Health inspection·October 26, 2022

42CFR §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. On 9/9/2022, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate complaints about refusal to readmit. The facility failed to permit Resident 2 to return to the facility after hospitalization in violation of the resident’s right. On 8/26/2022 Resident 2 was ready to return to the facility after nine days of hospitalization, but the facility refused to readmit the resident. As a result, Resident 2 underwent unnecessary prolonged hospitalization while placement was found and on 9/10/2022 Resident 2 was sent to an unfamiliar facility. A review of Resident 2's Admission Record indicated the facility admitted the resident on 5/20/2021 and the most recent readmission of the resident was on 5/27/2022. Resident 2’s diagnoses included end stage renal disease (ESRD final, permanent stage of kidney disease where kidney function has declined to the point that the kidneys can no longer function on their own) and dependence on renal hemodialysis (HD or dialysis - a process of purifying the blood of a person whose kidneys are not working normally through a machine that removes blood from your body, filters it through a dialyzer [artificial kidney] and returns cleaned blood back to the body). A review of Resident 2's Minimum Data Set (MDS, a standardized assessment and care-screening tool) dated 6/8/2022, indicated the resident rarely/never understood others and was rarely / never understood by others. Resident 2 was receiving routine HD treatment. A review of the Physician’s Order for Resident 1 dated 8/17/2022 at 2:40 p.m., indicated to transfer the resident to General Acute Care Hospital 2 (GACH 2) due to anemia (a condition in which the blood does not have enough healthy red blood cells). A review of GACH 2’s record for Resident 2 dated 8/26/2022, Case Manager 2 (CM 2) documented in the form titled, “General Care Management Assessment” that the facility where Resident 2 came from denied the return of the resident. A review of GACH 2’s record for Resident 2 CM 2 documented in Planned Discharge Documentation dated 9/10/2022 (19 days after Resident 2 was ready to be discharged back to the original facility), indicated the resident was being transferred to a different SNF. A review of the facility’s census on 8/26/2022, indicated that 13 beds were empty and available. On 9/15/2022 at 12:00 p.m., during an interview with the Director of Nursing (DON) and a concurrent review of Resident 2’s clinical record, the DON confirmed Resident 2 was transferred to GACH 2 and did not return to the facility. On 9/16/2022 at 9:55 a.m. during an interview about the facility’s refusal to readmit Resident 2, the Vice President of Operations (VP 1) stated she was responsible for coordinating admissions and readmissions of residents in the facility. VP 1 stated she denied Resident 2’s return to the facility. VP 1 stated that prior to transfer to GACH 2, Resident 2 was receiving routine in-house HD treatments provided by contracted dialysis provider (CDP 1). VP 1 explained the facility could not readmit Resident 2 because the CDPH had evaluated CDP 1’s provision of HD care and required a Dialysis RN to directly supervise (within the line of sight) each resident while having an on-going HD treatment and CDP 1 did not agree with the requirement and did not have enough Dialysis RNs. VP 1 stated the facility had six residents receiving HD in house and they were the maximum number they could have based on the Dialysis RNs provided by CDP 1. A review of the facility’s policy and procedure titled, “Re-admission of a Resident”, reviewed dated 6/1/2010, indicated if the resident is off the bed-hold (when the nursing home holds the bed for seven days after the resident is transferred to an acute hospital), the admission of the resident is contingent on bed availability. The facility failed to permit Resident 2 to return to the facility after hospitalization in violation of the resident’s right. On 8/26/2022 Resident 2 was ready to return to the facility after nine days of hospitalization, but the facility refused to readmit the resident. As a result, Resident 2 underwent unnecessary prolonged hospitalization while placement was found and on 9/10/2022 Resident 2 was sent to an unfamiliar facility. The above violation had a direct relationship to the health, safety, or security of Residents 2.