Other·March 12, 2021

F622 - 483.15(c)(1)(i)(ii)(2)(i)-(iii) -Transfer and Discharge Requirements §483.15(c) Transfer and discharge- §483.15(c)(1) Facility requirements- (i) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless- (A) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; (B) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; (C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident; (D) The health of individuals in the facility would otherwise be endangered; (E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or (F) The facility ceases to operate. (ii) The facility may not transfer or discharge the resident while the appeal is pending, pursuant to § 431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to § 431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose. §483.15(c)(2) Documentation. When the facility transfers or discharges a resident under any of the circumstances specified in paragraphs (c)(1)(i)(A) through (F) of this section, the facility must ensure that the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider. (i) Documentation in the resident's medical record must include: (A) The basis for the transfer per paragraph (c)(1)(i) of this section. (B) In the case of paragraph (c)(1)(i)(A) of this section, the specific resident need(s) that cannot be met, facility attempts to meet the resident needs, and the service available at the receiving facility to meet the need(s). (ii) The documentation required by paragraph (c)(2)(i) of this section must be made by- (A) The resident's physician when transfer or discharge is necessary under paragraph (c) (1) (A) or (B) of this section; and (B) A physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section. (iii) Information provided to the receiving provider must include a minimum of the following: (A) Contact information of the practitioner responsible for the care of the resident. (B) Resident representative information including contact information (C) Advance Directive information (D) All special instructions or precautions for ongoing care, as appropriate. (E) Comprehensive care plan goals; (F) All other necessary information, including a copy of the resident's discharge summary, consistent with §483.21(c)(2) as applicable, and any other documentation, as applicable, to ensure a safe and effective transition of care. The REQUIREMENT is not met as evidenced by: The facility failed to ensure a safe discharge for Resident 1 when the facility did not verify the actual existence of a shelter through the address given by the resident. This failure resulted with the resident being discharged to a location not verified by the facility and she was left alone on the street which put the resident at risk for accident and injury. Review of Resident 1's clinical record indicated Resident 1 had diagnoses including pneumonia (an infection inflaming the air sacs of the lungs) and malnutrition (a condition caused by a lack of sufficient nutrients in the body). Resident 1 was self-responsible with moderately impaired cognition. Review of social services (SS) notes dated 3/23/20 indicated the resident had lived in a shelter in Gilroy prior to contracting pneumonia and planned to return to the same shelter. The SS notes dated 4/15/20 indicated Resident 1 wanted to be discharged to a different shelter at a church. The SS notes dated 4/16/20 indicated Resident 1 was not accepted at the shelter at the church. A permanent group home placement was offered but the resident did not have access to her money at the time. The facility then offered to transport the resident to a motel. During an interview with the social services director (SSD) on 11/12/20 at 11:00 a.m., she stated Resident 1 was initially planning to be discharged to a shelter in Gilroy. She stated at the time of discharge, the resident wanted to be discharged to a shelter at a church. The SSD stated she made arrangements for a home health nurse (HHN) to meet the resident at the church. She also stated she offered to provide transportation for the resident, but she wanted to take the bus. The SSD stated when Resident 1 got to the church there was no shelter. The SSD admitted she never confirmed the church had a shelter prior to discharging Resident 1. During an interview the director of nursing (DON) on 11/12/20 at 12:30 p.m., she stated Resident 1's discharge arrangements were made by the SSD. She stated the SSD attempted to email the church regarding the shelter but never received a response. The DON stated the facility allowed the resident to go back to the church because she wanted to go there but the facility should have determined whether the church had a shelter, and whether the shelter would accept the resident. During an interview with the HHN on 12/1/20 at 11:35 a.m., she stated the facility contacted the home health agency (HHA) and requested assistance to assess Resident 1. The HHN stated when she arrived at the address, she discovered it was a church, and not a shelter. She also stated she was just about to leave when she saw a woman standing on the sidewalk. She stated after she ascertained the woman was Resident 1, she called the multi service center (MSC) that serves the homeless and took the resident to their location. During an interview with the director of the multi service center (DMSC) on 12/2/20 at 10:20 a.m., she stated the HHN brought Resident 1 to the MSC after the resident was discharged by the facility to a church that was not a shelter. The DMSC stated the facility had asked the HHN to meet the resident at the church but instead, the HHN found the resident standing on the sidewalk in front of the church. The DMSC stated she called the facility and spoke to the SSD. The DMSC stated she asked the SSD to readmit the resident but was informed the facility did not have any available bed. The DMSC stated she then called the facility again, and she was told that the facility was trying to get the resident into a group home but the resident did not have access to her money at the time. The facility also said they would attempt to place the resident in a motel. The DMSC thought placing the resident in a motel with no supervision or food was a safe placement. Review of the facility's policy on, "Discharging the Resident" dated 2016 indicated, the facility must ensure a transfer summary is completed and a telephone report is made to the receiving facility. These violations had a direct or immediate relationship to the health, safety, or security of the resident.