Other·August 23, 2018

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the Department of Public Health during the investigation of an facility reported incident during an Abbreviated survey. Complaint Number: CA00584057 Representing the Department of Public Health: Health Facilities Evaluator Nurse: 37861 This inspection was limited to the specific complaint and does not represent a full inspection of the facility. Deficiencies were issued for complaint number CA00584057

F625 SS=D Notice of Bed Hold Policy Before/Upon Trnsfr CFR(s): 483.15(d)(1)(2)

F625 07/30/2018 §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 bedhold periods, which must be consistent with paragraph (e)(1) of this section, permitting a resident to return; and 07/23/2018 GOLDEN LEGACY CARE CENTER 12260 Foothill Blvd Sylmar, CA 91342 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE (iv) The information specified in paragraph (e) (1) of this section. §483.15(d)(2) Bed-hold notice upon transfer. At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative written notice which specifies the duration of the bed-hold policy described in paragraph (d)(1) of this section. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to provide and offer a 7 day bedhold notification for one of three sampled residents, Resident 1. Resident 1 was transferred to an acute care hospital for evaluation and treatment, but was denied the right to return to the facility after care was rendered. This deficient practice prevented Resident 1 his right to return to the facility. On 4/25/18, an unannounced visit was made to the facility to investigate a complaint regarding Admissions, Transfers, and Discharge rights. A review of Admission Record for Resident 1 indicates an admit date of 2/8/18 with the diagnoses of encephalopathy (disease caused by damage to brain resulting in unclear thought process), convulsions (uncontrolled shaking of the body), and chronic obstructive pulmonary disease (a group of lung disorders characterized by shortness of breath). Record review of Resident 1's physician's orders dated 4/19/18 indicates a transfer order to hospital for further evaluation. Record review of Resident 1's Bed hold informed consent for the option of requesting seven (7) day bed hold was noted as 07/23/2018 GOLDEN LEGACY CARE CENTER 12260 Foothill Blvd Sylmar, CA 91342 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE incomplete on day of transfer. On 4/25/18 at 1:05 p.m., during a record review and follow up interview with the administrator (ADM), he confirmed that the daily census as of 4/24/18 has Resident 1 recorded as "Discharge to acute, no bed hold". During a concurrent interview with the ADM, he added purposely placing Resident 1 on a "No bed-hold" due to aggressive behavior. Record review of Resident 1's acute care hospital Social Worker notes dated 4/26/18 at 10:59 a.m., indicates Resident 1 was cooperative and not aggressive while in unit, but was continued to be denied his right to return to nursing facility. A review of the facility policy titled "Discharge Planning", last revised November 2017, states "When discharging a resident to an acute hospital; notify resident and resident representative of discharge, inform of bed hold policy and document in clinical record. Notify Admissions Coordinator of discharge. Admissions Coordinator to send written evidence of bedhold policy to the resident, their family member or responsible party on the next business day following the discharge.

F626 SS=D Permitting Residents to Return to Facility CFR(s): 483.15(e)(1)(2)

F626 07/30/2018 §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 07/23/2018 GOLDEN LEGACY CARE CENTER 12260 Foothill Blvd Sylmar, CA 91342 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE their previous room if available or immediately upon the first availability of a bed in a semiprivate 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 returns 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. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to readmit one of three sampled residents, Resident 1. Resident 1 was transferred to an acute care hospital (GACH) for evaluation and treatment, but was denied the right to return to the facility after care was rendered. This deficient practice prevented Resident 1 to exercise his right to return to the facility. Findings: On 4/25/18, an unannounced visit was made to 07/23/2018 GOLDEN LEGACY CARE CENTER 12260 Foothill Blvd Sylmar, CA 91342 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE the facility to investigate a complaint regarding Admissions, Transfers, and Discharge rights. A review of Admission Record for Resident 1 indicates an admit date of 2/8/18 with the diagnoses of encephalopathy (disease caused by damage to brain resulting in unclear thought process), convulsions (uncontrolled shaking of the body), and chronic obstructive pulmonary disease (a group of lung disorders characterized by shortness of breath). Record review of Resident 1's physician's orders dated 4/19/18 indicates a transfer order to hospital for further evaluation. Record review of Resident 1's Bed hold informed consent for the option of requesting seven (7) day bed hold was noted as incomplete on day of transfer. On 4/25/18 at 11:07 a.m., during an interview with the Business Office Assistant (BOA), she stated that for residents discharged to acute, we place them in a 7 day bed hold. We follow up daily to see if they are returning after 7 days, we would still call the hospital for follow up after 7 days. If we still have their old room, they can go back in that room. If the room is taken, we place them in a different room. On 4/25/18 at 1:05 p.m., during a record review and follow up interview with the Administrator (ADM), he confirmed that the daily census as of 4/24/18 has Resident 1 recorded as "Discharge to acute, no bed hold". During a concurrent interview with the ADM, he added purposely placing Resident 1 on a "No bed-hold" due to aggressive behavior. Record review of Resident 1's acute care hospital Social Worker notes dated 4/26/18 at 10:59 a.m., indicates Resident 1 was 07/23/2018 GOLDEN LEGACY CARE CENTER 12260 Foothill Blvd Sylmar, CA 91342 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE cooperative and not aggressive while in unit, but was continued to be denied his right to return to nursing facility. A review of the facility policy titled "Resident Bill of Rights", last revised 5/2011, under transfers and discharge indicated permitting resident to return to facility. A nursing facility must establish and follow a written policy under which a resident, whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if the resident requires the services provided by the facility.