Other·June 5, 2024

California Code of Regulations, Title 22, Section § 72527. Patients' Rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (1) To be fully informed, as evidenced by the patient's written acknowledgement prior to or at the time of admission and during stay, of these rights and of all rules and regulations governing patient conduct. (6) To be transferred or discharged only for medical reasons, or the patient's welfare or that of other patients or for nonpayment for his or her stay and to be given reasonable advance notice to ensure orderly transfer or discharge. Such actions shall be documented in the patient's health record. § 72521. Administrative Policies and Procedures. (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. Code of Federal Regulations, Title 42, Section §483.15(c) Transfer and discharge- §483.15(c)(1) Facility requirements- (i) The facility must permit each patient to remain in the facility, and not transfer or discharge the patient from the facility unless— (A) The transfer or discharge is necessary for the patient’s welfare and the patient’s needs cannot be met in the facility; (B) The transfer or discharge is appropriate because the patient’s health has improved sufficiently so the patient no longer needs the services provided by the facility; (C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the patient; (D) The health of individuals in the facility would otherwise be endangered; (E) The patient has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the patient does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the patient refuses to pay for his or her stay. For a patient who becomes eligible for Medicaid after admission to a facility, the facility may charge a patient only allowable charges under Medicaid; or (F) The facility ceases to operate. The facility failed to appropriately discharge Patient 1 by discharging the patient after the patient was picked up by local law enforcement. On 4/11/24 at 9 pm, Patient 1 was then sent home to Family (FAM) 1 without a physician ' s order, discharge medications, and appropriate discharge planning by the facility. This deficient practice resulted to Patient 1 not getting the patient’s prescribed and routine medications from 4/12/24 to 4/17/24 (6 days). This deficient practice may further result to medical complications due to inability to receive routine medications and the unsafe/unplanned discharge back to home. On 4/24/2024 an unannounced visit was conducted by California Department of Public Health (CDPH, the Department) to investigate a compliant regarding an inappropriately transferred/discharged on 4/11/24 at 9 pm, in accordance with the facility ' s policy and procedure titled "Discharging the Patient." A review of Patient 1's "Admission Record" indicated Patient 1 a 66 years old female, was admitted to the facility on 4/3/24, with diagnoses that included immunodeficiency (the decreased ability of the body to fight infections and other diseases), schizophrenia, and generalized anxiety disorder (a condition in which a person has excessive worry and feelings of fear, dread, and uneasiness). A review of Patient 1's Minimum Data Set (MDS- a comprehensive assessment and screening tool) dated 1/29/24, the MDS indicated, Patient 1 was cognitively intact (able to think, remember and reason) and need supervision or touching assistance (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently) in eating, and partial/moderate assistance (helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) in oral hygiene, and toilet hygiene. A review of Patient 1 ' s Medication Administration Record (MAR) for the month of April 2024, indicated the patients had ordered medications scheduled to be administered routinely. The MAR indicated all routine including as needed medications were discontinued on 4/11/24. -Docusate sodium 100 milligrams (mg) twice a day for bowel management. -Risperidone 1 mg tablet twice day for schizoaffective disorder (a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania). -Vitamin D3 25 micrograms (mcg) once a day for supplement. -Prednisone 5mg tablet once a day, for idiopathic thromobocytopenic purpura (a blood disorder characterized by a decrease in the number of platelets in the blood. Platelets are cells in the blood that help stop bleeding. A decrease in platelets can cause easy bruising, bleeding gums, and internal bleeding). -Invegga Sustena 156 mg/ml, intramusculary (IM) every month on the third day, for schizophrenia. -Levothyroxine 100 mcg capsule everyday before breakfast, for hypothyroidism (the thyroid gland can't make enough thyroid hormone to keep the body running normally). -Liothyronine 5 mcg tablet, every day before breakfast, for hypothyroidism. -Famotidine 20 mg tablet twice a day, for GERD (a common condition in which the stomach contents move up into the esophagus). -Desmopressin 0.1 mg tablet twice a day for bleeding disorder. A review of Patient 1's physician orders indicated an order dated 4/12/24 timed at 6:30 pm (one day after Patient 1 was discharged with law enforcement on 4/11/24) to discharge Patient 1 to home with family. The physician order did not indicate discharge medications or other follow up discharge orders for Patient1. A review of Patient 1's Physician Discharge Summary showed a pre-typed discharge summary form signed by the attending physician (not dated) that indicated the reason why the patient ' s transfer/discharge was necessary, discharge diagnosis and prognosis. The reason indicated in the form remained blank. The discharge diagnosis and prognosis also remained blank. A review of Patient 1's Departmental Notes dated 4/12/24 at 5:27 pm, written by Licensed Vocational Nurse (LVN) 2, indicated that around 9 pm on 4/11/24, two Police Officers arrived at the facility and informed LVN 2 that Patient 1 had been reported missing for "quite some time now." The Departmental Note indicated the police officers needed to take Patient 1 to the Police Station. The Departmental Notes indicated that after the police officers talked to Patient 1, the patient willingly went to the Police Station with the two police officers. The Departmental Notes indicated that LVN 2 left a message to the attending physician around 9:30 pm. The Departmental Notes indicated thar Patient 1's family member (FAM 1) called the facility (no time and date) to inform the LVN that Patient 1 will be coming back to the facility after being interviewed by the police. During a telephone interview on 4/24/24 at 10:30 am with Patient 1, Patient 1 stated that on 4/11/24 at around 8:45 pm, two police officers came to the facility and talked to her. Patient 1 stated, the police officers asked her to come with them to the Police Station. Patient 1 stated that she got scared when the police officers arrived at the facility and talked to her. Patient 1 stated, the police officers later told her that