Health inspection·July 3, 2025

State B citation was written. Code of Federal Regulations, Title 42, Section §483.15(c) Transfer and discharge- §483.15(c)(1) Facility requirements- §483.15(c)(1)(i) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless- (A)The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; (B)The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; (C)The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident; (D)The health of individuals in the facility would otherwise be endangered; (E)The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or (F)The facility ceases to operate. §483.15(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. Code of Federal Regulations, Title 42, Section §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. Code of Federal Regulations, Title 42, Section §483.15(d) Notice of bed-hold policy and return- §483.15(d)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the nursing facility must provide written information to the resident or resident representative that specifies- (i) The duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the nursing facility; (ii) The reserve bed payment policy in the state plan, under § 447.40 of this chapter, if any; (iii) The nursing facility's policies regarding bed-hold periods, which must be consistent with paragraph (e)(1 ) of this section, permitting a resident to return; and (iv) The information specified in paragraph (e)(1) of this section. §483.15(d)(2) Bed-hold notice upon transfer. At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative written notice which specifies the duration of the bed-hold policy described in paragraph (d)(1) of this section. Cal. Code Regs. Tit. 22, § 72527 - Patients' Rights (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. Cal. Code Regs. Tit. 22, § 72523 - Patient Care Policies and Procedures (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. 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. (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. Cal. Code Regs. Tit. 22, § 72520 - Bed Hold (a) If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed hold of seven (7) days, which may be exercised by the patient or the patient's representative. (b) Upon admission of the patient to the skilled nursing facility and upon transfer of the patient of a skilled nursing facility to a general acute care hospital, the skilled nursing facility shall inform the patient, or the patient's representative, in writing of the right to exercise this bed hold provision. No later than June 1, 1985, every skilled nursing facility shall inform each current patient or patient's representative in writing of the right to exercise the bed hold provision. Each notice shall include information that a non-Medi-Cal eligible patient will be liable for the cost of the bed hold days, and that insurance may or may not cover such costs. (c) A licensee who fails to meet these requirements shall offer to the patient the next available bed appropriate for the patient's needs. This requirement shall be in addition to any other remedies provided by law. On 6/16/25, at 4:28 p.m., the California Department of Public Health (CDPH) conducted an unannounced visit at the facility to investigate a complaint regarding a resident discharge. The Department determined the facility failed to complete the required actions related to transferring and/or discharging a resident (Resident 1) from the facility when: 1. The facility did not provide a written notice of bed hold (holding or reserving a resident's bed while the resident is absent from the facility for therapeutic leave or hospitalization) to Resident 1 at the time of transfer to a general acute care hospital (GACH); 2. Resident 1 was not notified of the discharge in writing and in a manner he/she understood; 3. 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 residents); and, 4. The facility refused to readmit Resident 1 to the facility after Resident 1 was cleared by the GACH to return to the facility on 6/15/25. These failures resulted in Resident 1 not being fully informed of their right to request a bed hold and to return to the facility after hospitalization, Resident 1 not having the opportunity to have had an advocate to inform him of his right to appeal a facility-initiated discharge, and Resident 1's prolonged stay at the GACH Emergency room and a temporary loss of residence resulting in emotional distress. 