Health inspection·September 6, 2024

§483.15(e) Permitting residents to return to facility. §483.15(e)(2) Readmission to a composite distinct part. When the facility to which a resident returns is a composite distinct part (as defined in § 483.5), the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of return, the resident must be given the option to return to that location upon the first availability of a bed there. 72523 (a) Patient Care Policies and Procedures Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 7/19/2024, the California Department of Public Health (CDPH) received a complaint alleging the facility would not readmit Resident 1 to the facility before the resident's seven-day bed hold expired. On 7/19/2024, CDPH conducted an unannounced visit to the facility to investigate the complaint allegation. Upon investigation CDPH determined, on 6/26/2024 Resident 1 was found unresponsive, without a pulse, and turning yellow, cardiopulmonary resuscitation ([CPR] a procedure that combines rescue breathing and chest compressions to temporarily pump enough blood to the brain until specialized treatment is available) was started, 911 was called and Resident 1 was transferred to a General Acute Care Hospital (GACH) for evaluation and treatment. The Facility failed to: 1. Ensure Resident 1 was readmitted to the facility within the seven-day bed hold period, after he was transferred to a GACH due to unresponsiveness for evaluation and treatment. 2. Ensure the facility staff adhered to the facility's policy and procedure (P/P), titled, "Bed-Holds and Returns," that indicated, "the resident will be permitted to return to an available bed in the location of the facility that he or she previously resided. If there is not an available bed in that part, the resident will be given the option to take an available bed in another distinct part of the facility and return to the previous distinct part when a bed becomes available." As a result, Resident 1 remained in the GACH for 16 days after being cleared by the GACH to return to the facility on 7/2/2024 and was placed at risk for depression, feeling of abandonment and confusion. Findings: A review of Resident 1's Admission Record (Face Sheet) indicated Resident 1 was admitted to the facility on 12/31/2022 with diagnoses including acute (sudden or severe) and chronic (having an illness persisting for a long time or constantly recurring) respiratory failure (when the lungs cannot provide enough oxygen or can't remove enough carbon dioxide [a colorless odorless gas that is a waste product in the human body] from the body), tracheostomy (an opening surgically created through the neck into the windpipe to allow air to fill the lungs) placement, and altered mental status ([ALOC] a change in mental function that stems from illnesses, disorders, injuries affecting the brain). A review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 5/28/2024, indicated Resident 1's cognitive skills for daily decision making were severely impaired. A review of Resident 1's History and Physical (H&P), dated 7/21/2024 indicated Resident 1 did not have the capacity to understand and make decisions. The H&P indicated Resident 1 had a surrogate decision maker (a legally designated person who makes medical decisions for someone who is unable to do so for themselves was a family member [FM 1]). A review of the Facility's Census dated 7/3/2024, indicated, there was a bed available on the facility's Subacute Unit (a type of inpatient care that provides more intensive services than skilled nursing facilities). A review of Resident 1's Progress Notes, dated 6/26/2024, indicated, Resident 1 was unresponsive, had no pulse, was turning yellow. The Progress Notes indicated, CPR was started, 911 was called, and Resident 1 was transferred to a GACH for evaluation and treatment. A review of Resident 1's Physician's Orders, dated 6/26/2024, indicated to transfer Resident 1 to a GACH for further evaluation due to unresponsiveness. The Physician's Orders indicated to hold Resident 1's bed for seven days. A review of Resident 1's GACH Communication Orders, dated 7/2/2024, and timed at 11:56 a.m., indicated, Resident 1 was stable, placed on Hospice (a type of care that focuses on the comfort and quality of life of a person who is nearing the end of their life) and was ready to be transferred back to the facility. During an interview on 7/19/2024, at 5 p.m., the Administrator (ADM), stated Resident 1 was denied readmission to the facility because they never had a hospice resident on the Subacute Unit before. The ADM stated Resident 1 had Carbapenem-Resistant Pseudomonas Aeruginosa ([CRPA] a serious bacterial infection that can cause a variety of infections in healthcare settings) and they did not have an isolation bed available on the skilled nursing side of the facility. The ADM stated, they had an isolation bed on the Subacute Unit, but they did not readmit Resident 1 there because a family member (not the Responsible Party [RP]) did not want Resident 1 at the facility. During an interview on 7/19/2024, at 5:02 p.m., FM 1 stated, he was told by the facility's Admission Coordinator (AC) and Case Manager (CM) that hospice residents were not accepted on the Sub Acute unit. During an interview on 7/23/2024, at 5:10 p.m., the Director of Nursing (DON) stated, they did not readmit Resident 1 to the facility because FM 1 and another family member were feuding and one FM who was not Resident 1's RP did not want Resident 1 to come back to the facility. A review of All Facility's Letter 24-15 (AFL 24-15), dated 6/13/2024, AFL 24-15 indicated as of 3/20/2024, all Skilled Nursing Facilities (SNFs) in compliance with the Centers for Medicare & Medicaid Services (CMS) Enhanced Barrier Precautions ([EBP] an infection control strategy that uses personal protective equipment ([PPE] clothing and gear that medical professional wear to protect themselves from infection and injury to reduce the spread of Multidrug-resistant Organisms {[MDROs] bacteria that have become resistant to certain antibiotics} in nursing homes) requirement are able to admit and provide care for residents with MDROs. Thus, there was no basis for the facility to refuse admission to Resident 1 based on their need for EBP or MDRO status. Residents on EBP do not require placement in a single-person room, even when known to be infected or colonized with an MDRO. A review of the facility's policy and procedure (P&P) titled, "Bed-Holds and Returns," dated 3/2017, indicated, "the resident will be permitted to return to an available bed in the location of the facility that he or she previously resided. If there is not an available bed in that part, the resident will be given the option to take an available bed in another distinct part of the facility and return to the previous distinct part when a bed becomes available." The Facility failed to: 1. Ensure Resident 1 was readmitted to the facility within the seven-day bed hold period, after he was transferred to a GACH due to unresponsiveness for evaluation and treatment. 2. Ensure the facility staff adhered to the facility's policy and procedure (P/P), titled, "Bed-Holds and Returns," that indicated, "the resident will be permitted to return to an available bed in the location of the facility that he or she previously resided. If there is not an available bed in that part, the resident will be given the option to take an available bed in another distinct part of the facility and return to the previous distinct part when a bed becomes available." As a result, Resident 1 remained in the GACH for 16 days after being cleared by the GACH to return to the facility on 7/2/2024 and was placed at risk for depression, feeling of abandonment and confusion This violation had a direct or immediate relationship to the health, safety, or security of Resident 1.