Other·September 26, 2022

Notice requirements before Transfer/Discharge Section 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. On 8/18/22 at 9:19 a.m., an unannounced visit was conducted at the facility to investigate a complaint regarding the discharge of a resident from the facility. Resident 1 was sent to the hospital on 4/10/22 from the facility related to a change in condition in Resident 1's status. On 4/19/22 the hospital informed the facility that Resident 1 was ready to be sent back to the facility. On 4/20/22 the facility determined that Resident 1's needs could not be met at the facility and discharged Resident 1 from the facility. The facility did not provide a notice of transfer/discharge to the resident, the resident representative, or the Office of the State Long-Term Ombudsman at the time when the decision was made to discharge Resident 1 from the facility. This failure violated Resident 1's right to be informed of how to appeal the decision of a facility-initiated discharge. This failure also resulted in Resident 1's representative and the State Long-Term Care Ombudsman from being uninformed of the discharge decision and removed the opportunity for the resident representative and/or the State Long-Term Care Ombudsman to advocate on Resident 1's behalf. The facility failed to notify the resident and the resident's representative(s) and the Office of the State Long-Term Ombudsman of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand when, Resident 1 was discharged from the facility on 4/20/22 and the facility did not provide a notice to the resident's representative and the State Long-Term Care Ombudsman of the discharge. Review of Resident 1's "ADMISSION RECORD" indicated that Resident 1 was admitted to the facility in 2021 with diagnoses which included dementia (a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life), bipolar disorder (a mental health condition that causes extreme mood swings), and schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly). During an interview, on 8/18/22, at 10:10 a.m., the Director of Nursing (DON) stated, Resident 1 was sent to the hospital from the facility on 4/10/22 for concerns of altered mental status. The DON explained, on 4/20/22 the hospital called the facility because Resident 1 was ready to be discharged from the hospital. The DON stated, because Resident 1 was on a blood pressure medication that was given through the vein, the facility was unable to accept Resident 1 back at that time. The DON confirmed, when the facility determined on 4/20/22 that they would be unable to readmit Resident 1 to the facility, a transfer/discharge notice was not provided to the resident's representative, nor the ombudsman. Review of Resident 1's "Resident Transfer Form..." dated 4/10/22, indicated, "...Date and Time of Transfer: 04/10/22 15:36 [3:36 p.m.] ...Reason For Transfer...change in ALOC [altered level of consciousness] ...Facility Name and Address Transferring To... [name of local hospital] ..." Review of a facility provided document obtained from the hospital regarding Resident 1, titled "Transition Planning Notes," date printed 6/9/22, indicated, "...April 19, 2022...spoke with [name of staff at skilled nursing facility] ...regarding possible DC [discharge] today...awaiting call back regarding acceptance..." The document further indicated, "...April 20, 2022... [Facility name] declining patient, stating "Patient off bed hold. No beds available" Spoke with [Resident 1's representative] ...states she was not told by [facility name] that they could not accept back..." The document indicated, "...April 22, 2022...Received a voicemail from... [facility name] ...stating that they will not accept patient back. No custodial beds available, patient is not appropriate for their facility, and if patient arrives there, they will redirect the ambulance back to our facility..." Review of a facility policy and procedure titled, "Transfer or Discharge Notice," revised 12/16, indicated, "...Under the following circumstances, the notice will be given as soon as it is practicable but before the transfer or discharge: a. The transfer is necessary for the resident's welfare and the resident's needs cannot be met in the facility...The resident and/or representative (sponsor) will be notified in writing of the following information: a. The reason for the transfer or discharge; b. The effective date of the transfer or discharge; c. The location to which the resident is being transferred or discharged; d. A statement of the resident's rights to appeal the transfer or discharge, including: (1) the name, address, email and telephone number of the entity which receives such requests; (2) information about how to obtain, complete and submit an appeal form; and (3) how to get assistance completing the appeal process; e. The facility bed-hold policy...A copy of the notice will be sent to the Office of the State Long-Term Care Ombudsman...The reasons for the transfer or discharge will be documented in the resident's medical record..." Review of a facility policy and procedure titled, "Appealing a Transfer of Discharge Notice," dated 3/17, indicated, "...Should a resident who has received a notice of a transfer or discharge disagree with the reasons for the transfer or discharge, the resident, and/or his or her representative (sponsor), may file an appeal with the state agency designated for such appeals...Upon notice of transfer or discharge, the resident will be provided with a statement of his or her right to appeal the transfer or discharge, including: a. the name, address, email and telephone number of the entity which receives such requests; b. information about how to obtain, complete and submit an appeal form; c. how to get assistance completing the appeal process; and d. the facility bed-hold policy..." Conclusion: In violation of the above cited standards, the facility failed to notify the resident and the resident's representative(s) and the Office of the State Long-Term Ombudsman of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand when, Resident 1 was discharged from the facility on 4/20/22 and the facility did not provide a notice to Resident 1's representative and the State Long-Term Care Ombudsman of the discharge. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of patients or residents.