Other·December 6, 2019

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during an abbreviated survey for the investigation of complaint #CA00657571. Representing the Department of Public Health: Health Facilities Evaluator Nurse, 40019 The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility.

F623 SS=D Notice Requirements Before Transfer/Discharge CFR(s): 483.15(c)(3)-(6)(8)

F623 11/25/2019 §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 LongTerm 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 055296 11/21/2019 CEDARWOOD POST ACUTE 1090 Rio Lane Sacramento, CA 95822 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE 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. §483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following: (i) The reason for transfer or discharge; (ii) The effective date of transfer or discharge; (iii) The location to which the resident is transferred or discharged; (iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request; (v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman; (vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency 055296 11/21/2019 CEDARWOOD POST ACUTE 1090 Rio Lane Sacramento, CA 95822 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and (vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act. §483.15(c)(6) Changes to the notice. If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available. §483.15(c)(8) Notice in advance of facility closure In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at § 483.70(l). This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to ensure a copy of the discharge notice for one resident (Resident 1) was sent to the Office of the State Long Term Care (LTC) Ombudsman, for a census of 43. This failure had the potential to result in Resident 1 not being protected from an 055296 11/21/2019 CEDARWOOD POST ACUTE 1090 Rio Lane Sacramento, CA 95822 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE inappropriate discharge by not having access to an advocate who can inform them of their options and rights. Findings: Resident 1 was admitted to the facility in mid 2019 with diagnoses including chronic kidney disease. Review of Resident 1's document titled, "Notice of Proposed Transfer/Discharge," dated 10/1/19, indicated resident was transferred/discharged to an acute hospital due to, "The health of the individuals in the facility would otherwise be endangered due to the clinical or behavioral status of the resident." Review of Resident 1's document titled, "EMERGENCY/ SPECIAL EVENT TRANSFER ONLY," dated 10/1/19, indicated Resident 1 was transferred to an acute hospital due to unsafe behaviors. The area labeled, "Ombudsman Notification Faxed," was left blank. There was no documented evidence that a copy of Resident 1's discharge notice was sent to the Ombudsman as required. During an interview with the Director of Nursing (DON) on 11/19/19 at 8:15 a.m., the DON stated the nurses fax the Notice of Proposed Transfer/Discharge to the Ombudsman when residents are being transferred or discharged from the facility. During an interview with the Data Specialist (DS) from the LTC Ombudsman's Office on 11/19/19 at 3:30 p.m., the DS stated the facility only sent the cover page with Resident 1's name and discharge location written on it. The DS further stated he usuallly receives a second 055296 11/21/2019 CEDARWOOD POST ACUTE 1090 Rio Lane Sacramento, CA 95822 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE page with the notice of the transfer/discharge. Review of the document sent to the Ombudsman's Office by the facility titled, "DISCHARGE FAX," dated 10/1/19, indicated Resident 1's name and discharge location. The document also indicated, "Pages: 1." There were no other documents attached to the page. During an interview with the DON on 11/20/19 at 8:12 a.m., the DON stated she could not find a fax information that the Notice of Transfer/Discharge for Resident 1 was faxed to the Ombudsman. Review of a facility policy titled, "TRANSFER AND DISCHARGE," reviewed 2/13, did not contain any information regarding notifying and providing a copy of a discharge notice to the Ombudsman.