Health inspection·April 3, 2024

The following reflects the findings of the California Department of Public Health during the investigation of facility reported incident CA00886040. Representing the Department, Health Facility Evaluator Nurse # 43454. A Class B State citation was written. Regulatory Violations: 42 CFR §483.15(d) Notice of bed-hold policy and return- §483.15(d)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the nursing facility must provide written information to the resident or resident representative that specifies- (i) The duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the nursing facility; (ii) The reserve bed payment policy in the state plan, under § 447.40 of this chapter if any; (iii) The nursing facility's policies regarding bed-hold periods, which must be consistent with paragraph (e)(1) of this section, permitting a resident to return; and (iv) The information specified in paragraph (e)(1) of this section. 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 § 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. (c) Each facility shall establish at least the following: (2) Policies and procedures for patient admission, leave of absence, transfer, pass and discharge, categories of patients accepted and retained, rate of charge for services included in the basic rate, type of services offered, charges for extra services, limitations of services, cause for termination of services and refund policies applying to termination of services. On 2/22/2024 the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint about Admission, Transfer, and Discharge Rights. The facility failed to keep Resident 1's bed hold for seven days and permit Resident 1 to return to the facility on 1/19/2024, after hospitalization, when ready for discharge from General Acute Care Hospital 1 (GACH 1) as per policies and procedures (P&P). As a result, Resident 1's right to return to Skilled Nursing Facility 1 (SNF 1) was violated, Resident 1 experienced sadness and had to undergo adjustment to a new living environment at Skilled Nursing Facility 2 (SNF 2). A review of Resident 1's Admission Record indicated the resident was originally admitted to the facility on 10/12/2023 with diagnoses including type II diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), unspecified dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems), and depression (a mood disorder that causes persistent feeling of sadness and loss of interest). A review of Resident 1's Physician Orders dated 1/15/2024 indicated to transfer Resident 1 to GACH 1 for further evaluation and bed hold for seven days (MediCal pays the daily stay fee for up to seven days, to hold the resident's bed). On 2/22/2024 at 1:06 p.m., during an interview, Resident 1's Family Member 1 (FM 1) stated Resident 1 was sent to SNF 2 on 1/18/2024 after hospitalization at GACH 1. FM 1 stated that she tried to have the facility readmit Resident 1, but she was told they could not readmit Resident 1 despite Resident 1 being within the seven-day bed hold on 1/19/2024. FM 1 further stated, Resident 1 ended up moving to SNF 2 and was not eating due to sadness and loneliness. On 2/22/2024 at 1:22 p.m., during an interview, Admission Coordinator 1 (AC 1) stated that she spoke with FM 1 on 1/19/2024 and informed FM 1 the facility could not readmit Resident 1 because there was no available bed close to the Nursing Station. AC 1 stated the facility had asked Resident 1's physician to refer Resident 1 to a memory care unit facility due to Resident 1's behavior. A review of facility's provided census list for 1/19/2024 indicated there were 15 vacant beds available. On 2/22/2024 at 2:38 p.m., during an interview, the Assistant Director of Nursing (ADON) stated Resident 1 was a high risk for falls and injury and they wanted to place Resident 1 close to the Nursing Station and to provide the resident with a one-to-one sitter (one person always with the resident for close monitoring). However, on 1/19/2024, the facility did not have an available room (bed) close to the Nursing Station and they could not readmit Resident 1. ADON acknowledged the facility has available beds on 1/19/2024. A review of the facility's P&P titled, "Bed Hold and Notice" reviewed on 2/22/2024, indicated, "inform the resident or resident representative, in writing, of their right to exercise the bed hold provision and the state bed-hold policy of seven days, which will permit the resident to return and resume residents in the facility. The same P&P also indicated, Provide this written information at the time of admission and transfer to a general acute care hospital or for a therapeutic leave." A review of the facility's P&P titled, "Resident Rights" reviewed on 2/22/2024 indicated, "A facility must protect and promote the rights of each resident, including each of the following rights: to be transferred or discharged only for medical reasons, or the resident's welfare or that of other residents or for nonpayment for his or her stay and to be given reasonable advance notice to ensure an orderly transfer or discharge." The facility failed to keep Resident 1's bed hold for seven days and permit Resident 1 to return to the facility on 1/19/2024, after hospitalization, when ready for discharge from GACH 1 as per P&P. As a result, Resident 1's right to return to SNF 1 was violated, Resident 1 experienced sadness and had to undergo adjustment to a new living environment at SNF 2. The above violations had direct or immediate relationship to the health, safety, or security of Resident 1.