Health inspection·March 24, 2021

F624, 483.15(c)(7) Preparation for Safe/Orderly Transfer/Discharge A facility must provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility. This orientation must be provided in a form and manner that the resident can understand The facility failed to provide a safe discharge to one of three sampled residents (Resident 1) whom had a trach (a breathing tube, called a trach tube, placed through the hole and directly into the trachea to help breathe) with suctioning required. When the facility discharged Resident 1 without ensuring a suction machine (a medical device for removing obstructions such as mucus, saliva, blood, or secretions from a person's airway) was ready at home on 10/1/2020. Failure to provide a safe discharge resulted in Resident 1 had an unnecessary acute care hospital transfer. During a review of Resident 1's clinical record indicated, he was admitted to the facility on 11/15/18 with diagnoses including cardiac arrest (is the abrupt loss of heart function, breathing and consciousness) and vegetative state (a person is awake but showing no signs of awareness). Resident 1 had a discharge and readmission to the facility on the same day of 10/1/2020. During a review of Resident 1's emergency department (ED) notes, dated 10/1/2020 at 13:17 p.m., indicated Resident 1 "was sent home today. However, the equipment necessary for his care, such as suction, has not yet arrived. Emergency medical services (EMS) were called after family heard a gurgling sound from his tracheostomy that lasted for 30 seconds." According to ED notes on 10/1/2020, at 14:56 p.m., it documented "per Resident 1's family reports that the patient had a brief episode of respiratory distress at home and they state that they did not have the equipment to address this issue given patient has a tracheostomy." During a review of Resident 1's social service progress notes dated 8/20/2020, indicated a discharge meeting conducted over the telephone with Resident 1's responsible party (RP, is the person who manage and sign consent for the resident) for discharge planning as follows: 1. Arranged Resident 1's discharge date on 10/1/2020. 2. The RP would get assistance by applying for in home support service (IHSS), she would be the caregiver and social worker (SW, is responsible for helping individuals, families, and groups of people to cope with problems they are facing to improve their patients' lives) would assist to do paperwork. 3. The home health (HH) would follow-up with Resident 1 at home for rehab and nursing needs. 4. The SW would assist RP for the enteral feeding/incontinent supplies of the resident upon discharge. 5. The SW would consider getting an order for durable medical equipment (DME): hospital bed, and wheelchair/recliner chair. During a review of the physician discharge order dated 8/27/2020, indicated the physician prescribed a list requesting DME, which included a suction machine with tubing and would discharge to home on 10/1/2020. During an interview with the social service director (SSD) on 2/22/21 at 10:30 a.m., she stated social services would need to coordinate discharge with the HH and resident's family to ensure the request for DME, such as a hospital bed, Hoyer lift, and suction machine were in place prior to discharge. The resident would go home with the requested DME. During a review of Resident 1's DME confirmation dated 9/22/2020, indicated the cover message documented nebulizer (is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs) and the suction machine was needed before discharge on 10/1/2020. During an interview with social service assistant A (SSA A) on 2/22/21 at 2:45 p.m., she stated she sent the requested DME orders to the vendor for processing and social services was responsible to follow-up for the DME. During an interview with the SSA on 2/22/21 at 3 p.m., she reviewed Resident 1's clinical record and stated on 9/29/2020, she verified with the vendor the required DME and was told, "All supplies and DME are on the way delivering to Resident 1's home." She further stated she did the follow-up to ensure all the DME was delivered to Resident 1's home on 10/2/2020. However, she did not verify and confirm the suction machine was delivered to Resident 1's home on 10/1/2020 prior to discharge. During a review of Resident 1's social service progress notes dated 9/29/2020 and 10/2/2020, indicated the RP made a follow-up call with the vendor and was informed, "Equipment will be delivered upon patient's discharge". A verification of needed DME was follow-up with RP on 10/2/2020. During an interview with the respiratory therapist (RT, are certified medical professionals who treat problems with your lungs or breathing) on 2/23/21 at 11:05 a.m., he stated Resident 1 required suctioning every two hours or even more frequently depending on his condition to keep airway patent. During a telephone interview with registered nurse B (RN B) on 3/5/21 at 5:20 p.m., she stated she attended Resident 1's discharge planning meeting regarding the needed equipment, which should have been delivered to Resident 1's home prior to discharge. She further stated to ensure the safety of Resident 1, the suction machine was required to be delivered prior to discharge on 10/1/2020. During an email interview with the director of nursing (DON) on 3/8/21 at 8:25 a.m., she confirmed, "we aim for all discharge to be deemed safe." During a review of the facility's policy and procedure," Discharge Summary and Plan", dated12/2016, indicated "The discharge plan will be re-evaluated based on changes in the resident's condition or needs prior to discharge. A member of interdisciplinary team (IDT, a group of health care professionals from different field who work together toward to the same goal and to provide the best care) will review the final post-discharge plan with the resident and family at least twenty-four hours before the discharge to take a place." The facility failed to provide a safe discharge as required. This violation had a direct or immediate relationship to the health, safety, or security of the residents.