Health inspection·October 17, 2024

Crestwood Manor The following reflects the findings of the California Department of Public Health during the investigation of: Complaint # CA00915762 Survey Event ID: V57E11 State Citation B was written. Code of Federal Regulations, Title 42, Section §483.15(e)(1) (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. California Code of Regulations, Title 22, Section §72527(a)(6) (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (6) To be transferred or discharged only for medical reasons, or the patient's welfare or that of other patients or for nonpayment for his or her stay and to be given reasonable advance notice to ensure orderly transfer or discharge. Such actions shall be documented in the patient's health record. California Health and Safety Code, Section §1599.1 h(1)(2)(3) (h)(1) If a resident of a long-term health care facility has been hospitalized in an acute care hospital and asserts his or her rights to readmission pursuant to bed hold provisions, or readmission rights of either state or federal law, and the facility refuses to readmit him or her, the resident may appeal the facility's refusal. (2) The refusal of the facility as described in this subdivision shall be treated as if it were an involuntary transfer under federal law, and the rights and procedures that apply to appeals of transfers and discharges of nursing facility residents shall apply to the resident's appeal under this subdivision. (3) If the resident appeals pursuant to this subdivision, and the resident is eligible under the Medi-Cal program, the resident shall remain in the hospital and the hospital may be reimbursed at the administrative day rate, pending the final determination of the hearing officer, unless the resident agrees to placement in another facility. On 8/20/24 at 8:55 a.m., the California Department of Public Health (CDPH) conducted an unannounced visit at the facility to investigate a complaint regarding discharge. The Department determined the facility failed to ensure Patient 1 was permitted to return to the facility after Patient 1 was transferred from the facility to an acute care facility (hospital) for stabilization. This failure resulted in Patient 1 being held in a temporary facility (acute care) for five days and not returning to the facility she had been at for nearly nine months, which could have resulted in emotional distress. A review of Patient 1's clinical record titled, "Admission Record," indicated Patient 1's diagnoses included Schizophrenia (a serious mental health condition that affected how people think, feel, and behave) and an anxiety (worried) disorder. A review of Patient 1's clinical record titled, "Progress Notes," dated 8/17/24, at 1 p.m., by the Psychiatric Technician (PT), indicated Patient 1 showed signs of aggression toward staff and lorazepam (anti-anxiety medication) was administered to Patient 1 via an intramuscular (IM - in the muscle) injection (shot). A review of Patient 1's clinical record titled, "Progress Notes," dated 8/17/24, at 1:38 p.m., by Licensed Nurse (LN) 1, indicated Patient 1 was transferred to [ACUTE CARE HOSPITAL NAME] at 1:24 p.m. A review of Patient 1's clinical record from [ACUTE CARE FACILITY NAME] titled, "ED [Emergency Department] Physician Notes," dated 8/17/24, at 2:32 p.m., by ED Physician 1 (ED Phys) 1, indicated, "...the patient is stable for discharge and does not need to be here in the emergency department. Unfortunately when we called the facility to discharge her back to the facility they refused stating that she was not allowed to come back...The patient will remain here in the emergency department pending disposition [discharge]..." A review of Patient 1's clinical record from [ACUTE CARE FACILITY NAME] titled, "ED Note," dated 8/17/24, at 6:29 p.m., by Emergency Department Staff (EDS) 2, indicated Patient 1's overall behavior was calm and cooperative. A review of Patient 1's clinical record titled, "Progress Notes," dated 8/17/24, at 10:30 p.m., by LN 2, indicated, "Around 4:30 writer received a call from the social worker from [ACUTE CARE HOSPITAL NAME] and asking if we are taking resident back to the facility. Writer explained that we are not taking her back..." A review of Patient 1's clinical record from [ACUTE CARE FACILITY NAME] titled, "ED Physician Notes," dated 8/18/24, at 4:05 PM, by ED Phys 2, indicated, "...patient has been medically cleared...Currently the placement facility where she was staying is [sic] refused to take her back. Nursing is interviewed no acute [new] events overnight..." A review of Patient 1's clinical record from [ACUTE CARE FACILITY NAME] titled, "ED Note," dated 8/18/24, at 6:12 p.m., by EDS 2, indicated Patient 1 was calm and