Health inspection·October 6, 2022

Section 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. On 12/20/21 at 2:35 p.m., an unannounced visit was conducted at the facility to investigate an allegation of refusal to readmit. The Department determined the facility failed to readmit Resident 2 after the resident was stable and cleared by the Doctor for readmission to the facility from the General Acute Care Hospital (GACH), as of 12/14/21. This failure resulted in the resident's prolonged hospital stay and increased the potential to cause emotional distress to Resident 2. Resident 2 was admitted to the facility in late-2021 with diagnosis which included anxiety. Resident 2's MDS indicated Resident 2 had mild impairment of her cognition. During the Initial Tour observation of the facility on 12/20/21 at 2:35 p.m., Resident 2 was not found residing in the facility. During a telephone interview with ADON on 12/20/21 at 4:24 p.m., she stated, "The facility did not readmit [Resident 2] due to her increase confusion and verbal aggression ..." During a telephone interview with Case Manager 2 at the acute care on 3/21/22 at 2:49 p.m., he stated Resident 2 was in the hospital from 11/29/2021 to 12/28/2021 for about 1 month. A review of the facility document titled "Order Details," dated 11/29/21, indicated Resident 2 was transferred to hospital for altered mental status, increased confusion. A review of the ED hospital record titled "Physician Note" dated 12/14/21, indicated Resident 2 had a, " ...Discharge orders placed for transfer to [rehabilitation/skilled nursing facility] ...Awaiting [skilled nursing facility] placement." A review of the facility document titled "Daily Census," dated 12/20/21, indicated Resident 2 was not listed in the facility. A review of the facility document titled "Daily Census" from 11/29/21 to 12/31/21, indicated Resident 2 was in the hospital and was not in the facility. During a telephone interview with ADON on 4/4/22 at 3:54 p.m., she confirmed there were available beds from 11/29/21 since the capacity is 138 beds. The ADON further stated the facility does have behavioral residents. A review of the facility document titled "Readmission to the Facility" dated 3/17, indicated, "A Medicaid resident whose hospital or therapeutic leave exceed the bed hold period allowed by the state will be admitted to the facility upon the first availability of a bed in a semi-private room if resident: requires the services provided by the facility." Therefore, the Department determined the facility failed to readmit Resident 2 after the resident was stable and cleared by the Doctor for readmission to the facility from the General Acute Care Hospital (GACH), as of 12/14/21. This violation had a direct or immediate relationship to the health, safety, or security of Long Term Care patients or residents.