Other·December 20, 2023

F623 (Rev. 208; Issued:10-21-22; Effective: 10-21-22; Implementation:10-24-22)§483.15(c)(3) Notice before transfer. Before a facility transfers or discharges a resident, the facility must- (i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman. (ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and (iii) Include in the notice the items described in paragraph (c)(5) of this section.

F626 (Rev. 208; Issued:10-21-22; Effective: 10-21-22; Implementation:10-24-22 §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. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 11/2/2023 the California Department of Health (CDPH) received a complaint alleging a resident (Resident 1) was admitted to a General Acute Care Hospital (GACH 2) on 10/18/2023 and was ready for readmission back to the skilled nursing facility (SNF) on 11/1/2023 but the facility refused to readmit Resident 1 because Resident 1 owed the facility $27,000.00. On 11/4/2023 the CDPH conducted an unannounced visit to the facility to investigate the allegation. The CDPH determined Resident 1 was transferred to GACH 1 on 10/10/2023 and from GACH 1 to GACH 2 10/18/2023 for evaluation and treatment following a change in condition (COC). On 11/1/2023 Resident 1 was cleared by GACH 2 to return to the facility. The facility refused to readmit Resident 1 back to the facility due to their inability to care for Resident 1's wound care needs. The facility failed to: 1. Ensure Resident 1, who was transferred to GACH 2, was readmitted back to the facility when the GACH 2 cleared Resident 1 to be return to the facility. 2. Ensure Resident 1 and/or Resident 1's Responsible Party (RP) was provided a 30-days' Notice of Transfer Discharge for an impending transfer or discharge from the facility, per the facility's P/P, titled, "Notice of a Transfer and/or Discharge." This deficient practice resulted in Resident 1's unnecessary stay at GACH 2 after being cleared (discharged) to return to the facility. This deficient practice placed Resident 1 at risk for interrupted and inconsistent continuity of care. A review of Resident 1's Admission Record (Face sheet), indicated Resident 1 was initially admitted to the facility on 5/3/2023 and readmitted on 3/23/2023 with diagnoses including spinal stenosis of the lumbar region (a condition of narrowing of the spinal canal compressing the nerves that result in pain and numbness), right buttock and bilateral (both) heel pressure ulcers (an injury that breaks down the skin and underlying tissue) and diabetes mellitus ([DM] a chronic condition associated with abnormally high levels of sugar in the blood). A review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 8/1/2023, indicated Resident 1 was able to make independent decisions that were reasonable and consistent. The MDS indicated Resident 1 required an extensive two-persons physical assistance to complete activities of daily living ([ADL] residents' daily self-care activities such as bed mobility, toilet use and personal hygiene). The MDS indicated Resident 1 had an indwelling urinary catheter (a catheter placed in the bladder to drain urine from the bladder into a bag outside of the body), a colostomy (an opening in the belly that is made during a surgery procedure to allow waste to leave the body) and three Stage 4 pressure ulcers (a deep wound that may impact the muscle, tendons, ligaments, and bone) that were present upon admission to the facility. A review of Resident 1's Situational Background Assessment Recommendation ([SBAR] a form of communication between members of a health care team) Communication Form and the Licensed Nurses Progress Notes dated 10/10/2023, indicated Resident 1 was transferred to GACH 1 on 10/10/2023 due to Resident 1's altered level of consciousness ([ALOC] a change in a person's state of awareness [ability to relate to self and the environment] and arousal [alertness]) and hyperglycemia (high blood glucose [sugar]) with a blood sugar (b/s) level of 514 milligrams ([mg] a unit of measurement/deciliter ([dl] a unit of measurement). The blood sugar reference range is 70 mg/dl to 100 mg/dl. A review of Resident 1's Order Summary (Physician's Order) dated 10/11/2023, indicated a to transfer Resident 1 to a GACH due to altered mental status ([AMS] a changed level of awareness or mental state that falls short of unconsciousness) with