cooperative and had not required a safety attendant (staff member who monitored the resident's behavior). A review of Patient 1's clinical record titled, "Physician's Orders," dated 8/19/24, by the Medical Director (MD), indicated Patient 1 was discharged from the facility. A review of Patient 1's clinical record from [ACUTE CARE FACILITY NAME] titled, "ED Note," dated 8/19/24, at 5:51 p.m., by EDS 1, indicated, "...Following medical clearance, EDS 1 was advised that the facility is evicting (not allowed to return) the pt [patient]..." During an interview on 8/20/24, at 10:40 a.m., with the Director of Nursing (DON), the DON stated the facility did not have a bed hold (save the patient's bed for return) for Patient 1 and Patient 1 was discharged from the facility. The DON stated Patient 1 would remain at the [ACUTE CARE FACILITY NAME] until placement at another facility was secured. During an interview on 8/20/24, at 10:50 a.m., with the Social Services Designee (SSD), the SSD stated the facility's normal practice when a resident was transferred out of the facility included serving the resident and/or the resident's conservator (court appointed person who made decisions for the resident when the resident was not able to do so independently) with a 7-day bed hold or a 30 day transfer or discharge notice (notice that after 30 days the resident would be transferred or discharged from the facility). The SSD stated the facility was not anticipating Patient 1 to return to the facility. During a follow up interview on 8/20/24, at 11:55 a.m., with the DON, the DON stated Patient 1 and/or her conservator were not provided at 7-day bed hold notice or a 30-day discharge or transfer notice as of 8/20/24 at 11:55 a.m. The DON further stated the facility should have provided notice to Patient 1 and/or the conservator when the decision was made by the DON and the Administrator (ADM) that Patient 1 would not be returning to the facility. During an interview on 8/20/24, at 12:30 p.m., with the Psychiatric Medical Doctor (PMD), the PMD stated when Patient 1 took her prescribed medications she did not have many psychiatric (mental) problems. The PMD stated he last evaluated Patient 1 the week of 8/5/24. The PMD stated he did not re-evaluate Patient 1 after Patient 1 was transferred to [ACUTE CARE HOSPITAL NAME] on 8/17/24. During a follow up interview on 8/20/24, at 1:50 p.m., with the DON, the DON stated the facility currently had 12 empty beds. During an interview on 8/20/24, at 3:56 p.m., with the DON, the DON stated neither the MD nor the PMD had gone to [ACUTE CARE FACILTIY NAME] to re-evaluate Patient 1 for the ability to return to the facility. The DON further stated the facility had only been in contact with [ACUTE CARE FACILTY NAME] once on 8/17/24 when [ACUTE CARE FACILITY NAME] wanted to discharge Patient 1 back to the facility. During an interview on 8/21/24, at 1:45 p.m., with Patient 1's conservator (Conserv), Concerv stated Patient 1 was still at [ACUTE CARE HOSPITAL NAME]'s ED and waiting for placement at a facility. During a review of the facility's Policy and Procedure (P&P) titled, "Bed-Hold and Return to the Facility," dated 11/18/16, indicated, "...Residents...have the right to secure a bed hold during hospitalization...or leave from the facility...C. At the time of transfer to an acute hospital in a medical emergency, or within 24 hours of the transfer, the facility...will provide to the resident and the resident representative, written bed-hold notice which specifies: iii. The resident is permitted to return to the facility to their previous room..." During a review of the facility's P&P titled, "Transfer And Discharge/Notice," dated 11/16/16, indicated, "...4. Written notice of Transfer or Discharge includes A. The reason for the transfer or discharge; B. The effective date of transfer or discharge; C. The location to which the resident is transferred or discharged; D. A statement of the resident's appeal rights...7. When the resident is to be transferred to another...setting or discharged...a facility designee assures the notice of transfer/discharge has been given to the resident/family surrogate..." Therefore, the Department determined the facility failed to ensure Patient 1 was permitted to return to the facility after Patient 1 was transferred from the facility to an acute care facility (hospital) for stabilization. Patient 1 was at risk for emotional distress when Patient 1 was being held in a temporary facility (acute care) for five days and not returning to the facility. Patient 1 underwent an unnecessary prolonged hospitalization while placement was being found. This violation had a direct or immediate relationship to the health, safety, or security of Patient 1.