Other·July 21, 2022

F626 Permitting Residents to Return to Facility §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. §483.15(e)(2) Readmission to a composite distinct part. When the facility to which a resident return 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 - Patient Care Policies and Procedures (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. § 72315 - Nursing Service - (b) Each patient shall be treated as individual with dignity and respect and shall not be subjected to verbal or physical abuse of any kind. On 5/6/2022, the Department received a complaint regarding the facility’s refusal to re-admit, a resident. On 5/20/2022, an unannounced visit to the facility was conducted to investigate a complaint allegation regarding refusal to re-admit a resident back to the facility. The facility failed to: 1. Ensure Resident 1 was provided a Notice of Proposed Transfer and Discharge. 2. Ensure the State Long Term Care Ombudsman was notified of Resident 1’s transfer and discharge from the facility. 3. Ensure Resident 1 was re-admitted back to the facility after hospitalization. These deficient practices resulted in Resident 1 being sent to a different facility which had the potential to cause psychosocial harm. During a review of Resident 1’s admission record, the admission record indicated Resident 1 was initially admitted to the facility on 10/11/2021 and re-admitted on 11/16/2021. Resident 1’s diagnoses included pressure ulcer (injury to the skin and underlying tissue, primarily caused by prolonged pressure on the skin) of sacral region (near the lower back and spine), paraplegia (paralysis of the legs and lower body, typically caused by spial injury or disease), dependence on wheelchair (relying on a wheelchair to move around), and generalized muscle weakness (reduced strength in one or more muscles). During a review of Resident 1’s History and Physical (H&P) dated 10/13/2021, the H&P indicated Resident 1 had the capacity to understand and make decisions. During a review of Resident 1’s Minimum Data Set (MDS), a standardized assessment and care-screening tool, dated 2/9/2022, the MDS indicated Resident 1 was able to make self-understood and is able to understand others. The MDS indicated Resident 1 required extensive assistance with transfer, locomotion on unit and off unit, and toilet use. The MDS also indicated Resident 1 required a total assistance for bathing. During a review of Resident 1’s Physician Order (PO) dated 3/23/2022 at 12:10 p.m., the PO indicated Resident 1 was to be transferred to General Acute Care Hospital (GACH) for psychiatric evaluation. During a review of the facility’s Resident Census (RS) dated 3/23/2022 at 9:47 p.m., the RS indicated Resident 1 was to be discharged to custodial care. During a review of Resident 1's Progress Notes dated 3/24/2022 at 8:36 p.m., the Progress Notes indicated Resident 1 was discharged via gurney with all belongings to a general acute care hospital (GACH) accompanied by two Emergency Medical Technicians (EMT). On 6/15/2022 at 11:36 a.m., during review of Resident 1's medical record, from 3/2022 to current, and concurrent interview with Discharge Coordinator (DC), the DC confirmed there was no Notice of Proposed Transfer or Discharge form. DC stated there was no discharge planning for Resident 1. DC stated the Notice of Proposed Transfer or Discharge form should have been completed and the Ombudsman (OMB) should have been notified. DC also stated that there was no discharge summary completed nor Interdisciplinary Team Meeting conducted prior to Resident 1 being discharged from the facility. During a review of Resident 1' California Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (CSAA), dated May 2011, the CSAA indicated, a written notice of discharge to another facility against the resident wishes will be provided to the resident thirty days in advance. The CSAA indicated a written notice will include the effective date, the location to which the resident will be discharged, and the reason for transfer/discharge. The CSAA indicated if the resident discharged against his or her wishes, the facility will provide discharge planning as required by law. During a review of facility's P/P titled "Transfer or Discharge, preparing a Resident for", revised December 2016, the P/P indicated a post-discharge plan is developed for each resident prior to his or her transfer or discharge. The P/P also indicated this plan will be reviewed with the resident at least twenty-four hours before the resident's discharge or transfer from the facility. During a review of facility's Policy and Procedure (P/P) titled "Transfer or Discharge Notice", revised March 2021, the P/P indicated the resident is given thirty days advance written notice of an impending transfer or discharge from the facility. B. During a review of Resident 1's Progress Notes (PN) dated 3/23/2022, the PN indicated the facility did not arrange to admit Resident 1 back to the facility. During an interview on 5/20/2022, at 12:30 p.m., Ombudsman (OMB), stated she was contacted by the GACH Social Services Director (SSD 1) regarding Resident 1 wanting to return to the facility, but there were no available beds. OMB stated per facility’s census on 5/4/2022, there were two female beds available, and ADMIN was refusing to re-admit Resident 1. OMB also stated the facility admitted new residents before re-admitting Resident 1. During a review of Facility Census (FC) dated 5/4/2022, the FC indicated there were two unassigned beds available, and four admissions, which two of the four admissions were female residents. On 6/3/2022 at 2:36 p.m., during review of Resident 1's PO's and GACH’s record, dated from 3/29/22 to 4/2/22, and concurrent interview, the Social Service Director (SSD 1) stated discharge planning for Resident 1 was initiated on 3/29/22 at 2:34 a.m. SSD 1 stated Resident 1 was initially discharged to a Board and Care (B&C) facility on 4/2/22 but immediately returned to GACH due to behavioral issues. SSD 1 stated Resident 1 wanted to return to SNF but was denied admission. SSD 1 stated OMB was notified on Resident 1's behalf due to SNF refusing to re-admit Resident 1. During an interview on 5/20/2022, at 10:20 a.m., the Administrator (ADMIN) stated, at the time Resident 1 was transferred to GACH on 3/23/2022, Resident 1 did not indicate she wanted to return to facility. ADMIN stated, Resident 1 exceeded seven day bed hold and had been officially discharged from the facility. ADMIN stated, “Since Resident 1 was self-responsible, the facility did not bill Medi-Cal for a bed hold. Instead, we cooperated with the GACH and assisted them in finding an alternate facility.” During an interview on 5/20/2022, at 10:30 a.m., with Admissions Coordinator (AC), AC stated re-admits to the facility are ultimately decided by the Director of Nursing (DON) and ADMIN. During a review of the facility's Policy and Procedure (P/P) titled "Bed-Holds and Returns", undated, the P/P indicated the resident will be permitted to return to an available bed in the location that he or she previously resided. The P/P also indicated 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. During a review of Resident 1's California Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (CSAA), dated May 2011, the CSAA indicated, if you are away from our facility for more than seven days due to hospitalization, we will readmit you to the first available bed in a semi-private room if you need the care provided by our Facility and wish to be readmitted. The facility failed to: 1. Ensure Resident 1 was provided a Notice of Proposed Transfer and Discharge. 2. Ensure the State Long Term Care Ombudsman was notified of Resident 1’s transfer and discharge from the facility. 3. Ensure Resident 1 was re-admitted back to the facility after hospitalization. This deficient practice resulted in Resident 1 being sent to a different facility which had the potential to cause psychosocial harm. These violations presented a direct or immediate relationship to the health, safety, security, or welfare of the residents.