Health inspection·February 6, 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. Based on interview and record review, the facility failed to provide notice of a facility-initiated discharge to the appropriate parties for one of two sampled residents (Resident 1) when, Resident 1 was provided a notice of discharge for failure to pay on 1/3/24 and the notice was not sent to a representative of the Office of the State Long-Term Care (LTC) Ombudsman (a patient rights advocate). This failure resulted in the State LTC Ombudsman being uninformed of the discharge decision, removed the opportunity for the State LTC Ombudsman to advocate on Resident 1's behalf, and removed the State LTC Ombudsman awareness of the facility's activities related to discharges. Findings: During an interview on 2/5/24, at 4:24 p.m., the Ombudsman stated Resident 1 informed her the facility provided Resident 1 a thirty-day notice of discharge. The Ombudsman stated the State LTC Ombudsman office had not received a thirty-day notice of discharge from the facility for Resident 1. During a concurrent interview and record review on 2/6/24, at 3:02 p.m., a 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 [LTCOP], revised 5/2022, was reviewed with the Social Services Director (SSD). The SSD stated she was provided the document from the Ombudsman office which directed what types of notices, resident initiated or facility-initiated transfer/discharge notices, needed to be sent to the State LTC Ombudsman Office and in what time frame. The SSD stated the notice of transfer/discharge would be sent to the State LTC Ombudsman office for a facility-initiated discharge. Resident 1's NOTICE OF TRANSFER / DISCHARGE, dated 1/3/24, was reviewed with the SSD. The notice of transfer/discharge indicated, .Notification Date: 1/3/2024 .Effective Date: 2/2/24 .This notice is to inform you that transfer/discharge is necessary for the following reason .[box was marked in front of the following reason] You have failed, after reasonable and appropriate notice, to pay for .a stay at the facility . The section Copy to .State LTC Ombudsman Office-Date was marked, but the date was left blank. The SSD confirmed Resident 1's notice of transfer/discharge was facility initiated due to nonpayment of cost of share for a stay at the facility. The SSD confirmed the notice was not sent to the State LTC Ombudsman Office. The SSD explained she did not send Resident 1's transfer/discharge notice to the State LTC Ombudsman Office because the facility rescinded the notice two weeks after it was issued. The SSD was unable to locate documentation of the notice being rescinded in Resident 1's medical record. Review of Resident 1's Social Services Note, dated 1/3/24, indicated, The resident was issued a Page 1 of 2 555080 555080 02/06/2024 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 Notice of Transfer/Discharge due to the resident has failed, after reasonable and appropriate notice, to pay for his share of cost to stay at this facility. The resident's share of cost started 12/1/2023. The resident continues to refuse to pay his share of cost. During an interview on 2/6/24, at 3:53 p.m., the Administrator (ADM) stated the purpose of providing the transfer/discharge notice to residents was to align the intent on the plan for discharge, so the resident had the opportunity to agree or disagree with the plan for discharge. The ADM stated the purpose of also providing the transfer/discharge notice to the State LTC Ombudsman office was to inform the Ombudsman, to represent resident 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 . In the section titled When should a notice be sent to the local LTCOP? indicated, 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 at the same time . 555080 Page 2 of 2