Health inspection·December 15, 2023

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 10/10/23, at 10:57 a.m., 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 acute hospitalization. This failure resulted in Resident 1 was sent to another skilled nursing facility 23 miles away and had the potential for emotional distress, feeling of lessened self-worth and potential for less visitation due to change in location. Findings: Resident 1 was a 65-year-old male with diagnoses that included cardiomegaly (enlarged heart), diabetes, muscle weakness, difficulty walking, unspecified dementia (group of conditions characterized by impairment of at least two brain functions, such as memory loss and judgment). During an interview on 10/10/23 at 9:32 a.m. with Complainant, Complainant stated the facility had sent Resident 1 to the hospital for treatment on 10/6/23. Complainant stated the hospital had informed him that Resident 1 was ready to be discharged back to the facility on 10/9/23 but they refused to take Resident 1 back. Complainant stated the hospital had to place Resident 1 at another skilled nursing facility. Complainant stated he went to the facility and spoke with the Chief Executive Officer (CEO) who informed him that Resident 1 did not meet criteria to be in their facility and that the facility was, “not a hotel.” During an interview on 10/10/23 at 11:15 a.m. with Medical Biller (MB), MB stated Resident 1 was on a bed hold (bed hold – a requirement that mandates the facility hold the bed for a resident sent out for higher level of care needs for a set number of days) at the facility in which his insurance covered. MB stated as of today (10/10/23) Resident 1 was still under bed hold in the facility. MB stated Resident 1 was not under skilled level of care in the facility but under custodial care (custodial care - non-medical care provided to assist people with daily living). During an interview on 10/10/23 at 11:20 a.m. with the Director of Nurses (DON), DON stated the hospital had contacted the facility and requested to send Resident 1 back. DON stated she and the Executive Director (ED) had contacted the CEO regarding the discharge of Resident 1 back to the facility. DON stated the CEO had instructed her and the ED to inform the hospital if Resident 1 could be placed at a more appropriate level of care since he did not meet a skilled level of care (skilled level of care - Residents who require ongoing medical care after an injury, rehabilitation, or other highly effective medical treatment). During an interview on 10/10/23 at 11:34 a.m. with CEO, CEO stated the hospital had contacted the facility on 10/9/23 that Resident 1 was ready to be discharged. CEO stated it was determined that Resident 1 did not meet skilled level of care. CEO stated, “I told him [complainant] we [facility]have a protocol and this isn’t a motel that [Resident 1] could stay here. I [CEO] told him [complainant] we [facility] determined that he [Resident 1] did not meet skilled [level of care].” CEO stated Resident 1 did not meet the appropriate level of care to be in the facility since the hospital could not show that he needed a skilled level of care. CEO stated he was not aware Resident 1 was under custodial care and not skilled. CEO stated it appears our [facility] judgment was not correct regarding Resident 1’s level of care. CEO stated, “I’m not aware of what our policies on discharge are as I am more used to working the acute level of care not skilled [nursing].” During an interview on 10/10/23 at 12:32 p.m. with DON, DON stated the facility had not provided Resident 1 or his son with a 30-day notice proposal for transfer or discharge as indicated on their facility policy. During a review of the facility’s policy and procedure (P&P) titled, “Transfer or Discharge” the P&P indicated, “It is the policy of the facility that residents may be discharged for medical reasons in the case of a level of care change, which cannot be cared for at the facility, or voluntary reasons as decided by the resident or the resident’s responsible party. Admission or discharge of residents shall not be on the basis of race, color, religion, ancestry or national origin. Complete and accurate information, in sufficient detail to provide for continuity of care, shall be transferred with the resident at the time of transfer. . . A. The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless one of the following requirements is met . . . The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility. . . The transfer or discharge is appropriate because the resident’s health has improved sufficiently so that the resident no longer needs the service provided by the facility. . . Documentation in the resident’s medical record must be made in any one of the situations as noted in transfer or discharge requirement . . . A. Before the facility transfers or discharges a resident, the facility must complete the following . . . The Charge Nurse will notify the resident and, responsible party or legal representative of the resident’s transfer or discharge by completing and providing them with a copy of the “Notice of Proposed Transfer/Discharge” form if transferring to an acute care hospital. . . A 30-day notice will be given to the resident or responsible party before a resident is transferred or discharged. Exceptions are when the health or safety of individuals would be endangered. In these instances, notice may be made as soon as practicable before transfer or discharge. Additionally, if the resident’s health improves sufficiently to allow a more immediate transfer, the 30-day notice may be waived. If an immediate transfer or discharge is required by the resident’s urgent medical needs, the 30-day notice is waived. Finally, if a resident has not resided in the facility for 30 days, the 30-day notice requirement is also waived. . . If the transfer or discharge is involuntary, the facility shall notify the Long-Term Care Ombudsman. . . When a resident is recommended for discharge, or pending placement elsewhere, such recommendation shall remain active as long as it takes place the resident. Every effort, by combined resources, should be made to return resident to their conservator, family, or county from which they came. Documented records should be kept of efforts for placement as well as continued problems with such residents. . . The Charge Nurse and/or Social Services staff will provide sufficient preparation and/or orientation to residents to ensure safe and orderly transfer or discharge from the facility. This preparation and/or orientation should be documented in the resident’s medical record. . . Residents discharged while hospitalized are eligible for readmission to the SNF immediately after release from such facility or upon availability of an appropriate bed. . . Residents who were not offered a bed hold will be readmitted to the facility immediately upon the first availability of a bed.” In violation of the Code of Federal Regulations §483.15(e)(1), the department determined that the facility failed to follow its own Admission Agreement policy and procedure and re-admit Resident 1 back to the facility. The above violations caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to Resident 1 and constitutes to a B citation.