Health inspection·December 12, 2024

The following reflects the findings of the California Department of Public Health during the investigation of complaint number CA00928901. A Class B citation was written. REGULATORY VIOLATIONS: Title 42 Code of Federal Regulations §483.15(e)(1) Permitting Residents to Return to Facility. A facility must establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave. The policy must provide for the following. (i) A resident, whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, returns to the facility to their previous room if available or immediately upon the first availability of a bed in a semi-private room if the resident- (A) Requires the services provided by the facility; and (B) Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. (ii) If the facility that determines that a resident who was transferred with an expectation of returning to the facility, cannot return to the facility, the facility must comply with the requirements of paragraph (c) as they apply to discharges. Title 22 California Code of Regulations. § 72521. Administrative Policies and Procedures. (a) Written administrative, management and personnel policies shall be established and implemented to govern the administration and management of the facility. CCR § 72520. Bed Hold (a) If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed holds of seven (7) days, which may be exercised by the patient or the patient's representative. (c) A licensee who fails to meet these requirements shall offer to the patient the next available bed appropriate for the patient's needs. This requirement shall be in addition to any other remedies provided by law. On 11/14/2024, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate an allegation regarding the facility's refusal to readmit Resident 1. The facility failed to readmit Resident 1 to the facility following hospitalization at General Acute Care Hospital 1 (GACH 1) on 8/13/2024 according to the facility's policy and procedure (P&P) titled, "Transfer or Discharge, Facility-initiated". As a result, Resident 1 remained in GACH 1 and had the potential to cause psychosocial harm. A review of Resident 1's Admission Record indicated resident was admitted to the facility on 7/9/2024 with diagnoses including hypertensive heart disease (a group of heart conditions caused by chronic high blood pressure), emphysema (lung condition that causes shortness of breath) and dysphagia (difficulty swallowing). A review of the Minimum Data Set (MDS - resident assessment tool) dated 7/13/2024, indicated Resident 1's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions was severely impaired. The MDS indicated Resident 1 required moderate assistance from staff for Activities of Daily Living (ADLs- routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves). A review of Resident 1's SBAR (situation, background, assessment, recommendation-a communication tool used by healthcare workers when there is a change of condition among the residents), dated 8/13/2024 indicated the physician recommended to send Resident 1 to GACH 1 due to low blood oxygen level. A review of Resident 1's GACH1 referral sent to the facility on 8/19/2024, indicated, Resident 1 was to be discharged from the hospital after 8/19/2024. During an interview with Business Development (BD) on 11/14/2024 at 1:57 p.m., BD stated, they received GACH 1's referral for Resident 1 on 8/19/2024 for readmission after hospitalization. BD stated the referral was sent to clinical staff to review in which the referral was to be approved by the clinical staff before the facility could readmit resident. BD stated the referral was reviewed by the Director of Nursing (DON) and the Administrator (ADM). BD stated, upon review by the clinical staff, BD was notified the facility was unable to readmit Resident 1 because the facility was unable to accommodate Resident 1's needs. During an interview with the Director of Nursing (DON) on 11/15/2024 at 3:06 p.m., the DON stated the facility was not able to accommodate Resident 1's needs which was why the facility did not readmit Resident 1 after hospitalization from GACH 1. The DON stated, Resident 1's family member (FM) tended to refuse care which could end with Resident 1 requiring transfer back to the hospital. The DON reviewed GACH 1's referral with surveyor and stated, the facility was able to clinically meet the Resident 1's post-hospitalization care plan but the DON was not aware of the GACH's referral. When asked if facility provided a reasonable and appropriate notice and documentation why the facility was unable to accommodate Resident 1 after hospitalization, DON stated, "no". A review of the facility's P&P titled, "Transfer or Discharge, Facility-Initiated", reviewed 1/2024, the P&P indicated, "Residents who are sent emergently to an acute care setting, such as a hospital, are permitted to return to the facility. Residents who are sent to the acute care setting for routine treatment/planned procedures are also allowed to return to the facility... If the facility does not permit a resident's return to the facility (i.e., initiates a discharge) based on inability to meet the resident's needs, the facility will notify the resident, and/or his or her representative in writing of the discharge, including notification of appeal rights... If the facility determines that the resident cannot return to the facility, the medical record will indicate that the facility made efforts to: a. determine if the resident still requires the services of the facility and is eligible for Medicare skilled nursing facility or Medicaid nursing facility services; b. ascertain an accurate status of the resident's condition, which can be accomplished via communication between hospital and facility staff and/or through visits by facility staff to the hospital." The facility failed to readmit Resident 1 to the facility following hospitalization at GACH 1on 8/13/2024 according to the facility's P&P titled, "Transfer or Discharge, Facility-initiated". As a result, Resident 1 remained in GACH 1 and had the potential to cause psychosocial harm. The above violation had a direct relationship to the health, safety, and security of Resident 1.