Other·February 25, 2022

Health and Safety Code 1336.2 Violation - Problem Transfer The following reflects the findings of the California Department of Public Health during a state monitoring visit. 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. On 2/4/22, at 10:30 PM, California Department of Public Health conducted an unannounced state monitoring visit to the facility to ensure safe transfer of residents related to the facility's certification termination and pending closure. The facility failed to comply with the psychosocial assessment and notice requirements when a licensed clinical social worker did not conduct a psychosocial assessment for Resident 78 prior to transfer as required by statue, and as indicated in its Relocation Plan, accepted by CDPH on 2/2/22. This failure had the potential to result in Resident 78 not receiving continuity of care and for the resident to experience emotional trauma due to leaving his home and friends. Resident 78 is a 59-year-old male who was admitted to the facility on 10/30/20. His diagnosis included dizziness, difficulty with walking and posture, high blood pressure, heart disease, depression, history of alcoholism, joint pain, and difficulty with breathing. Resident 78's Minimum Data Sheet (MDS, a standardized assessment tool), dated 1/17/22, indicated he spent most of his day in a wheelchair, and could walk in his room only with the assistance of one staff person. Resident 78's "Progress Notes," indicated he was discharged to another skilled nursing facility on 2/8/22. During a review of Resident 78's discharge packet on 2/15/22, the receiving facility received a psychosocial assessment, completed by Social Services Assistant 1, dated 1/31/22, the psychosocial assessment indicated, "no psychosocial concerns." During a concurrent interview and record review on 2/11/22, at 1:36 PM with Social Services Assistant 1, Social Services Assistant 1 stated, she was currently enrolled in social services classes. Social Services Assistant 1 stated, the facility had not trained her on transfer and discharging of residents. Social Services Assistant 1 stated, she was not familiar with the transfer and discharge policy. During a review of Social Services Assistant 1's personnel file, it was noted Social Services Assistant 1 started employment at the facility on 11/23/21, as a "Social Service Coordinator." Social Services Assistant 1's "Social Service Coordinator" checklist was reviewed on 2/11/22. The "Suggested Topics for Orientation" checklist contained over 35 different "Orientation topics" and was blank, indicating no orientation to the topics had occurred. However, the pages had both Social Services Assistant 1 and the Administrator's signatures. There were no documents in the file to show Social Services Assistant 1 was a licensed marriage and family therapist, a licensed clinical social worker, a licensed psychologist, a licensed psychiatrist, or a licensed professional clinical counselor. During a concurrent record review and interview on 2/11/22, at 2:40 PM, with Regional Resource Nurse, Social Service Assistant 1 personnel file was reviewed. Regional Resource Nurse stated, the facility did not currently have a full-time social worker. Social Services Assistant 1 was hired to be assistant. During a review of the facility's "Relocation Plan," accepted by CDPH 2/2/22, the Relocation Plan indicated; the psychosocial assessment "shall include recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer and a recommendation for the type of facility that would best meet the resident's needs. The following licensed staff will be conducting the psycho-social assessments: [Vice President Behavior Health Consultant, Social Services Director, and Social Services Assistant 1]. " In violation of the above cited standards, the facility failed to provide Resident 78 a psychosocial assessment as indicated in its Relocation Plan. This failure had the potential to result in Resident 78 not to receive continuity of care and for the resident to experience emotional trauma due to leaving his home and friends. This violation had a direct or immediate relationship to the health, safety, or security of residents and therefore, constitute a class B citation.