Health inspection·November 8, 2023

42 CFR §483.15(e)(1) Admission, transfer, and discharge rights 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. 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— Requires the services provided by the facility; and Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. 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. CCR Title 22 Section §72523 - 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. The facility failed to readmit Resident 1, a-51-year-old female, from the General Acute Care Hospital (GACH) after the resident was cleared by the GACH to return to the facility on 10/3/2023. This deficient practice resulted in denial of Resident 1 ' s right to return to the facility where she lived. A review of Resident 1’s Admission Record indicated Resident 1 was originally admitted on 2/26/2023 and was readmitted on 7/7/2023 with diagnoses including cerebral palsy (a condition that affects muscle tone, movement, and coordination that limit activity), dysphagia (difficulty swallowing), muscle weakness, diabetes mellitus (high blood sugar) and urinary tract infection. A review of Resident 1's History and Physical, dated 7/29/2023, indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care-screening tool) dated 7/13/2023, indicated Resident 1's cognitive (the ability to think, reason, and understand) skills for daily decision making were severely impaired. The MDS indicated Resident 1 was totally dependent on two-persons physical assistance for bed mobility, toileting, eating, dressing, and personal hygiene. During a review of Resident 1’s order summary dated 9/8/2023, the order summary note indicated Resident 1 had a seven-day bed hold in place if Resident 1was to be temporarily transferred out and readmitted. During a review of Resident 1’s physician's order dated 9/3/2023, the order indicated to transfer Resident 1 to a GACH due to desaturation (abnormally low blood oxygen concentration). A review of a GACH document titled Laboratory Results indicated Resident 1 tested positive for C-auris on 9/17/2023. A review of the GACH’s notification to the Ombudsman (public advocate), dated 10/10/2023, indicated the facility declined to take Resident 1 back on 10/3/2023 because Resident 1 had Candida auris (C- auris: a type of yeast that can cause severe illness and spreads easily) and the facility stated they did not have an isolation (keep separate due to highly contagious infection) room and could not accommodate Resident 1’s needs for isolation. A review of the facility’s census (daily official count and list of residents admitted to the facility) dated 10/13/2023 indicated the facility had a 53 bed capacity, there were 40 in-house residents and 3 beds on hold (if a resident is transferred out, the facility reserves the resident ' s bed for seven days) for residents not in the facility, with a total 43 resident census. The facility’s census indicated there were 10 available beds as of 10/3/2023. During an interview on 10/13/2023, at 12:35 pm, with the Director of Nursing (DON), the DON stated the facility could not readmit Resident 1 due to a C-auris diagnosis. The DON stated Resident 1's C-auris diagnosis required an isolation room and dedicated staff to care for Resident 1, and that the facility staff were not trained for this type of isolation. During an interview on 10/13/2023, at 12:45 p.m., with the GACH’s social worker (SW), the SW stated the skilled nursing facility informed her they did not have an isolation bed and therefore the facility would not be taking Resident 1 back. During an interview on 10/13/2023, at 1:35 pm, with the Admission Coordinator (AC), the AC stated the facility cannot take residents on isolation for Candida auris, because the facility is not equipped for that. The AC stated a resident with C-auris infection requires a lifetime isolation, and more attention than regular residents, if the residents are sharing rooms or bathrooms, the facility would be exposing other residents to the infected organism causing illness with Candida auris. According to the Centers for Disease Control and Prevention [CDC a Federal agency that supports the nation's health promotions, prevention and preparedness) if a skilled nursing facility has a resident positive for C-auris, the facility should place the resident on transmission based precautions (measures and tools used to prevent the spread of infections), ensure the appropriate use of gowns and gloves, perform hand hygiene, and the use of appropriate disinfectants. https://www.cdc.gov/candida-auris A review of the facility's policy and procedure (P/P) titled "Bed Hold & Readmission" revised on 1/2022, indicated if the resident's hospitalization or therapeutic leave exceeds the bed-hold period of 7 days, the resident may return 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 requires the services provided by the facility The facility failed to readmit Resident 1, a-51-year-old female, from the GACH after the resident was cleared by the GACH to return to the facility on 10/3/2023. This deficient practice resulted in denial of Resident 1 ' s right to return to the facility where she lived. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of patients or residents.