Other·September 26, 2024

HSC 1439.6(a) Except as provided in subdivision (b), if a resident is notified in writing of a facility-initiated transfer or discharge from a long-term health care facility, the facility shall also send a copy of the notice to the local long-term care ombudsman at the same time notice is provided to the resident or the resident's representative. HSC 1439.6(c) The copy of the notice shall be sent by fax machine or email, as may be directed by the local long-term care ombudsman, unless the facility does not have fax or email capability, in which case the copy of the notice shall be sent by first-class mail, postage prepaid. A facility's failure to timely send a copy of the notice shall constitute a class B violation, as defined in subdivision (e) of Section 1424. Code of Federal Regulations 483.15(c)(3) Notice before transfer. Before a facility transfers or discharges a resident, the facility must— (ii) Record the reasons for the transfer or discharge in the resident’s medical record in accordance with paragraph (c)(2) of this section; and (iii) Include in the notice the items described in paragraph (c)(5) of this section. Code of Federal Regulations 483.15(c)(4) Timing of the notice. (i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged. (ii) Notice must be made as soon as practicable before transfer or discharge when— (A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section; (B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section; (C) The resident’s health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section; (D) An immediate transfer or discharge is required by the resident’s urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or (E) A resident has not resided in the facility for 30 days. On July 23, 2024, at 9:20 a.m., an unannounced visit to the facility was conducted to investigate admission, transfer, and discharge rights issue. It was determined that the facility failed to provide a copy of the discharge or transfer notice to the local long-term care Ombudsman at the same time notice was provided to Patient 2 or the patient’s representative. This failure did not provide the long-term care Ombudsman the opportunity to advocate for the patients to ensure the transfer or discharge was necessary and appropriate. A review of Patient 2's "ADMISSION RECORD," indicated Patient 2 was admitted to the facility on February 7, 2022, with diagnoses which included Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills). Further review of the admission record indicated the patient did not have any listed legal representative. A review of Patient 2's document titled, "Brief Interview for Mental Status," dated May 15, 2024, indicated Patient 2 had severe cognitive impairment. A review of Patient 2's "Social Service Note," indicated the following: - Dated May 22, 2024, " ...Care plan conference held with patient in person on May 22, 2024, during which the change in the facility operations were discussed and patient verbalized a desire to explore a transfer to another long-term care (LTC) facility..." - Dated June 28, 2024, "...Spoke to patient and informed that he was accepted @ (at) (name of the facility)..." - Dated July 1, 2024, "...Patient will be transported to (name of the facility)..." A review of Patient 2's physician order dated June 28, 2024, indicated, "...Patient may transfer to (name of the facility) under custodial care..." A review of progress notes did not indicate whether a notice of proposed transfer or discharge was provided to the patient and the LTC Ombudsman prior to the proposed discharge date of July 2, 2024. On August 23, 2024, at 3:11 p.m., the Social Service Director (SSD) was interviewed. She stated the notice of the proposed transfer/discharge form would not be given to the patient unless the patient requested. The SSD stated the Ombudsman would receive the written notice of proposed transfer/discharge on the day of the discharge or the following day of the discharge. A review of the facsimile transmittal document dated July 2, 2024, provided by the facility indicated the Ombudsman was provided copy of the discharge notice on July 2, 2024, the day of the discharge. A review of the facility policy and procedure titled, "Transfer or Discharge, Facility-Initiated," dated October 2022, indicated, "...Once admitted to the facility, residents have the right to remain in the facility. Facility -initiated transfers and discharges, when necessary, must meet specific criteria and require resident/representative notification and orientation, and documentation...'Facility- initiated transfer or discharge' means a transfer or discharge which...did not originate through a resident's verbal or written request, and/or is in alignment with the resident's stated goals for care and preferences...the resident and his or her representative are given a thirty (30)-day advance written notice of an impending transfer or discharge from this facility...A copy of the notice is sent to the Office of the State Long-Term Care Ombudsman at the same time the notice of transfer or discharge is provided to the resident and representative..." Based on interview and record review, it was determined that the facility failed to provide a copy of the discharge or transfer notice to the local long-term care Ombudsman at the same time notice was provided to Patient 2 or the patient’s representative. This failure did not provide the long-term care Ombudsman the opportunity to advocate for the patients to ensure the transfer or discharge was necessary and appropriate. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents.