Other·August 27, 2020

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during the investigation of a Complaint Complaint Number: CA00694217 Representing the California Department of Public Health Surveyor: 41794 The inspection was limited to a complaint and does not represent the findings of a full inspection of the facility. One deficiency was issued as a result of Complaint Number: CA00694217.

F625 SS=D Notice of Bed Hold Policy Before/Upon Trnsfr CFR(s): 483.15(d)(1)(2)

F625 08/20/2020 §483.15(d) Notice of bed-hold policy and return§483.15(d)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the nursing facility must provide written information to the resident or resident representative that specifies(i) The duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the nursing facility; (ii) The reserve bed payment policy in the state plan, under § 447.40 of this chapter, if any; (iii) The nursing facility's policies regarding bedhold periods, which must be consistent with paragraph (e)(1) of this section, permitting a 055708 08/04/2020 ARROWHEAD SPRINGS HEALTHCARE 1335 N Waterman Ave San Bernardino, CA 92404 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE resident to return; and (iv) The information specified in paragraph (e) (1) of this section. §483.15(d)(2) Bed-hold notice upon transfer. At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative written notice which specifies the duration of the bed-hold policy described in paragraph (d)(1) of this section. This REQUIREMENT is not met as evidenced by: Based on interviews and record reviews, the facility failed to ensure a hospitalized timeframe, when one of three sampled residents (Resident 1) was not allowed to return to the facility after being sent out for a psychiatric evaluation. This failure had the potential to cause serious mental harm to Resident (Resident 1) who considers the facility his home. Findings: An abbreviated survey was conducted on June 26, 2020 at 10:30 AM, to investigate a complaint regarding the facility refusing to accept resident back after hospitalization. Resident 1 is a 61-year-old male admitted to the facility on April 29, 2019, and diagnosed with type 2 diabetes, (a disease in which the blood sugar is too high), hypertension, (a disease in which the blood pressure is too high), rhabdomyolysis, (muscle break down), cellulitis, (a bacterial skin disease), right and left buttock wounds. A review of the Social Service notes dated June, 7, 2019 documents that Resident 1 055708 08/04/2020 ARROWHEAD SPRINGS HEALTHCARE 1335 N Waterman Ave San Bernardino, CA 92404 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE called the Certified Nursing Assistant, (CNA), "a b****" while she was providing personal care to Resident 1. Resident 1 and his roommate got into an argument regarding speaking disrespectfully to the CNA. The Social Services Director informed Resident 1 of the need to be respectful towards others and not start arguments with his roommates. Resident 1 demanded a room change because he did not like his roommates. Resident 1 was given a change of rooms. A review of Social Services notes dated August 6, 2019 documents Resident 1 continued to have arguments with staff and refusing to have his showers, refusing his medications and refusing personal care. Resident 1 was not on any psychotropic medications. A review of Social Service notes dated August 19, 2019, documents that Resident 1 had thrown water from his water pitcher at his former roommate and Resident 1 would refuse to take his showers, refuse to take his medications and yell at the staff who were providing his care. A Psychiatric consult was completed on August 19, 2019, and Resident 1 was diagnosed with Poor Impulse Control and staff were instructed to de-escalate the resident when he became angry or displayed inappropriate behavior. Resident 1 was also prescribed Depakote 250 mg, (medication to decrease irritable behaviors), twice a day. A review of Social Service notes dated September 4, 2019 documented a Social Services meeting with Resident 1 regarding current incident of throwing urinal with urine at CNA and to refrain from throwing urine at staff. 055708 08/04/2020 ARROWHEAD SPRINGS HEALTHCARE 1335 N Waterman Ave San Bernardino, CA 92404 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE A review of Social Service notes dated February 6, 2020 documents that Resident 1 continues to have episodes of yelling at staff, refusing to take his medication, refusing his personal care and refusing to have his room cleaned. A review of Psychiatry Notes dated May, 21, 2020 documents that Resident 1 is taking Depakote (medication to decrease irritability) 250 mg, twice a day and Trazadone (medication to decrease anxiety) 50 mg at bedtime. Resident 1 is tolerating his medications without significant side effects. On June 26, 2020 at 10:45 AM, a review of a nursing note dated June 23, 2020, was conducted. The note reflected that Resident 1 threw a lunch plate out into hallway. The Director of Nurses, (DON) was called to speak with Resident 1 and without warning, Resident 1 threw a urinal filled with urine at the DON and then he threw a trashcan at the DON. The DON was covered in urine. The Physician was notified of Resident 1's behavior and ordered Resident 1 be placed on a 5150 (allows a mentally ill patient to be involuntarily placed in a psychiatric hospital for 72 hours) for Resident 1. Police were called to the facility and Resident 1 was transported to the hospital. During an Interview on June 26, 2020 at 11:10 AM with the Social Services Director, (SSD) regarding Resident 1, the Social Worker stated that Resident 1 has history of yelling and throwing objects at other staff during his care. The SSD stated that due to Resident 1's behaviors it would be difficult to have Resident 1 return to the facility. The SSD stated most residents are usually allowed to return to the facility. During an interview with the DON on June 26, 055708 08/04/2020 ARROWHEAD SPRINGS HEALTHCARE 1335 N Waterman Ave San Bernardino, CA 92404 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE 2020 at 12:10 PM, the DON stated the Discharge Planner at the hospital informed him on June 25, 2020, that Resident 1 was stabilized and ready to be discharged after two days at the hospital. The DON informed the Discharge Planner that he will not accept the resident back due to his behaviors and that Resident 1 is a danger to his staff and other residents. An interview was conducted with the Business Office Manager on July 20, 2020 at 10:35 AM, regarding providing the required notice to the Resident, (Resident 1) that his bed would be held for seven days as per facility policy. The Business Office Manager stated the resident was not provided a bed hold notice. When asked what was the reason for not obtaining a bed hold approval for Resident 1, the Business Office Manager did not provide an answer. Requested from the DON a copy of the Bed Hold Policy. The DON only provided the bed hold regulations, (rules imposed by authorities), and stated they follow the bed hold regulations. On June 26, 2020 at 12:10 PM, an interview and concurrent record review of the facility's policy titled, "Discharge/Transfer of Resident", dated May 2020 was conducted. The policy reflects, "It is the policy of this facility to effectuate an orderly transfer or discharge...Explain and give copy of Bed hold form to the resident and/or representative. (Note: if emergency transfer, complete as soon as possible.) The DON acknowledged that the bed hold form was not given to Resident 1 and he refused to accept Resident 1 back to the facility.