a seven-day bed hold. A review of GACH 2's Face Sheet, indicated Resident 1 was admitted to GACH 2 on 10/18/2023. A review of GACH 2's History and Physical (H&P), indicated Resident 1 was admitted to GACH 2 from GACH 1 on 10/18/2023. A review of the facility's Daily Room List indicated the facility had 25 available female beds on 11/1/2023 and 11/2/2023, 23 available female's beds on 11/3/2023, and 20 available female's beds on 11/4/2023, 11/5/2023 and 11/6 2023. During a telephone interview on 11/3/2023 at 9:42 a.m., Resident 1's Emergency Contact (EC) stated, the facility did not inform her of the facility's intention to discharge Resident 1 from the facility. The EC stated the Billing Officer informed her Resident 1 had a large unpaid bill and the facility was no longer equipped to care for Resident 1. During a telephone interview on 11/3/2023 at 1:51 p.m., the Case Manager (CM) from GACH 2 stated she called the facility on 11/1/2023 at 3:17 p.m., after faxing Resident 1's clinical inquiry to the facility and spoke to the facility's Admission Personnel (AP) and the facility's Director of Nursing (DON) to report Resident 1 was ready for discharge back to the facility. The CM stated the DON said something about staffing issues and Resident 1 needed a higher level of care due to her wound and the facility was unable to provide care to Resident 1 anymore. The CM stated she referred Resident 1's case to their Social Worker (SW) and the SW reported to her (CM) that Resident 1 had not paid her copayment/share of cost at the facility. During an interview on 11/3/2023 at 2:03 p.m., the DON stated she and the Administrator (ADM) decided they would not readmit Resident 1 to the facility because the facility was not able to accommodate Resident 1's wound care needs and procedures. During an interview on 11/3/2023 at 3:07 p.m., the Admissions Personnel (AP) stated she received a call from the CM at GACH 2 on 11/1/2023 indicating Resident 1 was ready to return to the facility, however, because of Resident 1's acuity (the severity of a resident's illness and the level of attention or service the resident will need from professional staff) which included Resident 1's pressure sores to her heels, therapy would be unsafe for Resident 1 so the facility was unable to readmit Resident 1. During an interview on 11/6/2023 at 10:56 a.m., the Administrator (ADM) stated the facility will not readmit Resident 1 due to the resident's high acuity. During a telephone interview on 11/8/2023 at 11:10 a.m., Resident 1's physician stated, Resident 1's current health status was the same as it was when Resident 1 was initially admitted to the facility (3/23/2023) and the facility staff provided care to Resident 1 from her admission to her transfer to the GACH 1 (10/10/2023). During a review of the facility's Policy and Procedure (P/P) titled, "Bed Holds and Readmission," dated 5/2011, the P/P indicated that a resident who was away from the facility past seven days due to hospitalization or other medical treatment, will be readmitted to the first available bed in a semi- private room, if the resident needs the care provided by the facility and wished to be readmitted. During a review of the facility's undated P/P, titled, "Notice of a Transfer and/or Discharge" the P/P indicated the resident, and his/her representative will be given a thirty (30) day notice of an impending transfer or discharge from the facility when the transfer or discharge is necessary for the resident's welfare and when the resident's needs cannot be met in the facility and if the resident has failed after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay in the facility. The facility failed to: 1. Ensure Resident 1, who was transferred to GACH 2, was readmitted back to the facility when the GACH 2 cleared Resident 1 to be return to the facility. 2. Ensure Resident 1 and/or Resident 1's Responsible Party (RP) was provided a 30-days' Notice of Transfer Discharge for an impending transfer or discharge from the facility, per the facility's P/P, titled, "Notice of a Transfer and/or Discharge." This deficient practice resulted in Resident 1's unnecessary stay at GACH 2 after being cleared (discharged) to return to the facility. This deficient practice placed Resident 1 at risk for interrupted and inconsistent continuity of care. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents