Health inspection·March 7, 2024

Tracy Nursing The following reflects the findings of the California Department of Public Health during the investigation of: Complaint #: CA00881317 Survey Event ID: KBFF11 Representing the Department, HFEN #43496 State Citation B was written. §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. 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. (b) If a resident is subject to a facility-initiated transfer to a general acute care hospital on an emergency basis, the facility shall provide a copy of the notice to the ombudsman as soon as practicable. (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. (d) For the purposes of this section, a "facility-initiated transfer or discharge" is a transfer or discharge that is initiated by the facility and not by the resident, whether or not the resident agrees to the facility's decision. On 2/6/24 at 12:51 p.m., an unannounced visit was conducted at the facility to investigate a complaint regarding resident rights. The facility failed to provide notice of a facility-initiated discharge to the appropriate parties when Patient 1 was given a thirty-day notice of transfer/discharge for failure to pay his share of the cost to stay at the facility on 1/3/24 and the notice was not sent to a representative of the Office of the State Long-Term Care (LTC) Ombudsman (a patient rights advocate). Review of Patient 1's "ADMISSION RECORD," indicated Patient 1 was admitted to the facility early 2021 with diagnoses of but not limited to major depressive disorder (persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), malnutrition (when the body doesn't get enough nutrients), and acquired absence of left leg below the knee, diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), and heart failure (heart muscle doesn't pump blood as well as it should). During an interview on 2/5/24, at 4:24 p.m., the Ombudsman stated Patient 1 had informed her the facility provided Patient 1 a thirty-day notice of discharge. The Ombudsman stated the State LTC Ombudsman office had not received a thirty-day notice of discharge from the facility for Patient 1. During a concurrent interview and record review on 2/6/24, at 3:02 p.m., a document titled "STATE OF CALIFORNIA OFFICE OF THE STATE LONG-TERM CARE OMBUDSMAN SENDING REQUIRED TRANSFER/DISCHARGE NOTICES TO YOUR LOCAL LONG-TERM CARE OMBUDSMAN PROGRAM [LTCOP]," revised 5/2022, was reviewed with the Social Services Director (SSD). The SSD stated she was provided the document from the Ombudsman office which directed what types of notices, patient initiated or facility-initiated transfer/discharge notices, needed to be sent to the State LTC Ombudsman Office and in what time frame. The SSD stated the notice of transfer/discharge would be sent to the State LTC Ombudsman office for a facility-initiated discharge. During a concurrent interview and record review on 2/6/24, at 3:02 p.m., Patient 1's "NOTICE OF TRANSFER / DISCHARGE," dated 1/3/24, was reviewed with the SSD. The notice of transfer/discharge indicated, "...Notification Date: 1/3/2024...Effective Date: 2/2/24...This notice is to inform you that transfer/discharge is necessary for the following reason... [box was marked in front of the following reason] You have failed, after reasonable and appropriate notice, to pay for...a stay at the facility..." The section "Copy to...State LTC Ombudsman Office-Date" was marked, but the date was left blank. The SSD confirmed Patient 1's notice of transfer/discharge was facility initiated due to nonpayment of cost of share for a stay at the facility. The SSD confirmed the notice was not sent to the State LTC Ombudsman Office. The SSD explained she did not send Patient 1's transfer/discharge notice to the State LTC Ombudsman Office because the facility rescinded the notice two weeks after it was issued. The SSD was unable to locate documentation of the notice being rescinded in Patient 1's medical record. Review of Patient 1's "Social Services Note," dated 1/3/24, indicated, "The resident was issued a Notice of Transfer/Discharge due to the resident has failed, after reasonable and appropriate notice, to pay for his share of cost to stay at this facility. The resident's share of cost started 12/1/2023. The resident continues to refuse to pay his share of cost." During an interview on 2/6/24, at 3:53 p.m., the Administrator (ADM) stated the purpose of providing the transfer/discharge notice to patients was to align the intent on the plan for discharge, so the patient had the opportunity to agree or disagree with the plan for discharge. The ADM stated the purpose of also providing the transfer/discharge notice to the State LTC Ombudsman office was to inform the Ombudsman, to represent patient rights. Review of a facility provided document titled "STATE OF CALIFORNIA OFFICE OF THE STATE LONG-TERM CARE OMBUDSMAN SENDING REQUIRED TRANSFER/DISCHARGE NOTICES TO YOUR LOCAL LONG-TERM CARE OMBUDSMAN PROGRAM," revised 5/2022, indicated, "...Facilities are required to send copies of all notices related to facility-initiated transfers and discharges..." The section titled "When should a notice be sent to the local LTCOP?" indicated, "Facilities must give residents and their representatives a notice of discharge or transfer at least 30 days in advance...The facility must send copies of these notices to the LTCOP at the same time..." In violation of the above cited standards, the facility failed to provide a copy of a transfer/discharge notice to the State-Long Term Ombudsman, including but not limited to: The facility failed to provide notice of a facility-initiated discharge to the appropriate parties when Patient 1 was given a thirty-day notice of transfer/discharge for failure to pay his cost of share to stay at the facility on 1/3/24 and the notice was not sent to a representative of the Office of the State Long-Term Care (LTC) Ombudsman (a patient rights advocate). This violation had a direct or immediate relationship to the health, safety, or security of patients or residents.