Health inspection·April 4, 2022

§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. The facility failed to follow their policy and procedure in permitting residents to return to the facility for one of three Patient, (Patient 1), when Patient 1 was not accepted to return to the facility after discharge from the acute hospital. This failure resulted in psychological distress with the family members (FM, a decison maker) and difficulty in meeting the resident's care. Review of Patient 1's clinical record indicated, he was admitted on 1/5/22 with diagnoses including myelodysplastic (MDS, a disorder in the production of blood cells). Review of Patient 1's nurses notes dated 2/9/22 indicated, Patient 1 was admitted to an acute care hospital on 2/9/22 with diagnoses of MDS, required blood tranfusion (a way of adding blood to your body) every other week, dementia (memory problem) and atrial fibrillation (a fib, an irregular heart rate). Review of Patient 1's clinical record indicated, there was no documented evidence, bed-hold was provided for Patient 1. Review of the acute care hospital discharge recommendations dated 2/15/22, indicated Patient 1 would benefit from further rehab which required assistance and supervision. It was also indicated, rehab services facility with physical and occupational therapy was recommended. During an interview with the social worker (SW) on 2/25/22 at 10:15 a.m., the SW stated, Patient 1 should have a bed-hold. The SW could not provide a reason, why Patient 1 was not being re-admitted. During an interview with the facility owner (FO) on 2/25/22 at 12:10 p.m., the FO stated Patient 1 could not return to the facility after he was admitted to the acute hospital because there was no available bed at the facility. During an interview with the acute hospital care case manager (ACCM) on 2/25/22 at 12:15 p.m., the ACCM stated she called the facility for Patient 1 to return but the FO did not have an available bed for Patient 1. Review of the facility's census dated 2/9/22, 2/10/22, 2/11/22, 2/12/22, 2/13/22, 2/14/22, 2/15/22, 2/16/22, 2/17/22, 2/18/22, 2/19/22, 2/20/22 and 2/21/22 indicated, the facility had available beds. During an interview with the FO on 3/10/22 at 10:25 a.m., the FO confirmed, the facility had available beds on the above dates and the bed-hold notice was not provided for Patient 1. Review of the facility's policy, "Transfer or Discharge, Preparing a Resident for" revised 12/2016, indicated "A post-discharge plan is developed for each resident prior to his or her transfer or discharge." Resident will be prepared in advance for discharge. Review of the facility's policy, "Bed-Holds and Returns" revised 3/2017, indicated "Prior to transfers and therapeutic leaves, residents or resident representatives will be informed in writing of the bed-hold and return policy..." In violation of the above cited standards, the facility failed to follow their policy and procedure in permitting residents to return to the facility for one of three patient, (Patient 1), when Patient 1 was not accepted to return to the facility after discharge from the acute hospital. This failure resulted in psychological distress with the family members (FM, a decison maker) and difficulty in meeting the resident's care. The above violation has a direct or immediate relationship to the health, safety, or security of the resident.