Health inspection·June 30, 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 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 § 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. 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. The California Department of Public Health (CDPH) received a complaint on 5/15/2023 regarding the facility’s refusal to readmit Resident 1 On 5/16/2023, CDPH conducted an unannounced visit at the facility. The facility failed to: 1. Permit Resident 1 from returning to the skilled nursing facility (SNF) after being hospitalized in a general acute care hospital (GACH) within the seven-day bed hold period per the facility’s policy. As a result, Resident 1 was transferred to another SNF against the resident’s wishes. Resident 1 was a 77-year-old female originally admitted to the facility on 9/14/2022 and readmitted on 4/15/2023. Resident 1’s diagnoses included Parkinson's disease (a disorder of nervous system that affects movement, including tremors), dementia (a group of conditions characterized by impairment of memory and abstract thinking), and depression (a group of conditions associated with the elevation or lowering of a person’s mood). A review of the Admission Record, Face Sheet, indicated Resident 1 was transferred to the GACH on 5/8/2023. A review of Resident 1's History and Physical (H&P) dated 4/15/2023, indicated Resident 1 had the capacity to understand and make decisions. A review of Resident 1's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 3/13/2023, indicated Resident 1 was able to understand and be understood by others and required extensive assistance from staff for activities of daily living (ADLs) such as bed mobility dressing and personal hygiene, limited assistance for walking and transferring, and supervision for eating. A review of Resident 1’s Order Summary Report, dated 5/8/2023, indicated Resident 1 may transfer to the GACH due to increased agitation, resistance to care, and failure to thrive. During an interview with Resident 1’s Responsible party on 5/15/2023 at 3:21 p.m., the Responsible party stated on 5/12/2023 she received a phone call from the GACH that Resident 1 was going to be discharged from the GACH and was going to go back to the facility on 5/12/2023. The Responsible party stated the GACH case manager and the facility’s admissions coordinator were in contact during Resident 1’s stay in the GACH. The GACH gave the facility Resident 1’s discharge summary. The Responsible party stated the GACH’s case manager obtained the bed hold for the facility to return Resident 1 back to the facility. During an interview on 5/16/2023 at 9:55 a.m. with the Facility’s Admissions Coordinator (AC), she stated, the bed hold meant that the facility would keep the resident’s bed available while the resident was in the GACH. The AC further stated Resident 1’s referral packet was received from the GACH on 5/12/2023 indicating the resident was ready to be discharged. The facility did not accept Resident 1 back because Resident 1’s family’s expectations were unreachable for the facility. However, the facility refused to take the resident back. During an interview with the Licensed Vocational Nurse (LVN) 1 on 5/16/2023 at 12:09 p.m., LVN 1 stated Resident 1 refused care, but staff were able to take care of Resident 1 when Resident 1 did not refuse care. During an interview on 5/16/2023 at 12:28 p.m. with the Administrator (Admin), Admin stated the facility did not accept Resident 1 back to the facility because the facility could not meet Resident 1’s family’s expectations. The Admin further stated, the facility did not have a medical reason for not accepting Resident 1 back to the facility. A review of the facility's Policy and Procedure (P&P) titled, "Bed-Holds and Returns," dated 3/2017, indicated residents may return to and resume residence in the facility after hospitalization or therapeutic leave. A review of the facility’s informed consent titled, “Bed Hold Notification,” dated 4/17/20 (the date of the resident’s initial admission) indicated residents have the option of requesting a seven-day bed hold to keep a bed vacant and available to return to the facility. In the area of Confirmation of Transfer & Bed Hold Provision, was not completed by the facility that the resident was transferred to the GACH, and the resident was given a 24-hour notification to have the bed hold. The facility failed to: 1. Permit Resident 1 from returning to the SNF after being hospitalized in a GACH within the seven-day bed hold period per the facility’s policy. As a result, Resident 1 was transferred to another SNF against the resident’s wishes. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to a resident.