Other·April 6, 2023

42 CFR §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. 22 CCR § 72520 Bed Hold (a) If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed hold of seven (7) days, which may be exercised by the patient or the patient's representative. c) A licensee who fails to meet these requirements shall offer to the patient the next available bed appropriate for the patient's needs. This requirement shall be in addition to any other remedies provided by law. The provisions of this section do not apply to patients covered only by Medicare, Title XVIII benefits pursuant to Code of Federal Regulations, Title 42, Subsection 489.22(d)(1). The facility failed to re-admit Resident 1 a 70-year-old-male to the facility following a hospitalization. This failure resulted in Resident 1 being unnecessarily sent to another facility (a totally new environment) which had the potential to cause psychosocial harm. Findings: During a review of Resident 1’s admission record, the admission record indicated Resident 1 was admitted to the facility on 2/2/2023. Resident 1’s diagnoses included unspecific psychosis (a mental condition that causes one to lose touch with reality), difficulty in walking, dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life), anxiety disorder (a condition in which a person has excessive worry and feelings of fear, dread, and uneasiness) and dysphagia (difficulty swallowing). During a review of Resident 1’s History and Physical (H&P) dated 2/2/2023, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1’s Minimum Data Set (MDS), a standardized assessment and care planning tool, dated 2/4/2023, the MDS indicated Resident 1's cognition (ability to think and reason) was severely impaired. The MDS indicated Resident 1 required extensive assistance (resident involved in activity, staff provide weight-bearing support) from one staff with bed mobility, transfers (moving from one surface to another), getting dressed, toilet use, personal hygiene, and supervision from one staff for eating. During a review of Resident 1’s Physician Order (PO) dated 2/4/2023 at 12:20 a.m., the PO indicated Resident 1 was to be transferred to a general acute care hospital (GACH) for possible Gastrostomy Tube ([G-tube] a plastic tube inserted into the abdominal wall to provide nutrition, hydration, and medication) and psychiatric evaluation. During a review of Resident 1’s Progress Notes (PN) dated 2/4/2023 at 1:35 a.m., the PN indicated Resident 1 was discharged to GACH. During an interview on 2/13/23 at 1:55 p.m., with the GACH’s Social Worker (SW), the SW stated Resident 1 was ready to go back to the facility on 2/9/2023. The SW stated she notified the facility of Resident 1’s discharge from GACH back to the facility on 2/9/23, however, the facility refused to re-admit the resident back. During an interview on 2/14/2023, at 11:15 a.m., with the Admissions Director (AD), the AD stated the Director of Nursing (DON) and the Administrator (ADM) decided which residents would be re-admitted to the facility. AD stated that she notified the GACH case manager (CM), on 2/9/2023 that they could not take back Resident 1 because he needed 1:1 supervision (a staff exclusively assigned to resident to ensure resident’s safety). AD stated she did not communicate with or attempt to contact the CM since 2/9/2023. The AD confirmed that in the past the facility has accommodated residents who needed 1:1 supervision due to psychosis. During a review of the AD’s Notes, dated 2/9/2023 to 2/14/2023, AD’s note on 2/9/2023, at 11: 19 a.m., indicated, “Received message to call CM. Called and informed we could not accommodate the resident.” AD’s note on 2/14/2023, at 11:21 a.m., indicated, “Received updated clinicals on 2/13/2023, (was not in on 2/13/2023) and spoke to CM this morning and told her will have it reviewed.” The AD’s notes indicated there was no communication with the GACH’s case manager between 2/9/2023 and 2/14/2023 (during which time Resident 1 was waiting to be transferred from GACH back to the facility). During an interview on 2/14/2023, at 11:23 a.m., with Resident 1’s wife who is also his Power of Attorney ([POA] one who has official authority to make legal and financial decisions on behalf of Resident 1), POA stated, the facility called and notified her of their refusal to re-admit Resident 1 to the facility on 2/9/2023. POA stated, the facility had knowledge of Resident 1’s mental illness prior to ever admitting him, and she did not understand why the facility could not accommodate Resident 1 suddenly. POA stated, the facility staff had not contacted her since 2/9/2023. POA stated, Resident 1 and family members were very upset and felt unwanted and unwelcomed in the facility. During an interview on 2/14/2023, at 3:25 p.m., with the Social Service Director (SSD), the SSD stated, the facility should have re-admitted Resident 1 and then attempted to find out the cause of the underlying behavioral issues instead of refusal to re-admit. The SSD stated, there was no obvious reason not to re-admit Resident 1 since the census (resident count) indicated there were available beds and Resident 1 was still on day five of seven-day bed hold (a reservation that allows one to stay in, or return to, a care facility for seven days) on 2/9/2023. During an interview with DON and ADM on 2/15/2023, at 8:50 a.m., DON and ADM confirmed that Resident 1’s behavior issues were known prior to admission. During a concurrent interview and record review on 2/15/2023, at 9:15 a.m., with DON and ADM, the “Facility Assessment (FA),” ([FA] an annual review and analysis of the facilities’ resident population; staffing required to care for the resident population, and other needs such as equipment) dated 8/29/2022 was reviewed. The FA indicated, among the most common resident’s diagnoses that the facility provides care and services included Anxiety disorder, Major Depressive Disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest, Major Depressive disorder, and psychosis (a condition of the mind resulting in a break from reality) not due to substance abuse or known physiological condition. The FA indicated, the type of care and services the facility or contracted services provide to the residents included Behavior management, Psychotropic (medications that affect the brain) management, Interdisciplinary team ([IDT] each residents’ care team while at the facility) meeting to identify if the use of psychotropic medications is warranted and medically justifiable, Gradual psychotropic dose reduction, Behavior modification, collaboration with psychiatrist and psychologist, Medication review by pharmacy consultant, Dementia care, psychiatric illness, intellectual or developmental disabilities, the IDT will develop and implement interventions in managing resident’s behavior and to help support individuals with issues dealing with anxiety, cognitive impairment, diagnosis of depression and other psychiatric diagnoses. The DON and ADM stated the facility had the capacity to provide the needed care for Resident 1 according to FA. During a review of the Facility Census (FC), dated 2/9/2023, the FC indicated there were two unassigned beds available, and one admission. The FC indicated, Resident 1 was still on day five of the seven-day bed hold, so his bed was still available for him to come back to. During an interview on 2/15/2023, at 12:20 p.m., with ADM, ADM stated, Resident 1 was admitted to a different facility on 2/14/2023. ADM stated there was no justifiable reason not to re-admit Resident 1 on 2/9/2023. ADM stated the refusal to re-admit could make Resident 1 and family upset. During a review of the facility’s Policy and Procedure (P&P) titled “Bed-Holds and Returns”, Revised 3/2017, the P&P indicated, the resident would be permitted to return to an available bed in the location of the facility that he or she previously resided in. 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.” A review of the facility's P&P titled, "Resident Rights," revised 10/2010, the P&P indicated employees were to treat all residents with kindness, respect, and dignity and honor the exercise of residents' rights. The facility failed to re-admit Resident 1 to the facility following a hospitalization. This failure resulted in Resident 1 being unnecessarily sent to another facility (a totally new environment) which had the potential to cause psychosocial harm. These violations, jointly, separately or in any combination, had a direct or immediate relationship to the health, safety, or security of patients or residents.