Health inspection·October 3, 2023

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, for one of three sampled residents (Resident 1), the facility failed to follow a written policy on permitting residents to return to the facility when Resident 1, who was transferred to the hospital on [DATE] and continued to require services provided by the facility, was not allowed to return on [DATE]. This failure resulted in an unnecessary hospital stay for nine days from [DATE] to [DATE].Findings: During a review of Resident 1's Detailed Summary, the Detailed Summary indicated Resident 1 was admitted to the facility on [DATE]. During a review of Resident 1's Progress Notes, dated [DATE], the Progress Notes indicated Resident 1 was admitted with diagnoses that included diabetes mellitus (abnormal blood sugar levels), chronic obstructive pulmonary disease (COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems), and right foot osteomyelitis (bone infection). During a review of Resident 1's Interdisciplinary Notes, dated [DATE], the Interdisciplinary Notes indicated Resident 1 was noted with altered mental status and did not recall place and event (way of measuring one's awareness, did not know where they are and why they are there). The Notes indicated Resident 1 was taken to the hospital for further evaluation. During a telephone interview on [DATE] at 3:03 p.m. with Case Manager (CM), CM stated Resident 1 was ready to be discharged from the hospital on [DATE]. CM stated he called Admissions Director (AD) on [DATE] but was told Resident 1 would not be allowed to return to the facility. CM also stated AD had indicated Resident 1 was already discharged from the facility. CM stated he was told by AD that Resident 1 did not have enough Medicare (federal health insurance that covers up to 100 days of care in a facility) days left and would require long-term stay. During an interview and concurrent review on [DATE] at 10:50 a.m. with Director of Nursing (DON), the facility's daily census from [DATE] to [DATE] was reviewed. DON stated when Resident 1 was transferred to the hospital on [DATE], Resident 1 was offered a seven-day bed hold (holding or reserving a resident's bed while the resident is absent from the facility for therapeutic leave or hospitalization). DON stated the seven-day bed hold expired on [DATE] so Resident 1 was discharged from the system. DON stated Resident 1 was clinically ready to return from the hospital on [DATE] and did not require special care different than what was provided before Resident 1's transfer to the hospital. DON stated the facility did not accept Resident 1 back because there was no available long-term bed at the time. DON was not able to explain further what long-term bed and short-term bed meant, but Page 1 of 2 555189 555189 10/03/2023 Mercy Retirement & Care Center 3431 Foothill Blvd. Oakland, CA 94601

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some explained that Resident 1, after staying in the hospital for 24 days, required long-term care services the facility could not provide. DON stated there were five available beds for potential residents on [DATE], which DON stated, were non-long term beds. DON stated there was no facility policy identifying a long-term bed from a short-term bed. During a follow-up interview on [DATE] at 11:21 a.m., with DON, DON stated, on [DATE], another resident, Resident 3 was admitted to the facility. DON stated as of [DATE], there were 35 residents currently receiving long term care services. During a review of the Hospitalist Discharge summary dated [DATE], the Hospitalist Discharge Summary indicated Resident 1 will likely need a prolonged course of rehabilitation. During an interview on [DATE] at 11:26 a.m. with AD, AD stated receiving a telephone call from CM on [DATE] about Resident 1's return to the facility. AD stated Resident 1 had 11 Medicare days available and had Medical (state program that pays for health care services) eligibility. AD stated, the facility's policy indicated that if a resident was admitted to the facility for short-term stay, transferred to the hospital unexpectedly, and returns to the facility for long-term stay, the resident would not be accepted back because there are no long-term beds available. AD stated she was not aware of a facility policy on permitting residents to return after hospitalization. During a concurrent interview and review of the facility's policy and procedure (P&P) titled Bed holds and Returns, last revised [DATE], on [DATE] at 11:47 a.m. with Regional Operations Specialist (ROS), the P&P indicated Residents who seek to return to the facility after a state bed-hold period has expired . are allowed to return to their previous room if available or immediately to the first available bed in a semi-private room provided that the resident: still requires the services provided by the facility; and is eligible for Medicare skilled nursing facility or Medicaid nursing facility services. ROS stated the facility's P&P was clear and well-written, Resident 1 should be allowed to return to the facility. 555189 Page 2 of 2