condition in which the heart doesn't pump blood as efficiently as it should), type 1 diabetes mellitus (a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood), and anemia (blood produces a lower-than-normal amount of healthy red blood cells). During an interview on 1/18/24 at 1:05 p.m. with Case Manager (CM), CM stated on 12/6/23, Resident 1 and RR 1 were told the insurance would stop paying for Resident 1's stay at the facility on 12/7/23. CM stated RR 1 was told an appeal could be made with the insurance but if denied, RR 1 and Resident 1 could end up paying out of pocket should Resident 1 choose to stay in the facility. CM stated RR 1 agreed for Resident 1 to be discharged home. CM stated the equipment that Resident 1 would need at home did not come before the planned discharge day, so CM stated she filed for insurance coverage for long term care to cover for Resident 1's stay at the facility while waiting for the equipment to be delivered. CM stated Resident 1 was approved for another year of long-term care services. CM stated the notice of approval for insurance coverage was received on 1/1/24 and would have covered Resident 1's stay at the facility for one year starting 1/1/24. During a review of Resident 1's Physician Order Report, dated 1/1/24 to 1/16/24, the Physician Order Report indicated an order dated 1/4/24 for Resident 1 to be under custodial care effective 1/1/24. During a review of Resident 1's Progress Notes, dated 1/16/24, the Progress Notes indicated on 1/16/24, RR 1 told CM that RR 1 wanted to keep Resident 1 as a resident in the facility but was told by CM the facility could not accommodate Resident 1 ' s last-minute request and the facility did, Not have a Long Term Care Bed available at the moment but can put [Resident 1's] name on our waiting list Page 1 of 2 056422 056422 02/28/2024 Fremont Healthcare Center 39022 Presidio Way Fremont, CA 94538

F 0582 and [Resident 1] will be our top priority. Level of Harm - Minimal harm or potential for actual harm During a telephone interview on 1/18/24 at 2:32 p.m. with RR 1, RR 1 stated he was told Resident 1 was to be discharged from the facility because there was no long-term bed available. RR 1 stated he was told by the facility the bed that Resident 1 occupied at the time was a short term-bed. RR 1 stated Resident 1 would have been safer at the facility than at home where 24/7 care was not available. RR 1 stated he was told there were two ways for Resident 1 could return to a facility once discharged , one was for RR 1 to look for a long-term care facility himself, and two, when Resident 1 goes to a hospital, RR 1 was to tell the hospital physician that Resident 1 needed to go to a skilled nursing facility. RR 1 stated the facility discharged Resident 1 on 1/16/24 despite RR 1's request for Resident 1 to stay at the facility for custodial care (care that is non-medical care provided to assist people with daily living such as bathing, cooking, cleaning, and other necessary functions). RR 1 stated, Resident 1 was taken to the hospital for blacking out on 1/18/24 after only being home two days. Residents Affected - Few During a review of Resident 1's Emergency Department (ED) Notes, dated 1/18/24, the ED Notes indicated Resident 1 was brought to the hospital unresponsive with abundant top ramen noodles suctioned from Resident 1's throat. The ED Notes indicated Resident 1's blood pressure on 1/18/24 at 10:54 a.m. was 84/55 (normal range: 120/80), Complete Blood Count (CBC, a blood test to look at overall health and find a wide range of conditions including infection and anemia) result: hemoglobin (a protein in red blood cells that carries oxygen) 6.4 grams per deciliter (gm/DL) (normal range: 11.2-15.7 mg/DL). The ED Notes also indicated interventions performed included intravenous (administering into a vein) blood transfusion, intravenous antibiotics, and intravenous fluids, that were done urgently to prevent sudden or life-threatening deterioration. Resident 1 tested positive for Methicillin-Resistant Staphylococcus Aureus (MRSA, a cause of infection that is difficult to treat because of resistance to some antibiotics). During a review of the facility certification information, the facility certification information indicated the facility had 115 beds which were all dually certified by Medicare and Medicaid. During a review of the facility ' s census report dated 1/16/24, the facility ' s census indicated there were 103 beds occupied and 5 female beds available. During a review of the facility's undated policy and procedure (P&P), titled, Transfer and Discharge, the P&P indicated each resident will be permitted to remain in the facility, and not be transferred or discharged unless; discharge is necessary for the resident's welfare and needs cannot be met in the facility, resident's health has improved sufficiently so the resident no longer needs the services provided by the facility, the safety, or health of other individuals in the facility is endangered, resident failed to pay for a stay in the facility or if the facility ceases to operate. 056422 Page 2 of 2