Health inspection·May 15, 2025

The following reflects the findings of the California department of Public Health during the investigation of a complaint. The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. A deficiency was written for complaint number 952482 at F626. Tit. 22, § 72520 - Bed Hold (a) If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed hold of seven (7) days, which may be exercised by the patient or the patient's representative. (1) Upon transfer to a general acute care hospital, the patient or the patient's representative shall notify the skilled nursing facility within twenty-four (24) hours after being informed of the right to have the bed held, if the patient desires the bed hold. F626 §483.15(e)(1) Permitting residents 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 room 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. (ii) If the facility that determines that a resident who was transferred with an expectation of returning to the facility, cannot return to the facility, the facility must comply with the requirements of paragraph (c) as they apply to discharges. On 3/20/25, at 11:52 a.m. to investigate a complaint regarding facility not permitting Resident 1 to return to the facility from the acute care hospital. Resident 1 was a 61-year-old female who was admitted on 10/25/23 with diagnoses of Type 2 Diabetes (abnormal sugar level in the blood), Rheumatoid Arthritis (pain and swelling of the joints), Anxiety Disorder (excessive worry or fear), Depression (mood disorder), Hypertension (high blood pressure), Intestinal Obstruction, and Localized Edema (swelling). Based an interview and record review, the facility failed to permit one of three sampled residents (Resident 1) to return to the facility after hospitalization. This resulted in Resident 1 having unnecessary stay in the hospital and violated Resident 1's rights. Findings: During an interview on 3/19/25 at 3:12 p.m. with acute hospital Social Worker (SW), SW stated on 3/19/25 she notified facility to inquire whether they would be permitting Resident 1 to return to the facility. SW stated she was made aware facility was not permitting Resident 1 to return to the facility. During an interview on 3/19/25 at 4:22 p.m. with Resident 1, Resident 1 stated on 3/13/25 she was not able to hold any food down and had severe abdominal pain and requested to be sent to the acute hospital. Resident 1 stated she feels better and would like to return to the facility. Resident 1 stated, "I'm comfortable there [facility]. . . I want to go back, I've made friends there." During a review of Resident 1's "Admission Record (AR)," dated 3/20/25, the AR indicated Resident 1 was a female initially admitted to the facility on 10/25/23. Resident 1's quarterly Minimum Data Set (MDS-a federally mandated resident assessment tool) dated 1/23/25, indicated Resident 1 had a BIMS (Brief Interview for Metal Status-an assessment tool used by facilities to screen and identify memory, orientation, and judgement status of the resident) score of 14 (13 to 15 cognition is intact). The "Progress Notes" dated 3/13/25 at 1:20 p.m. indicated Resident 1 had complain of severe abdominal pain and requested to be sent out to the acute hospital. During an interview an interview on 3/20/25 at 12:09 p.m. with Administrator and Assistant Director of Nurses (ADON), ADON stated Resident 1 was transferred to the acute hospital for abdominal pain. Administrator stated on 3/19/25, hospital SW were made aware facility had no beds available and would not be permitting Resident 1 to return to the facility even when a bed became available. Administrator stated, "We are not taking her [Resident 1] back." During a review of the facility's policy and procedure (P&P) titled, "Readmission to the Facility," dated 3/2017, the P&P indicated, "Residents who have been discharged to the hospital or for therapeutic leave will be given priority readmission to the facility." In violation of the above cited, the facility failed to permit Resident 1 to return to the facility. This failure resulted in violating Resident 1's right to return to the facility. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents and constitutes a class "B" citation.