Other·February 24, 2022

Health and Safety Code section 1336.2 (a) Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facility's Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following: (1) Be responsible for ensuring that the resident's attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the resident's condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, follow-up visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer. (2) Be responsible for ensuring that a licensed marriage and family therapist, a licensed clinical social worker, a licensed psychologist, a licensed psychiatrist, or a licensed professional clinical counselor and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the resident's health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the resident's needs. (3) (A) Be responsible for evaluating the relocation needs of the resident including proximity to the resident's representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the resident's representative. The health facility shall discuss the evaluation and medical assessment with the resident or the resident's representative and make the evaluation and assessment part of the medical records for transfer. (B) If the resident or resident's representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the resident's representative, in writing, of the importance of obtaining the assessments and follow-up consultation. (4) At least 60 days in advance of the transfer, inform the resident or the resident's representative of alternative facilities that are available and adequate to meet resident and family needs. (5) Arrange for appropriate future medical care and services, unless the resident or resident's representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services. (b) The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a). (c) The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or resident's representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or resident's representative that the transfer plan is available to the resident or resident's representative free of charge upon request. (g) (1) If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facility's Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or resident's representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall also include, but not be limited to, all of the following information: (A) The number of residents affected by the proposed closure. (B) The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8. (C) Attestation that each resident will undergo a medical assessment pursuant to paragraph (1) of subdivision (a) before being relocated. (D) The availability of alternative skilled nursing facility beds or other available long-term care beds within the community. (E) The reason for the proposed closure. (F) The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma. On 2/2/22, at 11:30 AM, California Department of Public Health (CDPH) conducted an unannounced monitoring visit at the facility related to a resident's transfer resulting from the facility's certification termination and pending closure. The facility failed to comply with the physician assessment and notice requirements to conduct a medical assessment for Resident 25 prior to transfer as required by statute and as indicated in its Relocation Plan, accepted by CDPH on 2/2/22. This failure had the potential to result in Resident 25 not receiving continuity of care and for the resident to experience emotional trauma due to leaving her home and friends. Resident 25 was an 87 year old female, admitted to the facility on 1/28/17. Resident 25's Admission Record, dated 1/28/17, indicated Resident 25's admission diagnoses included Bipolar Disorder (a mental health disease), and Major Depressive Disorder (a mental health disease). Resident 25's Minimum Data Set (MDS, a resident assessment tool) Section C500, Brief Interview for Mental Status Score (BIMS assesses cognitive function), dated 2/25/17, was 7 out of 15 (a score of 0 - 7 indicates severe impairment - loss of ability to reason, affects daily life functions; 8-12 indicates moderate impairment - poor decision making skills, needs reminders, cues and supervision in daily routines, 13-15 cogitatively intact). During an interview on 2/2/22, at 12:45 PM, with Assistant Chief Clinical Officer, Assistant Chief Clinical Officer stated, the facility will send hard copies of the residents' medical records to the receiving facilities. During an interview on 2/3/22, at 3:22 PM with receiving facility Director of Nursing (DON) 2, DON 2 stated, receiving facility admitted Resident 25 on 2/2/22. DON 2 stated, FM drove Resident 25 from the transferring facility to the receiving facility and brought the transfer documents. During a review of the receiving facilities transfer documents for Resident 25, there was no physician assessment. During a concurrent interview and record review on 2/15/22, at 11 AM, with Regional Resource Nurse, Resident 25's transfer documents were reviewed. Regional Resource Nurse was unable to provide a physician assessment for Resident 25. During a phone interview on 2/9/22, at 1:15 PM, with Interim Administrator and Assistant Chief Clinical Officer, Assistant Chief Clinical Officer stated, she called and emailed the facility's Medical Director, on 2/8/22, asking for his assistance. During an interview on 2/9/22, at 1:40 PM, with Medical Director, Medical Director stated, he would be willing to complete physician assessments starting tomorrow. Medical Director stated, the facility did not explain the reasons for the assessment. Medical Director stated, "Why the assessment, the residents are going to be discharged anyway because the facility is closing." During a review of facility's "Relocation Plan," it indicated: "Ensuring that the resident's attending physician, if available, or the facility's medical director, if available, completes the medical assessment of the resident's condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall provide recommendations for counseling, follow up visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer. The physician will note potential adverse health consequences in the event of a transfer." In violation of the above cited standards, the facility failed to provide a physician assessment to Resident 25 as indicated by statute and in its Relocation Plan, accepted by CDPH on 2/2/22. This failure had the potential to result in Resident 96 not receiving continuity of care and for the resident to experience emotional trauma due to leaving her home and friends. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents and therefore, constitute a class B citation.