Health inspection·January 22, 2025

§483.15(e)(1) Permitting residents to return to the facility. (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. §72527. Patients' Rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. §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. On 12/20/2024, the California Department of Public Health (CDPH) received a complaint alleging a resident (Resident 1) was not allowed to return to the facility from 12/5/2024 to 12/24/2024. On 12/20/2024, the CDPH made an unannounced visit to the facility. The facility failed to: 1. Implement its policy and procedure (P&P) titled “Readmission to the Facility,” which indicated the facility will readmit residents who required skilled nursing care at the facility and allow residents who were previously at the facility to be readmitted. This resulted in the denial of Resident 1’s right to return to the facility. Resident 1 was a 43-year-old male, admitted to the facility on 8/23/2024 with diagnoses including chronic obstructive pulmonary disease ([COPD] a chronic lung disease causing difficulty in breathing), encephalopathy (a brain disorder or disease that affects the brain’s function), and heart failure (a condition where the heart is unable to pump enough blood to meet the body’s needs resulting in inadequate oxygen delivery to organs and tissues). A review of Resident 1’s Minimum Data Set ([MDS] a resident assessment tool), dated 8/9/2024, indicated Resident 1’s cognition (ability to learn, reason, remember, understand, and make decisions) was moderately impaired. The MDS indicated Resident 1 was dependent on staff for showering, dressing, and personal hygiene. The MDS indicated Resident 1 had a feeding tube (flexible plastic tube that delivers nutrition, fluids, and medications directly into the digestive system), tracheostomy (an opening surgically created through the neck into the trachea to allow air to fill the lungs), and oxygen therapy (a medical treatment that involves administering extra oxygen to patients with breathing problems). A review of Resident 1’s History and Physical (H&P) dated 8/25/2024, indicated Resident 1 had the capacity to make medical decisions. A review of Resident 1’s GACH “Discharge Planning Progress Note,” dated 12/9/2024, the Discharge Planning Progress Note indicated Resident 1’s Clinical Social Worker (from GACH) spoke with the facility and left a message for the Admission Coordinator (AC). A review of Resident 1’s General Acute Care Hospital (GACH) titled, “Consultation,” dated 12/9/2024, the Consultation indicated Resident 1 was less agitated and off restraints. A review of the facility’s Census, dated 12/9/2024, indicated there were three male rooms available in the Sub-Acute (a specialized nursing specialty that provides care for patients who need more intensive care) and the Skilled Nursing Facility (SNF). A review of Resident 1’s GACH records titled, Discharge Planning Progress Notes, dated 12/16/2024, indicated the AC stated there were no open beds at the Skilled Nursing Facility (SNF) side and the barrier to acceptance was Resident 1 was on restraints. The Discharge Planning Progress Notes indicated the AC was informed that Resident 1 had not been on restraints since 12/5/2024. A review of the facility’s Census, dated 12/16/2024, indicated there were one male room available in the Sub-Acute and there were three male rooms available in the SNF. During a telephone interview on 12/20/2024 at 4:10 p.m., with the GACH Clinical Social Worker (CSW), the CSW stated Resident 1 was sent to GACH on 10/20/2024 by the facility due to mental changes. The CSW stated Resident 1 had to be placed in restraints and was medically cleared to returned to the facility on 10/22/2024. The CSW stated the facility refused to readmit Resident 1 because the resident was in restraints. The CSW stated once the restraints were discontinued on 12/5/2024, the CSW called the facility and was told there were no beds available on 12/9/2024 and 12/16/2024. The CSW stated the facility did not want to take Resident 1 back. During a concurrent interview and record review on 12/24/2024 at 11:00 a.m., with the Admission Coordinator (AC), the Census, dated 12/9/2024 and 12/16/2024 were reviewed. The AC stated the Census indicated there were three male beds available at the SNF side of the facility. The AC stated Resident 1 was in the Sub-Acute before he was transferred to the GACH. The AC stated the facility was not able to accept the resident back if he was in restraints. The AC stated the GACH had contacted her on 12/16/2024 and she forwarded the message about the resident’s return to the Administrator (ADM) and Director of Nursing (DON). The AC stated she was not sure if the Administrator and DON followed up with GACH about readmitting the resident. During an interview on 12/24/2024 at 11:15 a.m. with the Administrator (ADM), the ADM stated, “Resident 1 was in the Sub-Acute and we were able to manage the resident.” The ADM stated Resident 1 was sent to GACH and was not able to be readmitted due to him needing restraints. The ADM stated, “Resident 1 was manageable, and the resident was fine,” The ADM stated, “We were having an issue with his brother visiting and sleeping in the resident’s room and the resident did not have the capacity to tell the brother not to come.” The ADM stated, “We were misled by another hospital, and the resident required restraints initially upon admission is the reason for not wanting to readmit the resident” The ADM stated, “we are able to readmit the resident if he is clinically cleared and if we have a bed available.” During a concurrent interview and record review on 12/24/2024 at 12:34 p.m. with the DON, the Census, dated 12/5/2024 to 12/24/2024 were reviewed. The DON stated the census indicated there were male beds available in the Sub-Acute and the SNF. The DON stated Resident 1 was sent to GACH on 12/09/2024 due to altered mental behavior changes. The DON stated Resident 1 was in the Sub-Acute unit, pulling on his tracheostomy and required close supervision. The DON stated the only way Resident 1 could be readmitted to the facility was if the resident’s restraints were discontinued for 48 hours straight and if a bed was available in the facility. The DON stated there were male beds available from 12/5/2024 to 12/24/2024 in the Sub-Acute and in the SNF. A review of the facility’s policy and procedure (P&P) titled, “Readmission to the facility,” dated 3/2017, indicated residents who have been discharged to the hospital or for therapeutic leave will be given priority in readmission to the facility. A review of the facility’s policy and procedure (P&P) titled, Bed-Holds and Returns, dated 10/2022, indicated residents who week to return to the facility after the state bed-hold period has expired are allowed to return to their previous room if available or immediately to the first available bed. The facility failed to: Implement its policy and procedure (P&P) titled, “Readmission to the facility,” which indicated the facility would provide readmission of the residents who require skilled nursing care at the facility and allow residents who were previously at the facility to be readmitted. This resulted in the denial of Resident 1’s right to return to the facility. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to Resident 1.