Health inspection·January 24, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide notice of a facility-initiated discharge (a resident is given 30 days notice to find another place to live) to the appropriate parties for Resident 1 when, Resident 1's representative (RR, a designated person to make decisions for another person) was provided a notice of discharge on [DATE] and the notice was not sent to a representative of the Office of the State Long-Term Care (LTC) Ombudsman (a resident rights advocator) at the same time. This failure had the potential for the State LTC Ombudsman not being aware of Resident 1's facility initiated transfer/discharge and potentially prevented the opportunity for the State LTC Ombudsman to advocate for resident 1's rights. Findings: During an interview on 2/14/24, at 9 a.m., the Ombudsman stated the State LTC Ombudsman office had not received a notice of discharge from the facility for Resident 1. Review of Resident 1's Social Services Note dated 11/20/23, indicated, The resident's [Resident 1] son met with the Administrator, DON [Director of Nursing] & SSD [Social Services Director]. The son was issued a Notice of Transfer/Discharge. It was explained to the son that he should be prepared to transfer/discharge at the end of 30 days from the date of the Notice of Transfer/Discharge . Review of Resident 1's NOTICE OF TRANSFER / DISCHARGE, dated 11/20/23, indicated, .Notification Date: 11/20/2023 .Effective Date: 12/20/2023 .This notice is to inform you that transfer/discharge is necessary for the following reason . [box was marked in front of the following reason] The safety of individuals in the facility is endangered due to your clinical or behavioral status . During an interview on 2/22/24, at 1:57 p.m., the Administrator (ADM) stated Resident 1's transfer/discharge notice was not sent to the State LTC Ombudsman Office. The ADM stated the notice of transfer/discharge should be sent to the State LTC Ombudsman office for a facility-initiated discharge at the same time the notice was issued to the resident. During an interview on 2/27/24, at 12:28 p.m., the SSD stated Resident 1's notice of transfer/discharge was given to Resident 1's representative on 11/20/23. The SSD stated the facility initiated Resident 1's discharge because of Resident 1's behaviors of hitting other residents. The SSD stated a copy of Resident 1's notice of transfer/discharge was not sent to the Ombudsman's office. The SSD further stated she was under the impression that they needed to send the notice of transfer/discharge to the Ombudsman office after the resident left the facility. The SSD added she usually sent a copy Page 1 of 2 555080 555080 01/24/2024 Tracy Nursing and Rehabilitation Center 545 West Beverly Place Tracy, CA 95376

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of the transfer/discharge notice to the Ombudsman's office in a week or two after the resident/s left the facility. The SSD stated after they [facility staff] reviewed the documents in depth, she was now aware that the minute the notice of transfer/discharge was issued to the resident, the notice also needed to be sent to the Ombudsman's office. The SSD stated the notice of transfer/discharge needed to be sent to the Ombudsman's office at the same time it was issued to the resident/RR so the Ombudsman was aware of the resident's discharge/transfer notice being issued in case the resident wanted to appeal the decision. The SSD stated the Ombudsman was an advocate for residents and their rights. Review of a facility provided document titled STATE OF CALIFORNIA OFFICE OF THE STATE LONG-TERM CARE OMBUDSMAN SENDING REQUIRED TRANSFER/DISCHARGE NOTICES TO YOUR LOCAL LONG-TERM CARE OMBUDSMAN PROGRAM, revised 5/2022, .Facilities are required to send copies of all notices related to facility-initiated transfers and discharges .Facilities must give residents and their representatives a notice of discharge or transfer at least 30 days in advance .The facility must send copies of these notices to the LTCOP [Ombudsman] at the same time . 555080 Page 2 of 2