Health inspection·March 15, 2022

Facility ID: 555336 District Office: Bakersfield Intake: 774703 Event ID: QDOW11 Shari Darke, HFES 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. California Code of Regulations, title 22, section 72501 (d) Except where provided for in approved continuing care agreements, or except when approved by the Department, no facility owner, administrator, employee or representative thereof shall act as guardian or conservator of a patient therein or of that patient's estate, unless that patient is a relative within the second degree of consanguinity. On 2/18/22, at 10:30 AM, California Department of Public Health (CDPH) conducted an unannounced state monitoring visit at the facility to ensure the safe transfer of Residents related to the facility's Medicare certification termination. The facility failed to comply with the notice requirements before transferring a resident due to facility Medicare certification termination when: 1.The facility failed to timely submit an application for a public guardianship for Resident 22 when she was no longer capable of making decisions due to decreased cognitive functions (trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life); 2.Written notice was not provided at least 60 days in advance of the transfer to a responsible party for Resident 22 nor information of available alternative facilities that were adequate to meet resident needs, and resident and family rights. These failures had the potential for an unsafe transfer and placed Resident 22 at risk for adverse health consequences. During a review of Resident 22's Admission Record, dated 10/6/21, the Admission Record indicated, Resident 22 was a 64 year old female, and diagnoses included Acute and Chronic Respiratory Failure (low oxygen and high carbon dioxide levels in the blood), other heart failure, moderate persistent asthma, generalized muscle weakness, high blood pressure, malnutrition, bowel and bladder incontinence and a history of falling. Resident 22's Admission Record indicated, additional mental health disorders including: Unspecified Depression, Schizophrenia, Anxiety Disorder, Bipolar Disorder, and other recurrent depressive disorders. During a review of Resident 22's Minimum Data Set (MDS, a resident assessment tool) Section C500, Brief Interview for Mental Status Score (BIMS assesses cognitive function), dated 1/10/22, indicated Resident 22 was severely cognitively impaired (score: 3 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 a review of Resident 22's Admission Record, dated 10/6/21, the Admission Record indicated in addition to Resident 22, [Name] Responsible Party Rep Payee (RPRP) with a telephone number and an address, and [Name] Case Worker with a cell phone number. During a review of Resident 22's Social Services Quarterly Note, dated 1/5/22, the Quarterly Note indicated, "Comments related to discharge potential"... Resident 22 "has no family or friends to go out and live with..." During a review of Resident 22's Progress Note, dated 1/13/22, at 12:31 PM, the Progress note indicated, "Interview: BIMS Score: 3: 3.0 Severe cognitive Impairment" During an interview on 2/14/22, at 1:44 PM with the Responsible Party Rep Payee (RPRP), RPRP stated, she was only the conservator for Resident 22's funds, she wrote checks for Resident 22, such as her share of costs at the facility. RPRP stated, she was not and never would be the responsible party to approve the facility or any medical treatment for Resident 22. During a concurrent interview and record review on 2/14/22, at 5:15 PM, with the receiving facility Administrator, Resident 22's transferring facility documents were reviewed. Receiving facility Administrator stated, Resident 22 was not what the facility expected. Administrator stated, Resident 22 spits and screams at everyone who approaches and says she is HIV positive (viral infection). Receiving facility Administrator stated, Resident 22's Admission Record, dated 10/6/21, did not indicate an HIV infection. Receiving facility Administrator stated, Resident 22 History and Physical, dated 10/6/21, indicated, HIV infection, follows up with infectious disease specialist. Receiving facility Administrator stated, the receiving facility realized Resident 22 was not able to make sound decisions and convened an ethics committee and was seeking public guardianship to protect the resident rights and be able to provide consents for her. During an interview on 2/15/22, at 1:30 PM, with Case Worker's Receptionist, Case Worker Receptionist stated, Case Worker provides resources for mental health, housing, transportation to appointments, arranges mental health therapist, but was not a responsible party. During an interview on 2/15/22, at 1:45 PM, with the receiving facility Director of Nursing (DON 2), DON 2 stated, the receiving facility admitted Resident 22 on 2/8/22. DON 2 stated, Resident 22 was not conserved upon arrival at the facility. DON 2 stated, the facility was concerned, and held an ethics committee meeting, which included the facility medical director. DON 2 stated, the ethics committee determined Resident 22 needed conservatorship and began the process of obtaining conservatorship. During a concurrent interview and record review on 2/17/22, at 10:50 AM, with the transferring facility DON, Resident 22's MDS was reviewed. DON stated, the MDS indicated Resident 22 BIMS score was 3 on both 10/12/21 and 1/24/22. During an interview on 2/17/22, at 12:10 PM, with Vice President Behavior Health Consultant, Vice President Behavior Health Consultant, stated Resident 22 had family and a Responsible Party. Vice President Behavior Health Consultant stated, [Name] was her Responsible Party. Vice President Behavior Health Consultant identified RPRP as Resident 22's Responsible Party. [Name] was telephoned in presence of DON and Vice President Behavior Health Consultant. During an interview on 2/17/22, at 12:10 PM with RPRP, with DON and Vice President Behavior Health Consultant present, RPRP stated, she was not Resident 22's Responsible Party, had never been called by the facility to sign consents, she only issues Resident 22's Social Security money. Vice President Behavior Health Consultant stated, " We had a misunderstanding regarding responsible party for resident. We thought she had a responsible party." Vice President Behavior Health Consultant stated, she did not find any documentation the facility had applied for a public guardian for Resident. During a concurrent interview and record review, on 2/22/22, at 2:44 PM, with DON, the facility policy and procedure (P&P) titled "Informed Consent," dated 12/7/20, was reviewed. The P&P indicated, "C. Residents without Capacity or a Surrogate Decisionmaker...Members of the Surrogate IDT...Resident Representative (a) The Resident representative may not be affiliated with the Facility (b) The Resident representative may be: (i) A friend... (ii) A Resident advocate, legal counsel, a public guardian or a local ombudsman (iii) Any person who has an interest in the Resident's welfare (iv) Someone authorized by state or federal law... Identifying Members of the Surrogate IDT-Including a Resident Representative... ii. The Facility will identify a person (who is unaffiliated with the facility) to serve as a representative of the Resident. The Facility may contact any of the following: a. A person identified by the Resident (if any) b. A family member... c. Legal counsel (if known) d. Patient or senior advocates e. Public guardians or a local ombudsman... iii. Efforts to identify a representative will be documented in the Resident's medical record...3) Include a patient representative on the IDT...Whenever the resident has no family or friend willing to serve on the IDT, someone unaffiliated with the facility must be found to serve as the patient representative...Compliance Deadline for IDT Patient Representative Participation...For residents that do not currently have a patient representative participating on an IDT, the facility should make timely and good faith efforts to locate and obtain a patient representative on behalf of the resident." During a review of All Facility Letter (AFL) 20-83.1, dated 1/12/21, AL 20-83.1 indicated "By July 27, 2021, if no patient representative has been selected, a SNF seeking to continue authorized treatment interventions of the IDT shall apply to the superior court for the appointment of a conservator, a health care decision maker, or a public guardian, pursuant to Probate Code Section 2920..." 2. During an interview on 2/2/22, at 12:11 PM, with Interim Administrator, Interim Administrator stated, Resident's Responsible Parties were sent a letter regarding the facility closure dated 2/1/22. Interim Administrator stated, the facility called the families of the residents and read the second paragraph of the letter to them. Interim Administrator stated, the letter did not inform the residents and the responsible parties the residents had the right to remain in the facility for 60 days following the notice. Interim Administrator stated, a written Spanish translation of the letter was not provided. CDPH informed Interim Administrator the facility's Proposed Transfer Plan was not acceptable. CDPH informed Interim Administrator the letter must inform the residents and the responsible parties of the resident right to remain in the facility for 60 days following the notification. During a review of Resident 22's Notice of Proposed Transfer and Discharge, dated 2/8/22, the Notice of Proposed Transfer and Discharge indicated, "Name/relationship of person notified self...Discharge effective date 2-8-22." The Notice of Proposed Transfer and Discharge was signed by Social Service Assistant 1 and Resident 22. 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 had no training on transfer and discharging of residents. Social Services Assistant 1 stated, she was not familiar with the transfer and discharge policy. Social Services Assistant 1 stated, the facility did not have a Social Services Worker. During a concurrent record review and int