Health inspection·July 11, 2024

§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. On 5/24/2024, an unannounced visit was made to the facility to investigate a complaint regarding Admission, Transfer, and Discharge Rights. The facility failed to permit Resident 1 to return to the facility (from 5/20/2024) after hospitalization when the resident was ready to be discharged from General Acute Care Hospital 1 (GACH 1). Resident 1 was permitted to the facility on 5/24/2024, after California Department of Public Health (CDPH) surveyor arrived at the facility to investigate the allegation. As a result, Resident 1 experienced an unnecessarily prolonged hospitalization. A review of Resident 1’s Admission Record indicated the resident was originally admitted to the facility on 11/18/2023 and then readmitted on 5/24/2024 with diagnosis including basal cell carcinoma (a type of skin cancer that most often develops on areas of skin exposed to the sun, such as the face), tachycardia (a heart rate over 100 beats per minute [normal heart rate is 60 to 100 beats per minute]), and orthostatic hypotension (a drop in blood pressure that occurs when moving from a laying down position to a standing position). A review of Resident 1’s Minimum Data Set (MDS - a standardized assessment and care screening tool) dated 2/27/2024, indicated Resident 1 is able to understand others and able to be understood by others. A review of Resident 1’s Physician Orders dated 4/20/2024 timed at 11:59 a.m. indicated an order to transfer Resident 1 to GACH 1. A review of the facility’s census (daily list indicating resident names with corresponding room numbers), dated 5/20/2024, indicated that there were two available male beds (Room 33A and Room 38B) in the facility. A review of Resident 1’s Referral Activity Log (list of Residents ready to return to the facility) dated 5/20/2024 timed at 11:59 a.m. indicated that the facility rejected Resident 1’s readmission due to the facility’s inability to meet Resident 1’s needs (unspecified). A review of GACH 1’s progress note dated 5/21/2024 timed at 4:47 p.m., indicated that Resident 1’s discharged is pending a bed from the facility. The note further indicated that Social Worker 1 (SW 1) has been calling the facility daily but was informed that there was no bed available for Resident 1. A review of GACH 1’s final report dated 5/21/2024 timed at 5:03 p.m., indicated Resident 1 was seen and examined. The final report further indicated Resident 1 is doing well, awake, in good spirits, and ready to be discharged back to the facility. During an interview with the Director of Nursing (DON) on 5/28/2024 at 2:15 p.m. the DON stated that on 5/20/2024 the facility had two male beds available for admission. When the DON was asked why one of the two available male beds were not offered to Resident 1, the DON stated that the two available male beds on 5/20/2024 were assigned to two possible new admissions and not offered to Resident 1 re-admission. The DON stated that the two potential new admissions decided not to be admitted to the facility. The DON stated that from 5/20/2024 to 5/24/24 the two male beds remained available, but the facility did not inform SW 1 there were available beds at the facility. The DON stated Resident 1 was readmitted to the facility on 5/24/2024 only after CDPH surveyor arrived at the facility to investigate the complaint allegation. During a follow-up interview with the DON on 5/28/2024 at 3:29 p.m., the DON stated that if there are multiple admission inquiries with a limited number of available beds, the facility’s procedure dictates that the facility will prioritize the available bed to residents who are awaiting to be readmitted to the facility. During an interview with the Admission Director on 5/28/2024 at 3:30 p.m., the Admission Director stated that if there are multiple admission inquiries with a limited number of available beds, the facility’s procedure dictates that the facility will prioritize the available bed to residents who are awaiting to be readmitted to the facility. During an interview with the Administrator (ADM) on 5/29/2024 at 11:15 a.m. the ADM stated that the facility should prioritize available beds for those residents with an active bed hold (when a resident’s bed at a facility is held for a period of seven days so that the resident can return to the same bed), and then to those residents who were most recently admitted to the facility but have exceeded their seven day bed hold and are ready to return to the facility. A review of the facility’s policy and procedures titled “Readmission to Facility” dated 12/19/2022 indicated that it was the facility’s policy to protect resident’s right to readmission by permitting each resident to return to the facility after they are hospitalized; the facility will readmit the resident to the first available bed …; if a bed is not available in the same location at the time of readmission, the resident will be given the option to return to that location upon the first availability of a bed... The facility failed to permit Resident 1 to return to the facility (from 5/20/2024) after hospitalization when the resident was ready to be discharged from GACH 1. Resident 1 was permitted to the facility on 5/24/2024, after CDPH surveyor arrived at the facility to investigate the allegation. As a result, Resident 1 experienced an unnecessarily prolonged hospitalization. The above violations had a direct relationship to the health, safety, or security of Resident 1.