Health inspection·August 25, 2022

The following reflects the findings of the California Department of Public Health during the investigation of: Complaint CA00798189 Event ID: 9C1J11 Representing the Department: HFEN # 38174 State Citation B was written §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. §483.15(e) (2) Readmission to a composite distinct part. When the facility to which a resident returns is a composite distinct part (as defined in § 483.5), the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of return, the resident must be given the option to return to that location upon the first availability of a bed there. On 8/15/22, an unannounced visit was conducted at the facility to investigate a complaint regarding Admission, Transfer & Discharge Rights. The facility failed to permit Resident 1 to return to the facility after a hospitalization..This deficient practice violated Resident 1's right for readmission to the facility and extended an unnecessary hospital stay for Resident 1. Review of Resident 1's admission record indicated he was readmitted to the facility on 7/6/22 with a diagnosis including facial weakness after a cerebral infraction (stroke), pressure ulcer of left heel, unstageable. Review of Resident 1's minimum data set (MDS, an assessment tool) dated 7/6/22, indicated he needed assistance with personal hygiene and during transfers. His Brief Interview of Mental Status (BIMS) score was 14, meaning he was cognitively intact. Review of Resident 1's care conference summary dated 7/23/22 , indicated discharge potential was too early to determine , depending on physical status in 3-4 weeks and if wound is manageable, possible alternate placement (ALF [Assisted Living Facility] setting ). Review of Resident 1's nurse's note dated 8/4/22, indicated Resident 1 was admitted to the acute care hospital from a wound clinic and did not include notification of a family member. Review of Resident 1's care plan did not include the discharge planning. Review of the intake received by the California Department of Public Health (CDPH) on 8/12/22, indicated the facility refused to take Resident 1 back after he was taken to the emergency department and stayed in the hospital for five days. During a tour observation on 8/15/22 at 9:15 a.m., there were 13 empty rooms, with one bed and two beds in each room. During a telephone interview with the family member (FM) on 8/12/22 at 11:55 a.m., the FM stated on 8/5/22, she received a phone call from the hospital discharge planner to inform her Resident 1 was ready to be discharge back to the facility.The discharge planner then informed her the facility would not take Resident 1 back with no reason provided. The FM stated she then called the facility on 8/5/22 and was told Resident 1 would not be accepted because he would be considered a long term resident and the facility did not have a long term bed. The FM was aware Resident 1's medical coverage would end on 8/4/22, and she made an appeal to his insurance. The first appeal was denied and she made a second appeal, in which the decision was still pending .The FM stated, the family was willing to pay privately after 8/4/22 and she communicated with the facility. The FM stated they did not receive a call from the facility about Resident 1's transferred to the emergency department. Resident 1 went home on 8/8/22 and felt the family was not prepared with the sudden transition. During an interview with the director of nursing (DON) on 8/15/22 at 9:30 a.m., the DON stated on 8/4/22, Resident 1 had an appointment at at a wound clinic and was transferred to the emergency room same day for a change in condition .The DON stated the facility did not get a referral from the hospital on 8/5/ 22 because she called the hospital case manager ahead of time to let them know Resident 1 was ready to go home and he did not need therapy in the facility anymore. The DON stated she was aware the insurance coverage had expired on 8/4/22 and there was an appeal by the FM and stated they lost both appeal. The DON stated they have beds available on 8/5/22 and they could have accepted Resident 1 but he was on "high level of acuity", he was frail and needed maximum assist to be taken care of. During an interview and concurrent record review with the social service director (SSD) on 8/15/22 at 9:50 a.m., the SSD stated she talked with the FM lengthy regarding Resident 1's medical coverage. The SSD stated the FM decided to appeal and lost the first appeal. The FM asked for guidance to appeal second time. The SSD stated the FM was willing to pay out for two more days after 8/4/22 and she referred to the business office. The SSD stated when Resident 1 was readmitted to the facility, he was wheel chair bound and needed two person assistance with transfers, on high acuity level. The SSD stated the facility do not have a long term care bed designation. The SSD acknowledged she missed to develop a discharge care plan when Resident 1 was readmitted on 7/6/22. During an interview and concurrent record review with the business office manager (BOM) on 8/15/22 at 10:45 a.m., the BOM stated the FM was aware Resident 1's medical coverage would end on 8/4/22. The FM decided to appeal but the first appeal was denied and the FM went for second appeal. According to the BOM, the second appeal was still pending as of 8/15/22, and the DON was aware. The BOM stated she spoke with the FM on 8/2/ 22, and the family was willing to pay for two more days after 8/4/22 .The BOM stated the DON was aware about the family willingness to pay out of packet .The BOM provided an email dated 8/4/22, indicating her discussion with the FM regarding the payment. During a follow up interview with the DON on 8/15/22 at 12:30 p.m., the DON stated the reason the facility would not take Resident 1 back was the facility could not meet his needs. The DON stated they did not have documentation indicating Resident 1 would need a high level of acuity and the facility determination of not able to provide his needs. The DON stated Resident 1 was ready to go home and it was better for him. Review of the facility's census for 8/15/22, indicated facility has 64 residents .The facility approved licensed bed capacity was 99, in which it indicated the facility was able to have 99 residents. Eight private rooms (one bed) and five semi-private (two beds) were empty. Review of the facility's action summary form, dated 8/15/22, indicated Resident 1 was in Room A on 8/4/22. Review of the facility's daily census dated 8/5/22, indicated Room A was listed empty. Review of the facility's daily census from 8/5/22 to 8/15/22, indicated there were beds available. Review of social services notes, dated 8/2/22, indicated the FM plans to file an appeal, and provided the insurance contact number. Review of facility's policy, "Transfer or Discharge Notice", dated 12/2016, indicated the resident and/or representative (sponsor) will be notified in writing of the following information: a. The reason for the transfer or discharge; e. The facility bed-hold policy; the reasons for the transfer or discharge will be documented in the resident's medical record Review of the facility's policy, "Care Planning -Interdisciplinary Team" , dated 9/2013 , indicated a comprehensive care plan for each resident is developed within seven (7) days of completion of the resident assessment (MDS). In violation of the above cited standards, the facility failed to permit Resident 1 to return to the facility after a hospitalization. This deficient practice violated Resident 1's right for readmission to the facility and extended an unnecessary hospital stay for Resident 1. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents.