Other·October 16, 2023

42 CFR §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. 22 CCR § 72521 Administrative Policies and Procedures. (a) Written administrative, management and personnel policies shall be established and implemented to govern the administration and management of the facility. On 8/23/2023, the California Department of Public Health (CDPH) made an unannounced visit 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 on 8/22/2023, after hospitalization, when ready for discharge from General Acute Care Hospital 1 (GACH 1). As a result, Resident 1 experienced an unnecessarily prolonged hospitalization while GACH 1 found new placement. Resident 1’s right to return to Skilled Nursing Facility 1 (SNF 1) was violated and resulted in Resident 1’s displacement in an unfamiliar environment requiring adjusting to new surroundings, when transferred to Skilled Nursing Facility 2 (SNF 2), on 8/23/2023. A review of Resident 1’s Admission Record indicated the facility admitted Resident 1, a 49-year-old male, on 4/7/2023 with diagnosis of schizophrenia (a mental disorder characterized by hallucinations [seeing things that are not there], delusions [believing something is true when it’s not], and disturbances in thought, perception [process of thinking] and behavior). A review of Resident 1’s Minimum Data Set (MDS- a standardized assessment and screening tool) dated 7/14/2023, indicated the resident understood others and was understood by others. A review of the Physician’s Order for Resident 1, dated 8/6/2023, indicated to transfer Resident 1 from SNF 1 to GACH 1 for 5150 (a psychiatric [relating to mental illness or its treatment] hold placed on a patient with suicidal ideations [thoughts of harming self] or homicidal ideations [thoughts of harming others]) for psychiatric evaluation. A review of GACH 1 Medical Doctor 2’s (MD 2) progress note for Resident 1, dated 8/22/2023, indicated Resident 1’s discharge for the day was rescinded (to withdraw or cancel) because of a lack of placement (not having a place to return to). During an interview on 8/23/2023 at 11:20 a.m. with GACH 1 Social Worker 1 (SW 1), SW 1 stated Resident 1 had been admitted to GACH 1 on 8/6/2023 and was ready to be discharged back to the facility on 8/15/2023. SW 1 stated she spoke with the facility multiple times since 8/15/2023 in efforts to return Resident 1 back to the facility after stabilizing at GACH 1. SW 1 stated that on 8/21/2023, because SNF 1’s Admissions Coordinator 1 (AC 1) previously stated that the Administrator (ADM) makes the final decision regarding readmission, she called to speak with the ADM to coordinate Resident 1’s discharge back to the facility. SW 1 stated the ADM did not return calls to be able to schedule the resident’s return to the facility. SW 1 stated that on 8/22/2023, MD 2 rescinded the order to discharge resident back to the facility due to a lack of placement. SW 1 stated Resident 1 was transferred out to SNF 2 on 8/23/2023. During an interview on 8/23/2023 at 2:35 p.m. with AC 1, AC 1 stated that while she would communicate with the GACH regarding a resident’s readmission process, the decision to readmit is ultimately up to the supervisors including the ADM and the Director of Nursing (DON). AC 1 stated that the GACH sent the request to readmit Resident 1 on 8/15/2023 and that she gave the information to the DON. AC 1 stated that she does not know what happened with the resident’s readmission status after that. During an interview on 8/23/2023 at 4:30 p.m. with the ADM, the ADM stated she did not have direct communication with SW 1 regarding Resident 1’s readmission status. The ADM stated that AC 1 and Marketing Director Nurse 1 (MDN 1) were in contact with GACH 1 regarding Resident 1’s readmission status. During an interview on 8/25/2023 at 3:00 p.m. with AC 1, AC 1 stated she spoke with SW 1 on 8/21/2023 over the phone and was told by SW 1 that she wanted to speak with the ADM regarding Resident 1’s readmission. AC 1 stated that she wrote SW 1’s phone number and information and gave it to the ADM. During an interview on 8/25/2023 at 3:10 p.m. with the DON, the DON stated the ADM makes the final decision to readmit residents. During a concurrent interview and record review on 9/6/2023 at 12:05 p.m. with the ADM, the ADM verified on the facility’s census (facility’s document indicating number of beds and names of all residents in the facility), dated 8/22/2023, that the facility had four empty male beds that Resident 1 could have been readmitted to. The ADM stated that she was aware of SW 1’s attempt to contact her on 8/21/2023 and 8/22/2023. The ADM stated that she was busy on 8/22/2023 and returned the call by 4:30 p.m. and could not get ahold of the SW 1. When asked who was responsible for readmitting residents back to the facility, the ADM stated that the AC 1 is responsible to notify either the DON or the ADM regarding the readmission request by the GACH. The ADM stated that AC 1 and the DON are aware that when the ADM is busy, that readmission can be coordinated with the DON. The ADM stated that Resident 1 should have been readmitted to the facility on 8/22/2023 and that their facility including the ADM, the DON and AC 1 failed to ensure that Resident 1 could return on 8/22/2023. A review of the facility’s policy titled, “Readmission to the Facility,” undated, indicated that residents who have been discharged to the GACH or for therapeutic leave will be given priority in readmission to the facility. The facility failed to permit Resident 1 to return to the facility on 8/22/2023, after hospitalization, when ready for discharge from GACH 1. As a result, Resident 1 experienced an unnecessarily prolonged hospitalization while GACH 1 found new placement. Resident 1’s right to return to SNF 1 was violated and resulted in Resident 1’s displacement in an unfamiliar environment requiring adjusting to new surroundings, when transferred to SNF 2, on 8/23/2023. The above violations had a direct relationship to the health, safety, or security of Resident 1.