1. During a concurrent interview and record review on 6/17/25, at 1 PM, Resident 1's medical record was reviewed with the Director of Nursing (DON). The DON stated Resident 1 did not have a bed hold and did not sign a bed hold prior to the hospital transfer on 6/14/25. The DON stated Resident 1 had chosen the option not to put a bed hold during admission and signed the Notice of Bed Hold Policy dated 8/16/23. The DON stated the Notice of Bed-hold is only signed one time during admission. The DON stated the resident was considered AMA (Against Medical Advice - leaving a healthcare facility against medical advice means a patient chooses to discontinue their treatment or leave the healthcare facility before their doctor recommends discharge) and that was why Resident 1 did not have a bed-hold. The DON confirmed Resident 1 did not sign the AMA form. During a concurrent interview and record review on 6/17/25, at 4:19 PM, Resident 1's medical record was reviewed with the Administrator (ADM). The ADM stated they elected not to hold Resident 1's bed because he signed "do not hold my bed" during admission. The ADM stated Resident 1's Notice of Bed Hold Policy form was signed during his admission and was dated 8/16/23. The ADM stated residents signed the bed-hold notice form during admission or if they need to readmit a resident. A review of the facility's policy and procedure (P&P) titled, "Bed-Holds and Returns," dated 10/22, the P&P indicated "...Residents and/or representatives are informed (in writing) of the facility and stated (if applicable) bed-hold policies...1. All residents/representatives are provided written information regarding the facility and state bed-hold policies, which address holding or reserving a resident's bed during periods of absence (hospitalization or therapeutic leave). Residents, regardless of payer source, are provided written notice about these policies at least twice: 1. notice 1: well advance of any transfer (e.g., in the admission packet); and b. notice 2: at the time of transfer (or, if the transfer was an emergency, within 24 hours)..." Review of an online article published by the California Advocates for Nursing Home Reform (CANHR) titled, "Nursing home residents have the right to a 7-day bed hold when hospitalized," dated 10/17, indicated, "...In addition to including information about bed-hold policies in the admissions agreement, the facility must give a written bed-hold notice to the resident and/or the resident's family upon being transferred to the hospital, as is required by both federal law and state regulations..." (https://canhr.org/nursing-home-residents-have-the-right-to-a7-day-bed-hold-when-hospitalized/) 2. During an interview on 6/17/25, at 3 PM, the DON stated they have not sent the notice of transfer and discharge because the resident was not in their building. During an interview on 6/17/25, at 4:19 PM the ADM stated resident left the facility without staff's knowledge and they considered it AMA, but the resident returned to the facility intoxicated and they sent him to the hospital for evaluation. The ADM stated Resident 1 was too intoxicated to make the decision to go to the hospital, so the facility initiated it for him making it a facility-initiated discharge. The ADM stated Resident 1 was not issued a notice of transfer or discharge when he was transferred to the hospital. 3. During a concurrent interview and record review on 6/17/25, at 1 PM, the DON stated they have not sent the notice of discharge/transfer, regarding to Resident 1's transfer to an acute hospital on 6/14/25, to the ombudsman's office. A review of the facility's P&P titled, "Transfer or Discharge, Facility-Initiated", dated 10/22, the P&P indicated, "...Notice of Transfer or Discharge (Emergent or Therapeutic Leave)...4. Residents who are sent emergently to an acute care setting, such as hospital, are permitted to return to the facility...5. Under the following circumstances, the notice is given as soon as it is practicable...c. An immediate transfer or discharge is required by the resident's urgent medical needs...Notice of Discharge after Transfer 1. If discharge is initiated by the facility after an emergency transfer to the hospital, the reason for discharge is based on the resident's status at the time the resident seeks return to the facility (not at the time the resident was transferred to acute care). 2. If the facility does not permit a resident's return to the facility (i.e., initiates a discharge) based on inability to meet the resident's needs, the facility will notify the resident, and/or his or her representative in writing of the discharge, including notification of appeal rights. 3. The facility will send a copy of the discharge notice to a representative of the Office of the State LTC Ombudsman. 4. Notice to the Office of the State LTC Ombudsman will occur at the same time the notice of discharge is provided to the resident and resident representative..." Review of an online article published by the California Advocates for Nursing Home Reform (CANHR) titled "TRANSFER AND DISCHARGE RIGHTS," updated 9/4/24, the article indicated, "...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... 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... Exceptions to 30-Day Notice...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... 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...California law requires nursing homes to give "reasonable advance notice" in writing in all cases of transfer or discharge..." (https://canhr.org/transfer-and-disch