Health inspection·April 25, 2023

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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, the facility failed to follow its written policy on permitting residents to return to the facility after they were hospitalized for 1 of 1 closed record (Resident #1) reviewed for admission/transfer/discharge rights. CR #1 was not allowed to return to the facility after being sent to doctor's office and hospital. This failure could place residents at risk for not receiving care and services to meet their needs upon discharge, a disruption of care, and being discharged without alternate placement. The findings included: Review of CR #1's closed record's face sheet dated 04/25/23 reflected a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included: muscle weakness, difficulty in walking, repeated falls, anxiety disorder, hypothyroidism (A condition resulting from decreased production of thyroid hormones) and hypertension. Resident #1 was her own responsible party. Record review of CR #1's MDS dated [DATE] reflected her BIMs Score was 15 indicating she was mentally competent. Record review of CR #1 Hospital discharge paper dated 12/27/22 reflected CR#1 was discharged from hospital to another facility on 12/27/22. Record review of Intake ID # 415595 dated 03/31/23 reflected CR #1 was involuntary discharged from facility. Record review of facility's provided letter, titled NMNC signed by facility staff on 10/02/22 and unsigned by resident \responsible party reflected that skilled service would end on 10/03/22. Record review of nurse's note dated 12/16/2022 3:30PM, read in part: Resident went to the MD appointment on 6am-2pm shift, on this 2pm-10pm shift, PCT called and said that resident was transported to the emergency from the doctor appointment . In an interview with facility staff on 04/25/23 at 3:00PM, she said CR # 1 was issued a discharge notice on 10/20/22 and an appeal was requested on 11/10/22. She said Resident was not accepted back to the facility since resident was already issued a discharge letter while she was in and out of hospital. She said Resident #1 was in the window period of being discharged . She said the hospital Page 1 of 2 676204 676204 04/25/2023 Focused Care at Cedar Bayou 2000 W Baker Road Baytown, TX 77521

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Staff told her that Resident #1 was discharged to a safe place where her needs could be met. She said CR #1 would not be re-admitted to the facility due to nonpayment. She said Resident#1's Medicaid application was denied due to lack of medical necessity. Record review of Fair Hearing - Medicaid dated 12/20/2022 titled - Nursing Facility Discharge Case Number: 184427248; Appeal ID: 3614410 read in part- The Hearings Officer instructs the nursing facility to: o Allow the Appellant to remain in the facility and do not discharge Appellant from the facility. o Within 10 days from the date of this decision, the nursing facility must report compliance with this order. o This order does not preclude the nursing facility from processing any future notices of discharge, and the Appellant or Appellant's representative retains the right to appeal any future discharge actions by the nursing facility. During an interview with Hospital Social Worker B on 04/25/22 at 4:00PM, he said the initial facility was contacted prior to resident's discharge and he was told by the facility staff that the facility would not accept the resident back. He said he made other arrangements and was able to send CR # 1 to another local rehab facility for treatment. During an interview with Facility Administrator and DON on 04/25/22 beginning at 4:30PM the Administrator said it was the policy of the facility to accept resident's back to the facility. She said all discharges\readmit always come through another department that handle all admissions. She said the facility normally receive a letter from the admission team to expect the resident she said she was not at the facility during the time of Resident #1. The DON said the facility did not receive any notice from the admission team on behalf of CR #1. Record review of facility's policy on admission, transfer and discharge rights dated 2001 updated 2005 read in part-Each resident will be permitted to remain in the facility and not transferred or discharged . #2 if the resident exercises his or her right to appeal a transfer or discharge notice he\she will not be transferred or discharged while appeal is pending . 676204 Page 2 of 2