Health inspection·June 6, 2025

State Citation B was written. F628 Discharge Process §483.15(c)(2) Documentation. §483.15(c)(3) Notice before transfer. Before a facility transfers or discharges a resident, the facility must- (i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman. (ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and (iii) Include in the notice the items described in paragraph (c)(5) of this section. §483.15(c)(4) Timing of the notice. (i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged. (ii) Notice must be made as soon as practicable before transfer or discharge when- (A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section; (B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section; (C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section; (D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or (E) A resident has not resided in the facility for 30 days. California Code, Health and Safety Code - HSC § 1439.6 (a) Except as provided in subdivision (b), if a resident is notified in writing of a facility-initiated transfer or discharge from a long-term health care facility, the facility shall also send a copy of the notice to the local long-term care ombudsman at the same time notice is provided to the resident or the resident's representative. (c) The copy of the notice shall be sent by fax machine or email, as may be directed by the local long-term care ombudsman, unless the facility does not have fax or email capability, in which case the copy of the notice shall be sent by first-class mail, postage prepaid. A facility's failure to timely send a copy of the notice shall constitute a class B violation, as defined in subdivision (e) of Section 1424. On 5/8/25, at 8:03 a.m., the California Department of Public Health (CDPH) conducted an unannounced visit to the facility to investigate a complaint regarding resident discharge rights. The department determined the facility failed to provide the proper notice for discharge for Resident 1 when, Resident 1 was not given a 30-day advance written notice of the impending transfer or discharge from the facility as soon as practicable and the facility did not notify or send Resident 1's Notice of Transfer or Discharge form to the Ombudsman's office (a government appointed person who actively supports the rights of the residents) on the same day that Resident 1 was served the notice (day of proposed discharge). 1. A review of Resident 1's medical record titled "ADMISSION RECORD," indicated Resident 1 was admitted to the facility in 2025 with diagnoses that included acute respiratory failure (the inability to maintain adequate oxygenation for tissues or adequate removal of carbon dioxide from tissues), influenza (a viral respiratory illness that causes symptoms like fever, chills, cough, and body aches) and pneumonia (an infection that inflames the air sacs in one or both lungs). A review of Resident 1's "Notice of Transfer/Discharge," indicated a notification date of 3/4/25 and was signed by Resident 1 on 3/8/25. During an interview on 5/8/25, at 9:43 a.m., Resident 1 stated on 3/8/25 he was verbally told by facility staff that he was going to be discharged because he had recovered enough. Resident 1 further stated he was given the discharge paperwork on the same day the facility was trying to discharge him on 3/8/25. Resident 1 stated there was no information or paperwork given by the facility to him about discharge prior to 3/8/25. During a concurrent joint interview and record review on 5/8/25, at 12:42 p.m., with the Social Services Director (SSD) and the Case Manager (CM), the CM stated the facility did not issue the discharge notice for residents with Medi-Cal coverage because it was already discussed through the care conference meetings with the residents. The CM further stated Resident 1 received the Notice of Transfer or Discharge notice on 3/8/25 as part of the discharge paperwork. The CM stated the Notice of Transfer or Discharge would include the reason for discharge and resources on their right to file an appeal. Both the SSD and the CM confirmed Resident 1's Notice of Transfer or Discharge had a notification date of 3/4/25 but was signed by Resident 1 on 3/8/25. 2. During an interview on 5/8/25, at 9:43 a.m., Resident 1 stated he called the Ombudsman's office on 3/8/25 when the facility was trying to discharge him and was told by the Ombudsman their office did not receive a copy of Resident 1's Notice of Transfer or Discharge. During an interview on 5/8/25, at 11:36 a.m., the Ombudsman (OMB) stated Resident 1 called the Ombudsman's office on the after-hours line late in the afternoon on 3/8/25 to report the facility was discharging him. The OMB confirmed the Ombudsman's office did not receive Resident 1's Notice of Discharge or Transfer from the facility. The OMB stated their office usually received a 30-day notice prior to discharge from the facility so that the residents would be notified of their right to appeal and to have enough time to make arrangements for discharge. During a concurrent joint interview and record review on 5/8/25, at 12:42 p.m., with the SSD and the CM, the CM stated the Notice of Transfer or Discharge notice would be sent over to the Ombudsman's office on the discharge date via