Other·July 11, 2023

72521 (C) (2) - 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, rates of charge for services included in the basic rate, type of services offered, changes for extra services, limitations of services, cause for termination of services and refund policies applying to termination of services. § 72523. (a) Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. F626 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 7/3/23 at 1:20 PM, an unannounced visit was made to the facility to investigate a complaint regarding Admission, Transfer and Discharge Rights. Specifically, involving Patient 1 with diagnosis of dementia (the impaired ability to remember, think, or make decisions that interferes with doing everyday activities), and was assessed as having moderately impaired cognition. As a result of the investigation, the California Department of Public Health determined that the facility failed to ensure Patient 1 who was transferred to a General Acute Care Hospital (GACH) for a therapeutic leave was permitted to be readmitted back to the facility on the first available bed, in accordance with the facility’s policy and procedure on “Readmission to the Facility.” Patient 1 who was transferred to the GACH from Skilled Nursing Facility (SNF)1 on 6/15/23 due to a change in condition and was medically stable to be discharged back to SNF 1 on 6/23/23, had to stay in the GACH setting for (14 days) from 6/23/23-7/7/23 when Patient 1 was transferred and admitted to SNF 2 due to SNF 1 refusing to readmit the patient back. This deficient practice had the potential to cause psychosocial harm to Patient 1 and incurred unnecessary hospital days (14 days) at the GACH, from 6/23/23 to 7/7/23. A review of Patient 1’s Admission Record indicated a 77-year-old female patient, was initially admitted to the facility on 1/27/2023 with the diagnosis of dementia, major depressive disorder (mood disorder that causes a persistent feeling of sadness and loss of interest) and Type 2 diabetes (a disease that occurs when your blood sugar is too high). A review of Patient 1’s Minimum Data Set (MDS – a standardize assessment and care screening tool) dated 5/25/2023 indicated the patient had moderately impaired cognition (the ability or mental action or process of acquiring knowledge and understanding). A review of Patient 1’s Change of Condition Form (COC) dated 6/15/2023 timed at 4:15 PM, indicated Patient 1 was transferred to the GACH for ALOC (ALOC – a change in one’s mental state). A review of Patient 1’s Notice of Proposed Transfer/Discharge dated and signed by Patient 1’s family member/responsible party (Family [FM]1) and facility administrator on 6/15/2023, indicated Patient 1 was transferred/discharge to the GACH for further evaluation and treatment, due to altered level of consciousness. A review of Patient 1’s Notification of Bed Hold (a hold or reservation on the resident’s bed while out of the facility for therapeutic services) dated 6/15/2023, indicated a bed hold would be maintained for Patient 1 (not to exceed seven [7] days) for the period of “Bed hold start date 6/15/2023, Bed hold stop date 6/21/2023.” A review of SNF 1’s Social Service Note dated 6/15/2023 timed at 9:31 PM, indicated a verbal instruction from FM 1 that stated, “Per FM 1, at this moment don’t refer Patient 1 to other facility until I give written notice discharge to other SNF.” A review of Patient 1’s GACH record titled “Social Work Note” dated 6/26/2023, timed at 4:57 PM, indicated that GACH Social Worker (SW) 1 contacted several other skilled nursing facilities to follow up regarding placement. A review of Patient 1’s GACH record titled “Social Work Note” dated 6/27/2023 timed at 5:48 PM, indicated that GACH SW 1 informed FM 1 that there were no other facilities accepting Patient 1 at that time. A review of Patient 1’s GACH record titled “Social Work Note” dated 7/3/2023, timed at 4:48 PM, indicated GACH SW 1 contacted SNF 1 and asked if SNF 1 would be accepting Patient 1 back to the facility. The note further indicated FM 1 also called SNF 1 and spoke with one of the facility staff and was informed SNF 1 declined Patient 1’s readmission back to SNF 1. A review of Patient 1’s GACH Final Report dated 7/3/2023 indicated Patient 1 had discharge orders to a SNF since 6/23/2023. The Report indicated Patient 1’s status as “Pending SNF placement and medically stable to be discharged when bed is available.” During a telephone interview on 7/3/2023 at 11:56 AM, GACH SW 1 stated that SNF 1’s Director of Nurses (DON) refused to readmit Patient 1 pending a legal matter. During an interview on 7/3/2023 at 1:30 PM, the DON acknowledged that SNF 1 had refused to readmit Patient 1 back to the facility according to the advice of SNF 1’s corporate attorney due to the legal matter. The DON further stated that on 6/15/2023, SNF 1 planned to readmit Patient 1 back to the facility. However, on 6/17/23, the facility decided they would not readmit Patient 1 back to the facility. During an interview with the DON on 7/6/23 at 11:30 AM, the DON stated the facility still would not readmit Patient 1 back to SNF 1. During a review of an email communication dated 7/6/23 timed at 4:49 PM, sent by SNF 1’s DON to FM 1 indicated a “Written Involuntary discharge notification” sent for Patient 1. The email attachment indicated a document titled “Notice of Discharge.” The Notice indicated “The facility had determined the patient should be discharged on 6/19/2023 at the GACH.” The Notice indicated under Advance Notice of Discharge that 30 days advance notice is not required because the patient is being discharged for one or more of the reasons checked under Section 4 (a – f), and notice was being provided as soon as practicable. The Notice indicated the reason for discharge under Section 4 d. indicated, “The safety of individuals in the facility are endangered due to the clinical or behavioral status of the resident.” During an interview with GACH SW 1 on 7/7/23 at 4:30 PM, GACH SW 1 stated that Patient 1 was transferred to another facility (SNF 2) on 7/7/23. A review of the facility’s policy titled, “Readmission to the Facility” (undated) indicated, residents who have been discharged to the hospital or for therapeutic leave will be given priority in readmission to the facility. The policy indicated that a patient whose stay exceeded the bed hold period would be readmitted to the facility upon the first availability of a bed... As a result of the investigation, the California Department of Public Health determined that the facility failed to ensure Patient 1 who was transferred to a General Acute Care Hospital (GACH) for a therapeutic leave was permitted to be readmitted back to the facility on the first available bed, in accordance with the facility’s policy and procedure on “Readmission to the Facility.” Patient 1 who was transferred to the GACH from Skilled Nursing Facility (SNF)1 on 6/15/23 due to a change in condition and was medically stable to be discharged back to SNF 1 on 6/23/23, had to stay in the GACH setting for (14 days) from 6/23/23-7/7/23 when Patient 1 was transferred and admitted to SNF 2 due to SNF 1 refusing to readmit the patient back. This deficient practice had the potential to cause psychosocial harm to Patient 1 and incurred unnecessary hospital days (14 days) at the GACH, from 6/23/23 to 7/7/23. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of patients.