Health inspection·October 22, 2024

The following reflects the findings of the California Department of Public Health (Department) during the investigation of a complaint. Complaint number: CA00920421. Class B citation was issued. Regulatory Violations. 42 CFR §483.15(c)(3) Notice Requirements Before Transfer/Discharge §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. §483.15(c)(4) Timing of the notice. (i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged. (ii) Notice must be made as soon as practicable before transfer or discharge when- (A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section; (B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section; (C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section; (D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or (E) A resident has not resided in the facility for 30 days. §483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following: (i) The reason for transfer or discharge; (ii) The effective date of transfer or discharge; (iii) The location to which the resident is transferred or discharged; (iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request; (v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman; (vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and (vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act. §483.15(c)(6) Changes to the notice. If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available. §483.15(c)(8) Notice in advance of facility closure. 22 CCR §72527. Patients' Rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (6) To be transferred or discharged only for medical reasons, or the patient's welfare or that of other patients or for nonpayment for his or her stay and to be given reasonable advance notice to ensure orderly transfer or discharge. Such actions shall be documented in the patient's health record. 22 CCR §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 9/14/2024, the Department of Public Health (State Survey Agency [SSA]) made an unannounced visit to the facility to investigate a complaint regarding discharge rights for Resident 1. The facility failed to: 1.Ensure the Notice of Proposed Transfer and Discharge for a facility-initiated transfer was provided at least 30 days prior to discharging Resident 1. The facility issued the notice of discharge on 7/22/2024 and Resident 1 was discharged on 7/22/2024. 2.Provide documented evidence that indicated the State Long Term Care Ombudsman (public advocate) was notified that Resident 1 was being transferred/discharged from Skilled Nursing Facility 1 (SNF- a type of inpatient facility that provides short or long-term skilled nursing care, and rehabilitation services to patients). As a result, Resident 1' s right was violated and caused Resident 1 to have feelings of anxiety. During a review of Resident 1's Admission Record indicated Resident 1 was initially admitted to the facility on 3/10/2022 and was readmitted on 2/16/2024 with diagnoses including major depressive disorder (a serious mental disorder that affects how a person feels, thinks, and acts. It's characterized by a depressed mood, loss of interest, and other symptoms that last for at least two weeks), chronic obstructive pulmonary disease (COPD- is a common lung disease that makes it difficult to breathe, and essential hypertension (high blood pressure that is not caused by another disease). During a review of the Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 7/16/2024, indicated Resident 1 was cognitively intact (when someone has sufficient judgment, planning, organization, self-control, and the persistence needed to manage the normal demands of the participant's environment). The same MDS indicated Resident 1 required supervision or touch assistance and partial/moderate assistance for Activities of Daily Living (ADLs - toileting hygiene, shower/bathe, upper & lower body dressing, and personal hygiene). During a review of a physician's order dated 7/22/2024 at 1:11 pm, indicated, may discharge [Resident 1] to SNF 2 with hospice evaluation (specialized care that provides physical comfort and emotional, social, and spiritual support for people nearing the end of life). During a review of the facility's Social Services Director (SSD), note dated 7/22/2024 at 1:37 pm, indicated "Note Text: SSD was informed by Resident (Resident 1) that she intends to leave facility on 7/22/24 per request and transfer to [SNF 2]." During a review of the form titled "Notice of Transfer/Discharge," dated 7/22/2024, indicated to transfer Resident 1 to another SNF and that the transfer/discharge was necessary for the following reason: "The transfer or discharge is necessary for your welfare and your needs cannot be met in the facility." During an interview with Resident 1 on 9/14/24 at 10:01 am, Resident 1 stated that she had been in SNF 1 for over 2 years and considered it home. Resident 1 stated that she sometimes complained about some things but that does not mean she wanted to move out. Resident 1 stated that she felt like the Administration retaliated against her because she was vocal about her needs and felt that was the reason why they discharged her in a hurry. Resident 1 stated that she had never asked any staff for discharge because moving was very disruptive. Resident 1 started that the whole thing (discharge) caused her anxiety to talk and think about. During an interview with SNF 1 SSD on 9/14/24 at 11: 11 am, the SSD stated that she was not aware about Resident 1's discharge until the day of her (Resident 1) discharge on 7/22/2024. The SSD stated that Resident 1 asked the SSD to see Resident 1 in the resident's room and informed the SSD that she [Resident 1] was going to a different SNF. The SSD admitted that she was responsible for informing the Ombudsman as soon as possible after the facility was aware about Resident 1's discharge to ensure that the ombudsman can investigate if the discharge is appropriate or not. The SSD stated that she was aware that the Discharge Planner (DP-a healthcare professional who helps patients transition from a hospital to their home or another care setting) was looking for placement with other facilities weeks prior. The SSD stated that she notified the ombudsman on the day Resident 1 was discharged to SNF 2. During an interview with the Discharge Planner (DP) on 9/14/24 at 11:24 am, the DP stated that sometime in July, the DP asked Resident 1 if she would like to be discharged to a different facility of which Resident 1 had agreed. The DP stated that he worked with an outside transfer coordinator (a health care personnel who helps coordinate transfers between facilities) and found placement at a different SNF on 7/22/2024. The DP stated he then informed Resident 1 on 7/22/2024 that there was a bed and Resident 1 agreed to the transfer. The DP confirmed that there was no documented evidence of any discussions with Resident 1 requesting for a discharge. The DP was unable to verbalize the importance of informing the Ombudsman about planned discharges. During a concurrent interview and record review of Resident 1's chart with the Director of Nursing (DON) on 9/14/24 at 11:47 am, the DON stated that Resident 1 constantly spoke about discharging to another SNF. The DON stated that Resident 1's needs that the facility could not meet was her (Resident 1) stating "I want to be discharged." The DON stated that the DP had started working on finding a bed with different facilities until one day (7/22/24) when Resident was told that there was an open bed at the SNF she was discharged to, of which Resident 1 said that the resident would go. The DON stated and admitted that when a resident verbalizes desire to discharge, it must be documented in the resident's medical chart. The DON confirmed and stated that there was no documented evidence that the resident expressed the desire to be discharge prior to 7/22/2024. During a review of the facility's policy and procedures (P&P) titled "Discharge Planning Process," reviewed on 4/17/2024, the P&P indicated, "It is the policy of this facility to develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions. The procedure included the following: - The facility will determine the resident's expected goals and outcomes regarding discharge upon admission, routinely in accordance with the MDS assessment cycle, and as needed. a. Initial information and discharge goals will be included in the resident's baseline care plan. b. Subsequent assessment information and discharge goals will be included in the resident's comprehensive plan of care. - The evaluation of the resident's discharge needs, and discharge plan will be completely documented on a timely basis in the clinical record. - Education needs, as identified in the discharge plan, will be provided to the resident and/or Family member prior to discharge." The facility failed to: 1.Ensure the Notice of Proposed Transfer and Discharge for a facility-initiated transfer was provided at least 30 days prior to discharging Resident 1. The facility issued the notice of discharge on 7/22/2024 and Resident 1 was discharged on 7/22/2024. 2.Provide documented evidence that indicated the State Long Term Care Ombudsman was notified that Resident 1 was being transferred/discharged from SNF 1. As a result, Resident 1' s right was violated and caused Resident 1 to have feelings of anxiety. These violations caused or occurred under circumstances likely to cause significant humiliation, anxiety, or other emotional trauma to Resident 1.