Health inspection·April 25, 2025

§483.15(e)(1)(i)(A)(B)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. §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. On 3/12/2025, the California Department of Public Health (CDPH) received a complaint alleging a resident (Resident 1), who resided at a skilled nursing facility (SNF) for almost 20 years, and who was discharged to a General Acute Care Hospital (GACH) was refused readmission. On 3/13/2025, the CDPH conducted an unannounced visit at the facility, to investigate the complaint allegation. Upon investigation the CDPH determined Resident 1 was transferred from the facility to a GACH on 2/20/2025 due to blood in her urine. On 2/24/2025 the GACH determined Resident 1 was appropriate for transfer back to the facility, however, on 2/24/2025, the GACH called the facility and attempted to readmit Resident 1, but the facility refused to readmit Resident 1 because she had a clostridium difficile ([C. diff] a highly contagious bacteria that causes severe diarrhea) infection. The facility failed to: 1. Ensure Resident 1 was readmitted to the facility once the GACH cleared her for discharge back to the facility. 2. Follow their Policy and Procedure (P/P), titled "Bed-Holds and Returns" dated 10/2022, that indicated "residents be permitted to return to the facility following hospitalization or therapeutic leave, applies to all residents regardless of payer source." 3. Follow their P/P, titled "Clostridium Difficile" dated 9/18/2023, that indicated "residents asymptomatic for 48 hours can be removed from precautions (isolation) (diarrhea free). These deficient practices resulted in Resident 1 remaining in the GACH for 17 days after attempts to transfer her back to the facility were made by the GACH. These deficient practices placed Resident 1 at risk for disruption in Resident 1's routine, cause her anxiety and non-continuity of care. Findings: A review of Resident 1's Admission Record (Face Sheet), indicated Resident 1, a 54-year-old female, was admitted to the facility on 6/18/2024 with diagnoses including alcohol cirrhosis (a severe and irreversible liver disease caused by long-term excessive alcohol consumption) of the liver with ascites (a condition where excessive fluid accumulates in the abdomen) and portal hypertension (a condition in which there is increased blood pressure in the portal vein which is the large vein that carries blood from the digestive organs to the liver). A review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool), dated 12/20/2024, indicated Resident 1's cognition (ability to think and reason) was intact. A review of Resident 1's Physician's Order dated 2/20/2025, indicated to transfer Resident 1 to a GACH due to blood in her urine. A review of Resident 1's Bed Hold Notice, dated 2/20/2025 indicated Resident 1 and/or her emergency contact were notified of the bed hold. A review of Resident 1's SBAR note ([situation, background, assessment, recommendation] a communication tool used by healthcare workers when there is a change of condition among the residents), dated 2/20/2025 and timed at 8:42 p.m., indicated Resident 1 was discharged via ambulance to the GACH. A review of the Facility Census, dated 2/24/2025, indicated Resident 1's bed was available. A review of Resident 1's GACH Emergency Department (ED) record, dated 2/21/2025, indicated Resident 1 arrived at the ED on 2/21/2025 at 12:04 a.m. A review of a Fax from the GACH, dated 3/7/2025, indicated Resident 1 was no longer on C. diff isolation. During an interview on 3/13/2025 at 12:31 p.m., the Director of Nursing (DON) stated on 2/24/2025 the GACH contacted them to readmit Resident 1 to the facility. The DON stated she was informed by the Admissions Director (AD) that Resident 1 had an active C. diff infection. The DON stated she did not readmit Resident 1 to the facility because Resident 1 needed to be placed on contact isolation precautions (a set of practices to prevent the spread of infection such as wearing a gown when providing care for a person who with a contagious disease transmitted via contact), in a private room. The DON stated active C. diff meant Resident 1 was still experiencing diarrhea and needed to be isolated. The DON stated she was not sure if Resident 1 had symptoms of diarrhea on 2/24/2025 when the GACH attempted to coordinate with the AD to readmit Resident 1 to the facility. During an interview on 3/13/2025 at 1:53 p.m., the AD stated on 2/24/2025 she spoke to the GACH's Case Manager (CM) who informed her that Resident 1 was ready to be readmitted to the facility, but the CM informed her that Resident 1 was currently on contact isolation for C. diff. The AD stated she never discussed with the CM if Resident 1 had symptoms of diarrhea because she was not aware that she should do so. During an interview on 3/13/2025 at 2:02 p.m., the Administrator (ADM) stated Resident 1 was not readmitted to the facility on 2/24/2025 because she needed to be placed on contact isolation because she had a C. Diff infection, and they did not have a single or cohort room (a shared room for residents infected or colonized with the same pathogen) at the time. The ADM stated she was not aware that after 48 hours without C. Diff symptoms (diarrhea) Resident 1 could be taken off isolation and share a room with another resident. A review of facility's P&P titled "Bed-Holds and Returns" dated 10/2022, indicated residents be permitted to return to the facility following hospitalization or therapeutic leave applies to all residents regardless of payer source. A review of facility's P&P titled "Clostridium Difficile", dated 9/18/2023, indicated residents asymptomatic for 48 hours can be removed from precautions (isolation) (diarrhea free). The facility failed to: 1. Ensure Resident 1 was readmitted to the facility once the GACH cleared her for discharge back to the facility. 2. Follow their P/P, titled "Bed-Holds and Returns" dated 10/2022, that indicated "residents be permitted to return to the facility following hospitalization or therapeutic leave, applies to all residents regardless of payer source." 3. Follow their P/P, titled "Clostridium Difficile" dated 9/18/2023, that indicated "residents asymptomatic for 48 hours can be removed from precautions (isolation) (diarrhea free). These deficient practices resulted in Resident 1 remaining in the GACH for 17 days after attempts to transfer her back to the facility were made by the GACH. These deficient practices placed Resident 1 at risk for disruption in Resident 1's routine, cause her anxiety and non-continuity of care. These violations, jointly, separately or in any combination, had direct or immediate relationship to the health, safety, or security and welfare of Resident 1.