Health inspection·February 17, 2022

F626 §483.15(e)(1)(2) §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 2/1/2022 at 2 p.m., an unannounced visit was conducted at the facility to investigate a complaint regarding Admission, Transfer and Discharge Rights. On 1/27/2022, Patient 1 was transferred from the facility to an acute care facility for a psychiatric evaluation of Patient 1's increased aggressiveness. During the evening of 1/27/2022 Patient was cleared by the acute care hospital emergency department's physician and psychiatrist to return to the facility. The facility failed to accept the patient back to the facility after a psychiatric evaluation, resulting in patient 1 remaining in the acute care hospital emergency department for the past 15 days awaiting placement to another facility. This failure had the potential to negatively affect the Resident 1's comfort and psychosocial well-being. Review of Resident 1's clinical record indicated he was originally admitted to the facility on 12/10/2021 with diagnosis of dementia (a disorder of the mental processes marked by memory loss, behavior/personality changes and impaired reasoning) and history of wandering. Further clinical record review indicated Resident 1 was positive for COVID-19 (a new strain of virus that can cause mild to severe respiratory illness) at the time of transfer to the acute care facility. Review of Resident 1's "SBAR (Situation, Background, Assessment, Recommendation) Communication Form" dated 1/27/2022 indicated Resident 1 had new onset confusion, agitation, combative and resistance to care. Review of Resident 1's "Physician Orders" dated 1/27/2022, signed by the facility's Medical Director, indicated an order for transfer to the acute care hospital emergency department (ED) for aggressiveness and being combative. Review of Resident 1's "Acute Care Physician Notes" (PN) dated 1/27/2022 at 9:04 p.m. indicated Resident 1's dementia was evaluated by crisis/psychiatry physician in the ED. PN indicated acute inpatient psychiatry was not necessary for Resident 1. PN indicated Resident 1 did not require further stabilization in the ED and could be returned to the facility. PN indicated the information was relayed to the facility administrator who reported the facility did not feel comfortable taking back the patient. Review of the facility's census report dated "1-28-22" indicated there were three empty beds available that could accommodate male residents who were positive for COVID-19 and who required special isolation. During an interview with the administrator (ADM) on 2/1/22 at 2:30 p.m. he stated he refused to readmit Resident 1 from the acute care hospital on 1/27/2022. ADM stated the facility was not able to provide for Resident 1's safety needs or the safety and privacy needs of other residents. In violation of the above cited standards, the facility failed to accept the resident back to the facility after a psychiatric evaluation, resulting in Resident 1 remaining in the acute care hospital emergency department for the past 15 days awaiting placement to another facility. This violation had a direct or immediate relationship to the health, safety, comfort and well-being of patients.