Other·October 13, 2022

F626 Permitting Residents to Return to Facility 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 1 after the resident was stable and cleared by the Doctor for readmission to the facility from the General Acute Care Hospital (GACH), as of 12/16/21. This failure increased the risk for psychosocial distress in Resident 1. Resident 1 was admitted to the facility in mid-2021 with diagnosis which included dementia (memory loss and judgement impairment), depression, and anxiety. Resident 1's Minimum Data Set (MDS, an assessment tool) indicated Resident 1 had severe impairment to her cognition (the activities of thinking, understanding, learning, and remembering). During the Initial Tour observation of the facility on 12/20/21 at 2:35 p.m., Resident 1 was not found residing in the facility. During an interview with the Director of Nursing (DON) on 12/20/21 at 3:21 p.m., she stated Resident 1 cannot be readmitted into the facility due to the safety of other residents. During a telephone interview with Case Manager 1 at the acute care on 12/21/21 at 9:19 a.m., she stated, "Resident 1 is still in the hospital for 180 hours now...[Skilled Nursing Facility] is refusing to take the resident back..." During a telephone interview with Assistant Director of Nursing (ADON) on 3/30/22 at 10:45 a.m., she stated, "The facility did not readmit [Resident 1] due to her behaviors..." It was 98 days since Resident 1 was cleared from the hospital to be discharged. During a telephone interview with DON on 3/30/22 at 1:32 p.m., she confirmed the bed-hold ended 12/21/21; there were available beds since 12/22/21 and the facility would not readmit the resident back. A review of the facility document titled "Order Details," dated 12/15/21, indicated Resident 1 was transferred to hospital for evaluation and treatment related to lacerated wound on her chin for stitching from a fall. A review of the Emergency Department (ED) hospital record titled "ED in [Hospital name]" dated 12/16/21, indicated, "...[Resident 1] was medically cleared...Her care facility will not take [Resident 1] back..." A review of the facility document titled "Daily Census," dated 12/20/21, indicated Resident 1 was not listed as a current resident in the facility. A review of the facility document titled "Daily Census" from 12/20/21 to 2/28/22, indicated Resident 1 was not in the facility from 12/20/21 through 2/28/22. A review of the facility document titled "Admission Criteria" dated 3/19, indicated, "...Residents are admitted to this facility as long as their needs can be met adequately by the facility. Examples of conditions that can be treated adequately in this facility included...Dementia..." A review of the facility document titled "Readmission to the Facility" dated 3/17, indicated, "A Medicaid resident whose hospital or therapeutic leave exceeds 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 1 after the resident was stable and cleared by the Doctor for readmission to the facility from the General Acute Care Hospital (GACH), as of 12/16/21. This violation had a direct or immediate relationship to the health, safety, or security of Long Term Care patients or residents.