her family has been waiting for her, that is why she went with the police officers to the Police Station on 4/11/24. Patient 1 stated, she did not know how long she would stay in the Police Station when she went with them on 4/11/24. Patient 1 stated, no facility staff had expressed any concern about her going to the Police Station on 4/11/24. Patient 1 stated, LVN 2 did not educate her about the importance of her medications or why she should stay in the facility, before she left the facility on 4/11/24. Patient 1 stated she did not receive any documentation regarding her diagnoses, medications, or any treatments that she needed before leaving the facility and going to the Police Station. During an interview on 4/24/24 at 10:45 am with FAM 1, FAM 1 stated, he did not know what medications or treatments that Patient 1 needed when he picked her up at the Police Station. FAM 1 stated, Patient 1 did not get any prescribed medications from 4/12/24 to 4/17/24. FAM 1 stated, he had to call the general acute care hospital (GACH) and gather whatever medications that Patient 1 had prior to be missing from home. FAM 1 stated, he did not receive any call from the nursing facility to check on Patient 1's safety and discharge orders. FAM 1 stated, the first time he heard from the nursing facility's Administrator(ADM) was on 4/17/24, six days after Patient 1 left the facility on 4/11/24. During an interview on 4/24/24 at 3:24 pm with the Director of Nurses (DON), the DON stated, on 4/11/24 at nighttime, she received a telephone call from LVN 2 letting her know that police officers were at the facility. The DON stated, LVN 2 informed her that the police officers wanted to take Patient 1 to the Police Station for questioning. The DON stated the incident was so unusual that she did not know what to do. The DON stated, there was no physician's order to allow Patient 1 to go out of the facility on 4/11/24. The DON stated, they were police officers so they could not say no and therefore, allowed Patient 1 to go with the police officers on 4/11/24. During an interview on 4/24/24 at 3:49 pm with the Social Service Worker (SSW), the SSW stated, before a patient can transfer to another facility, or go out with supervision, there has to be a physician's approval to make sure the patient is stable enough to leave the facility because the patient still needs treatments, medications and care from the facility. The SSW stated any transfer from the facility to a different facility without a physician ' s order is considered as "improper (inappropriate) discharge" because it is an unsafe transfer. During an interview on 4/24/24 at 4:05 pm with LVN 2, LVN 2 stated, on 4/11/24 at around 8:45 pm, two police officers came to the facility and informed him that Patient 1 had been missing and requested to speak to the patient. LVN 2 stated that when the police officers came out of Patient 1's room after talking to the patient, the police officers told LVN 2 that they were going to take Patient 1 to "prison." LVN 2 stated, that around 9 pm, LVN 2 let Patient 1 go with the police officers without knowing how long Patient 1 would be out of the facility, and if Patient 1 would come back to the facility. LVN 2 stated, he called Patient 1 ' s attending physician after Patient 1 already left the facility on 4/11/24. LVN 2 stated, he did not know if Patient 1 needed any medications before letting Patient 1 go because he was not Patient 1 ' s medication nurse. During an interview on 4/24/24 at 4:37 pm with the DON, the DON stated, the facility was responsible for Patient 1 ' s safety and make sure the patient had a safe discharge or transfer to another facility. The DON stated that the transfer/discharge to the Police Station on 4/11/24 at 9 pm was inappropriate. The DON stated, the facility could have asked the police officers to come back for questioning or bring the family to the nursing facility the next day, for a proper discharge to home. The DON stated, the incident happened so fast that they (DON and LVN 2) "did not think clearly enough." During an interview on 4/24/24 at 4:52 pm with the ADM, the ADM stated, he followed up with the Police Station on 4/12/24 and could not get a confirmation if Patient 1 was released safely to her family or not. The ADM stated, on 4/15/24 (4 days after Patient 1 left the facility), he got FAM 1 ' s phone numbers from the Police Station and had a brief conversation with FAM 1 to confirm Patient 1's location. The ADM stated, they were responsible for the patient ' s whereabouts and safety. The ADM stated, they did not have any information for how long Patient 1 would stay in the Police Station and if she would come back to the facility, on 4/11/24. The ADM stated, they should have been more upfront with the police officers to gain more information and made better decision, on 4/11/24. The ADM confirmed that the Police Station would not be able to provide any medical care that Patient 1 needed. A review of the facility ' s Policy and Procedure (P&P) titled "Discharging the Patient," revised December 2016, indicated the following information: -The patient should be consulted about the discharge. -If the patient is being discharged home, ensure that patient and/or responsible party receive teaching and discharge instruction. -If the patient is being discharged to a hospital or another facility, ensure that a transfer summary is completed, and telephone report is called to the receiving facility. -Assess and document patient ' s condition at discharge. A review of the facility ' s P&P titled "Discharging a Patient without a Physician ' s Approval," revised October 2012, indicated the following information: -A physician ' s order should be obtained for all discharges, unless a patient or representative is discharging himself o herself against medical advice. -If the patient or representative (sponsor) insists upon being discharged without the approval of the Attending Physician, the patient and/or representative (sponsor) must sign a Release of Responsibility form. Should either party refuse to sign the release, such refusal must be documented in the patient ' s medical record and witnessed by two staff members. The facility failed to appropriately discharge Patient 1 by discharging the patient after the patient was picked up by local law enforcement. On 4/11/24 at 9 pm, Patient 1 was then sent home to Family (FAM) 1 without a physician ' s order, discharge medications, and appropriate discharge planning by the facility. This deficient practice resulted to Patient 1 not getting the patient’s prescribed and routine medications from 4/12/24 to 4/17/24 (6 days). This deficient practice may further result to medical complications due to inability to receive routine medications and the unsafe/unplanned discharge back to home. This violation had a direct or immediate relationship to the health, safety, or security of Patient 1.