Other·May 29, 2024

F626 §483.15(e)(1) Permitting resident 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 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. On 2/8/24 at 9:50 AM, an unannounced visit was conducted at the facility to investigate a complaint regarding its refusal to re-admit Resident 1 back to the facility. Based on interview and record review, the facility failed to allow Resident 1 to return to the facility after three days of hospitalization. Resident 1 was a female, admitted to the facility on 1/26/24 with diagnosis including muscle wasting and atrophy (loss of muscle tissue), diabetes (too much sugar in the blood) and muscle weakness. Resident 1's "Progress Notes" dated 2/3/24 at 1:22 a.m. indicated, Resident 1 complained of "severe chest pain and SOB [shortness of breath]" and requested to be sent out to the acute hospital. During an interview on 2/7/24 at 3 p.m. with acute hospital Social Worker (SW), SW stated Resident 1 had discharge order to return to the facility on 2/6/24 (3 days after hospitalization). SW stated the facility was notified on 2/6/24 of Resident 1's discharge orders and was told by the facility Business Developer and Marketer (BDM) Resident 1's bed had been given to another resident and they did not have any long-term beds available. During an interview on 2/8/24 at 10:07 a.m. with Interim Administrator (IA), IA stated the facility currently had 90 residents in house and two on a bed-hold (Resident 2 and Resident 3). IA reviewed the current facility census and stated there were a total of seven female beds available. During a concurrent interview and record review on 2/8/24, at 10:48 a.m. with Director of Nursing (DON), DON stated Resident 1 had abnormal vital signs and was transferred to the acute hospital on 2/4/24. DON stated she spoke to the acute hospital SW on 2/6/24. DON stated on 2/6/24 Resident 1's bed was "already filled," family had picked up Resident 1's belongings and therefore was unable to re-admit the resident. During an interview on 2/13/24 at 10:49 a.m. with Resident 1's Family Member (FM), FM stated the facility had refused to take Resident 1 back when they found out Resident 1 needed long-term care. FM stated Resident 1 verbalized wanting to return to the facility. FM stated Resident 1 was discharge from the acute hospital on 2/12/24 (7 days after discharge order) to a different long-term care facility (two hours away from where family lives). FM stated, "We liked [facility name], we wanted her [Resident 1] to go back." During an interview on 2/22/24 at 1:11 p.m. with DON and IA, DON stated she did not see or review Resident 1's clinical report provided by the acute hospital and therefore was not able to make the clinical decision whether the facility was able to meet Resident 1's needs. During an interview on 2/22/24 at 1:29 p.m. with BDM, BDM stated Resident 1 was originally admitted for a short-term care. On 2/5/24, she received Resident 1's clinical report from the acute hospital indicating Resident 1 needing a long-term care. BDM stated Resident 1 had a change in condition from needing short-term care to a long-term care and the facility was not able to meet her needs. BDM stated, "Business wise we didn't want to take her because she was going to be long term." BDM stated the facility was only able to "allocate [distribute]" so many long-term beds with the insurance Resident 1 had. BDM stated, "Well in the business aspects, that's what we need to do to make money." During a review of Resident 1's hospital "Discharge Summary (DS)" report dated 2/12/24, the DS indicated Resident 1 was admitted to the hospital on 2/3/24 at 12:59 a.m. was treated for sepsis (infection), chest pain and urinary infection. Resident 1 was ready for discharge on 2/6/24, back to the facility. During a review of Resident 1's "Clinical Note Social Services (CNSS)," dated 2/6/24 at 2:19 p.m. the CNSS indicated, "Pt [Resident 1] reports she resides at [facility name]. Reports her plan is to discharge back. . . The CNSS dated 2/6/24 at 4:20 p.m. indicated, "[Facility name] is refusing to take pt [Resident 1] back." "Permitting resident to return to facility" P&P was requested from IT on 3/19/24 at 3:18 p.m. None was provided. In violation of the Code of Federal Regulations §483.15(e)(1), the department determined that the facility failed to re-admit Resident 1 back to the facility. This resulted in Resident 1's unnecessary stay in the hospital, potential to cause emotional trauma and violation of Resident 1's rights. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents and constitutes a class "B" citation.