Health inspection·December 4, 2024

Title 42 Code of Federal Regulations §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. 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. 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 holds 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. On 10/30/2024, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate an allegation regarding the facility's refusal to readmit Resident 1. The facility failed to readmit Resident 1 to the facility following hospitalization at General Acute Care Hospital 1 (GACH 1) on 10/16/2024 according to the facility's policy and procedure (P&P) titled, Bed-holds and Returns. As a result, the facility violated Resident 1's right. Resident 1 remained in GACH 1 since 10/16/2024 and had the potential to cause psychosocial harm to Resident 1. A review of Resident 1's Admission Record indicated Resident 1, a 67-year-old female was admitted to the facility on 11/29/2023 with diagnoses including chronic obstructive pulmonary disease (COPD), encephalopathy and respiratory failure. A review of the Minimum Data Set (MDS - a resident assessment tool) dated 5/24/2024, indicated Resident 1's cognitive skills for daily decisions was severely impaired. The MDS indicated Resident 1 was total dependent from staffs for activities of daily living (ADLs. A review of facility's License, effective 6/15/2024 indicated, facility has a bed capacity of 98 residents for skilled nursing. A review of Resident 1's SBAR (situation, background, assessment, recommendation-a communication tool used by healthcare workers when there is a change of condition among the residents), dated 8/13/2024 indicated the physician's recommendation to send Resident 1 to General Acute Care Hospital 2 (GACH 2) Emergency Department for the resident to be placed on intravenous hydration (IV -fluids given directly into the blood stream), have gastrostomy tube taken out... A review of Resident 1's Physician Order Report, dated 8/14/2024 indicated "if transferred to the acute hospital, seven-day bed hold if appropriate". A review of the facility's daily census indicated the following: i. On 10/16/2024, facility has a census of 89. ii. On 10/17/2024, facility has a census of 90. iii. On 10/18/2024, facility has a census of 91. iv. On 10/29/2024, facility has a census of 92. During an interview with GACH 1's Case Manager Director (CMD) on 10/30/2024 at 9:40 a.m., CMD stated, Resident 1 was ready to be discharged back to facility on 10/16/2024. CMD stated she sent the referral to the facility and contacted the facility, in which she was told that there was no bed available for Resident 1. CMD stated, she contacted the facility again on 10/21/2024 at 10/24/2024 in which she was told that there was no bed available, and Resident 1 has been discharged and no bed held. During an interview with Admission Director (AD) on 10/30/2024 at 12:17 p.m., the AD stated, Resident 1's referral from GACH 1 was sent to the facility in which she forwarded the information to clinical nurse for review. The AD stated, she was notified that since Resident 1 is on contact isolation (residents with known or suspected infections that represent an increased risk for contact transmission), they don't have a bed available for Resident 1. When asked about the census on 10/16/2024, 10/17/2024, 10/18/2024 and 10/29/2024, the AD stated, according to their census, they have beds availability. The AD stated, Resident 1 is a custodial and the resident lived in the facility, therefore, Resident 1 should be readmitting to the facility. During an interview with the Director of Nursing (DON) on 10/30/2024 at 12:6 a.m., the DON stated Resident 1 lived in the facility, and she should be readmitted when ready to be discharged from GACH. The DON stated, she was not aware that Resident 1 was ready to be discharged from GACH 1. The DON stated, the facility did have bed available on 10/16/2024 and as of today, the facility also have available according to the facility's census and facility's administrative staff should make necessary room changes as needed to accommodate Resident 1. During a review of the facility's P&P titled, "Bed-Holds and Returns, dated 10/3/2024, the P&P indicated, "all residents/representatives are provided written information regarding the facility and state bed-hold policies, which address holding or reserving a resident's bed during periods of absence (hospitalization or therapeutic leave). Residents, regardless of payer source, are provided written notice about these policies at least twice: well in advance of any transfer; and at the time of transfer (or, if the transfer was an emergency, within 24 hours) ... The requirement that residents be permitted to return to the facility following hospitalization or therapeutic leave applies to all residents regardless of payer source... Residents who seek to return to the facility after the bed-hold period has expired are allowed to return to their previous room if available or immediately to the first available bed in a semi-private room provided that the resident: still requires the services provided by the facility; and is eligible for Medicare skilled nursing facility." The facility failed to readmit Resident 1 to the facility following hospitalization at GACH 1 on 10/16/2024 according to the facility's P&P titled, Bed-holds and Returns. As a result, the facility violated Resident 1's right. Resident 1 remained in GACH 1 since 10/16/2024 and had the potential to cause psychosocial harm to Resident 1. The above violation had a direct relationship to the health, safety, and security of Resident 1.