Other·December 15, 2023

F626 (Rev. 208; Issued:10-21-22; Effective: 10-21-22; Implementation:10-24-22) §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. §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. On 11/1/2023, the California Department of Public health (CDPH) received two complaints alleging a resident (Resident 1) was not allowed to return to the facility after transfer to the General Acute Care Hospital (GACH). On 11/2/2023 CDPH conducted an unannounced visit to the facility to investigate the allegations. The CPDH determined that on 10/29/2023 Resident 1 was assessed with confusion, disorientation (state of being confused or having lost your bearings) and an elevated heart rate of 130 beats per minute ([bpm] a normal heart rate range between 60-100 bpm). Resident 1 was transferred the same day to a GACH for evaluation and treatment. On 11/2/2023 when Resident 1 was deemed appropriate for return back to the facility, the facility refused to readmit Resident 1. The facility failed to: 1. Ensure Resident 1, who resided at the facility for approximately six years was readmitted to the facility after Resident 1 was cleared by the GACH to return to the facility. 2. Ensure staff followed the facility’s policy and procedure (P/P) titled, “Bed Holds and Returns,” to readmit Resident 1 back to the facility and resume the residence after hospitalization. These deficient practices resulted in Resident 1 remaining at the GACH for seven days after Resident 1 was cleared by the GACH to return to the facility. Resident 1 was subsequently transferred to a different facility (11/9/2023), placing the resident at risk for continued confusion, disorientation and psychosocial harm related to dislocation from a place Resident 1 considered home. A review of Resident 1’s Admission Records (Face Sheet) indicated Resident 1, a 90-year-old female, was admitted to the facility on 4/17/2017 with diagnoses including atherosclerotic heart disease (thickening or hardening of the arteries caused by a buildup of plague in the inner lining of the artery), congestive heart failure ([CHF] a condition in which the heart does not pump blood as efficiently as it should), sick sinus syndrome (a syndrome that causes slow heartbeats, pauses or irregular heartbeats), vascular dementia (a disruption in the blood flow to the brain that leads to problems with memory, thinking, and behavior), respiratory failure, diabetes mellitus ([DM] a condition associated with abnormally high levels of sugar in the blood) and atrial fibrillation (an abnormal heartbeat). A review of Resident 1’s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 9/11/2023, indicated Resident 1’s cognitive (the ability to think, reason, and understood) skills for daily decision-making were moderately impaired. A review of Resident 1’s History and Physical (H&P) dated 3/1/2023, indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1’s Nurse Progress Notes dated 10/29/2023 and timed at 9:22 a.m., indicated Resident 1 was confused and disoriented with an elevated heart rate of 130 beats per minute ([bpm] a normal heart rate ranges between 60-100 bpm). A review of Resident 1’s Physician's Orders dated 10/29/2023, indicated to transfer Resident 1 to the Emergency Room via 911 for further evaluation. A review of Resident 1’s Bed Hold Informed Consent, dated 10/29/2023, indicated, Resident 1’s Responsible Party (RP) was notified of the seven-days bed hold on 10/29/2023 at 10 a.m. A review of Resident 1’s Notice of Transfer/Discharge, dated 10/29/2023 indicated “The transfer or discharge is necessary for your welfare and your needs cannot be met in the facility.” The Notice of Transfer/Discharge indicated there was no signature present by Resident 1 or Resident 1’s RP. A review of the GACH’s records, indicated Resident 1 was admitted to the GACH’s emergency room on 10/29/2023, and was discharged to a different facility on 11/9/2023. A review of the GACH’s Case Coordination Notes dated 11/2/2023 and timed at 11:58 a.m., and dated 11/3/2023, indicated the facility was unable to take Resident 1 back because “the facility was unable to adequately meet Resident 1’s needs.” A review of GACH’s Case Coordinator Noted dated 11/2/2023 indicated Resident 1 “was not on a bed hold.” A review of Case Coordinator Note dated 11/3/2023 indicated Resident 1 had a discharge order for 11/3/2023 but was informed that the facility would not accept Resident 1 back. During an interview on 11/2/2023 at 12:35 p.m., and a subsequent interview on 11/6/2023 at 1:03 p.m., the Director of Nursing (DON), stated they were not accepting Resident 1 back to the facility because they could not meet Resident 1’s needs anymore. The DON stated Resident 1’s RP made “outrageous” requests the facility could not fulfill and Resident 1’s RP caused the facility staff anxiety and to quit because of Resident 1’s RP’s behavior. A review of the facility’s P/P titled “Bed Holds and Returns,” revised 3/2017, the P/P indicated prior to transfers and therapeutic leaves, residents or resident representatives will be informed in writing of the bed-hold and return policy. Residents may return to and resume residence in the facility after hospitalization or therapeutic leave as outlined in the policy. The facility failed to: 1. Ensure Resident 1, who resided at the facility for approximately six years was readmitted to the facility after Resident 1 was cleared by the GACH to return to the facility. 2. Ensure staff followed the facility’s policy and procedure (P/P) titled, “Bed Holds and Returns,” to readmit Resident 1 back to the facility and resume the residence after hospitalization. These deficient practices resulted in Resident 1 remaining at the GACH for seven days after Resident 1 was cleared by the GACH to return to the facility. Resident 1 was subsequently transferred to a different facility (11/9/2023), placing the resident at risk for continued confusion, disorientation and psychosocial harm related to dislocation from a place Resident 1 considered home. These violations jointly, separately, or in any combination, presented had a direct relationship to the health, safety, or security to Resident 1.