Health inspection·August 23, 2024

The following reflects the findings of the California Department of Public Health during the investigation of complaint number CA00909071. A Class B Citation was written. REGULATORY VIOLATIONS: Title 42 Code of Federal Regulations 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. Title 22, California Code of Regulations § 72521 - Administrative Policies and Procedures (a) Written administrative, management and personnel policies shall be established and implemented to govern the administration and management of the facility. (b) All policies and procedures required by these regulations shall be in writing and shall be carried out as written. They shall be made available upon request to patients or their agents and to employees and the public. Policies and procedures shall be reviewed at least annually, revised as needed and approved in writing by the governing body or licensee. (c) Each facility shall establish at least the following: 3) Policies and procedures for admission or discharge of a patient which state that a patient shall not be admitted or discharged based on race, color, religion, ancestry, national origin, sexual orientation, disability, medical condition, marital status, or registered domestic partner status... Title 22, California Code of Regulations § 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 7/12/2024, the Department of Public Health made an unannounced visit to the facility to investigate a complaint regarding admission, transfer, and discharge. The facility failed to permit Resident 1 to return to Skilled Nursing Facility (SNF) 1 after being discharged from a general acute care hospital (GACH) on 6/24/2024 for pain management. As a resulted, violated Resident 1's right to return to the facility, after the resident's hospitalization. During a review of Resident 1's admission record indicated Resident 1 was admitted to SNF 1 on 6/7/2024, with a diagnosis but not limited to anxiety disorder (a condition in which a person has excessive worry and feelings of fear, dread, and uneasiness), unspecified asthma (chronic lung disease that causes the bronchial airways in the lungs to narrow and swell, making it difficult to breathe). During a review of Resident 1's History and Physical dated 6/10/2024, indicate Resident 1 had the capacity to make medical decisions. During a review of Resident 1's Minimum Data Set (MDS- a standardized assessment and care screening tool) dated 6/11/2024, indicated Resident 1 had moderately impaired cognitive (mental ability to make decisions) skills for daily living. During a review of the facility document titled, Transfer Form - V2," dated 6/24/2024, indicated Resident was transferred to GACH for "Other: delusional ideation." The Primary Goals of Care at the Time of the Transfer was for Resident 1 "Rehabilitation and/or medical Therapy with intent of returning home." During a review of the facility document titled, "Progress Note," dated 6/24/2024, the Progress Note indicated, "Resident transferred out to GACH at 3:40pm. During an interview with the Admissions Director (AD), on 7/16/2024 at 8:54 am, the AD stated she never told SNF 1 Administrator or the Director of Nursing (DON) that she spoke with the Case Manager at the GACH regarding Resident 1 not wanting to return to SNF 1. The AD stated the administrator told her that Resident did not want to return back to SNF 1. During a concurrent interview on 7/16/2024 at 10:10 am, the Administrator stated there was no documentation in the nurse's progress notes, Situation Background Assessment Recommendation (SBAR), Change of Condition (COC) or transfer sheet indicating that Resident 1 stated he did not want to return back to the facility. During a concurrent record review with the Administrator of the facility census a new Resident 4 was admitted to the facility on 6/24/2024 and placed in Resident 1's room and bed. The Administrator stated she never heard Resident 1 say that Resident 1 did not want to return to SNF 1. The Administrator stated SNF1's AD spoke with a Case Manager (unable to recall the name) at the GACH that the case manager informed the AD that Resident 1 did not want to return back to SNF 1. The Administrator stated the AD told the Administrator that Resident 1 did not want to return back to SNF 1. The Administrator stated she should have discussed with Resident 1 regarding the resident's wishes to return back to SNF 1. The Administrator stated, "typically when residents are sent to the hospital the resident sign a 7-day bed hold and can return back to the facility." During a concurrent record review on 7/16/2024 at 10:41 am, with the DON, Resident 1's Physicians orders dated 6/24/2024 were reviewed. There were no physicians order for 7-day bed hold for Resident 1. There was no documentation on 6/24/2024 (day Resident 1 was transferred to the GACH) that Resident 1 stated he did not want to return back to SNF 1. During an interview on 7/16/2024 at 11 am, the DON stated the nurse that got the order to transfer Resident 1 to the GACH should have obtained a physician's order for a 7-day bed hold for Resident 1. The DON stated she never heard Resident 1 say that he does not want to return back to the facility. The DON stated she should have talked to Resident 1 or followed up with GACH's Case Manager prior to GACH transferring the resident to SNF 2. During a review of the facility's policy and procedure titled "Bed-Holds and Returns" revised 3/2017, indicated, "The resident will be permitted to return to an available bed in the location of the facility that he or she previously resided. 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." The facility failed to permit Resident 1 to return to Skilled Nursing Facility (SNF) 1 after being discharged from a general acute care hospital (GACH) on 6/24/2024 for pain management. As a resulted, violated Resident 1's right to return to the facility, after the resident's hospitalization. The above violations had direct or immediate relationship to the health, safety, or security of Resident 1.