fax. The CM further stated Resident 1's Notice of Transfer or Discharge was not sent to the Ombudsman's office because the discharge did not happen. The CM stated the expectation was to send the Notice of Transfer or Discharge to the Ombudsman's office on the day of Resident 1's discharge. During an interview on 5/8/25, at 1:38 p.m., the ADON stated the Notice of Transfer or Discharge was usually sent out to the Ombudsman's office via fax on the day of resident's discharge. The ADON stated that the importance of sending Resident 1's Notice of Transfer or Discharge to the Ombudsman's office was for the Ombudsman to be aware that Resident 1 was discharging to the community and if there were follow-ups needed to be done on their end. During an interview on 5/8/25, at 3:02 p.m., the Administrator (ADM) stated it was his expectation for the facility staff to follow the facility's policy when providing residents with the Notice of Transfer or Discharge. The ADM stated that it was important to provide the Notice of Discharge or Transfer to Resident 1 to provide information on Resident 1's right on how to appeal the discharge. A review of the facility's policy titled, "Transfer of Discharge, Facility-Initiated," dated 10/22, indicated "...Once admitted to the facility, residents have the right to remain in the facility. Facility-initiated transfers and discharges, when necessary, must meet specific criteria and require resident/representative notification and orientation, and documentation as specified in this policy...Notice of Transfer or Discharge (Planned)...1. Except as specified below, the resident and his or her representative are given a thirty (30)-day advance written notice of an impending transfer or discharge from this facility...Notice of Transfer or Discharge (Emergent or Therapeutic Leave)...2. The resident and representative are notified in writing of the following information...The specific location (such as the name of the new provider or description and/or address if the location is a residence) to which the resident is being transferred or discharged...3. A copy of the notice is sent to the Office of the State Long-Term Care Ombudsman at the same time the notice of transfer or discharge is provided to the resident and representative...5. Under the following circumstances, the notice is given as soon as it is practicable but before the transfer or discharge...b. The resident's health improves sufficiently to allow a more immediate transfer or discharge...6. Notice of transfer is provided to the resident and representative as soon as possible before the transfer and to the long-term care (LTC) ombudsman when practicable..." A review of an online document published by the California Advocates for Nursing Home Reform (CANHR) titled, "TRANSFER AND DISCHARGE RIGHTS," updated 9/4/24, indicated "...Federal and California laws provide strong protections against evictions of nursing home residents. Residents have very specific rights that are intended to prevent inappropriate, unnecessary and untimely transfers and discharges...Written Notice...Before transferring or discharging a resident, the facility must provide written notice to the resident and the resident's representative in a language and manner they understand. 42 CFR §483.15(c)(3)(i). The facility must send a copy of the notice to the long-term care ombudsman program. Except when specified below, the notice must be given at least 30 days before the resident is transferred or discharged (see the next section)...Exceptions to 30-Day Notice...As mentioned above, there are a few exceptions to the 30-day notice requirement. Federal regulations permit notice to be made "as soon as practicable" before transfer or discharge when: the health or safety of individuals in the facility would be endangered; the resident's urgent medical needs require a more immediate transfer; the resident's health has improved sufficiently to allow a more immediate transfer or discharge; or the resident has resided in the facility less than 30 days. 42 CFR §483.15(c)(4)...Even if an exception to the 30-day notice requirement is satisfied, the facility must nevertheless provide written notice in advance of a proposed transfer or discharge and an opportunity to appeal. A nursing home cannot transfer or discharge a resident while an appeal is pending, unless delay would endanger the health or safety of the resident or other individuals in the facility. 42 CFR §483.15(c)(1)(ii)...California law requires nursing homes to give "reasonable advance notice" in writing in all cases of transfer or discharge, unless there is an emergency. H&S Code §1599.78, 22 CCR §72527(a)(6)..." (https://canhr.org/transfer-and-discharge-rights/) Therefore, the Department determined the facility failed to provide the proper notice for discharge for Resident 1 when, Resident 1 was not given a 30-day advance written notice of the impending transfer or discharge from the facility as soon as practicable and the facility did not notify or send Resident 1's Notice of Transfer or Discharge form to the Ombudsman's office on the same day that Resident 1 was served the notice (day of proposed discharge). This violation had a direct or immediate relationship to the health, safety, or security of Resident 1.