Health inspection·October 6, 2023

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. §483.15(e)(2) Readmission to a composite distinct part. When the facility to which a resident return is a composite distinct part (as defined in § 483.5), the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of return, the resident must be given the option to return to that location upon the first availability of a bed there. 72523(a) Patient Care Policies and Procedures Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 8/22/2023, the California Department of Public Health (CDPH) received a complaint regarding Resident 1 was not allowed to return to the facility on 8/19/2023 because the resident tested positive for Candida Auris ([C. Auris] a yeast type of fungus that causes severe infections) while in the General Acute Care Hospital (GACH) on 8/13/2023. On 8/23/2023, CDPH conducted an unannounced visit at the facility to investigate a complaint. Upon investigation, it was determined the facility refused to re-admit Resident 1 back to the facility because Resident 1 tested positive for C. auris on 8/13/23 while at the GACH. Resident 1 was medically cleared by GACH to return to the facility on 8/19/2023. The facility failed to readmit Resident 1 from the GACH after Resident 1 was medically cleared by GACH’s physician to return to the facility on 8/19/2023. As a result, Resident 1’s rights were violated by denying returning to the facility not until six days later on 8/25/23 after CDPH investigation of a complaint allegation. A review of Resident 1’s Admission Record (AR), indicated Resident 1 was a 53 year old originally admitted to the facility on 6/1/2022 with diagnoses that included cardiac arrest (occurs when the heart suddenly and unexpectedly stops pumping), anoxic brain damage (caused by a complete lack of oxygen to the brain which results in death of the brain cells), respiratory failure (difficulty breathing on your own), tracheostomy (an incision in the throat to deliver oxygen to the lungs if you cannot breathe normally) and a Stage 4 pressure ulcer (most severe bedsore with tissue damage to the muscle, bone or tendon). A review of Resident 1’s Minimum Data Set ([MDS], a standardized assessment and care-screening tool), dated 6/1/2023, 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 required extensive assistance (resident involved in activity, staff provide guided maneuvering) from staff with activities of daily living [(ADL) such as transferring, dressing, toilet use and personal hygiene]. A review of Resident 1’s physician order (PO) dated 8/11/2023, indicated to transfer Resident 1 via 911 (emergency) ambulance for further evaluation due to low oxygen saturation level (the amount of oxygen circulating in the blood). A review of Resident 1’s Nurses Progress Note (NPN) dated 8/11/2023 at 10:41 p.m., indicated Resident 1 was transferred to the GACH emergency room (ER) for further evaluation due to low oxygen saturation level. A review of Resident 1’s GACH Progress Notes dated 8/19/2023, indicated Resident 1 continued to stay at the GACH until 8/25/23 because of the facility’s refusal to readmit Resident 1 back due to diagnosis of C. Auris. The GACH’s progress notes indicated Resident 1 needed an isolation for C. Auris infection. A review of the facility’s census dated 8/21/2023 and 8/22/2023 indicated there were two double occupancy rooms with one bed available in each room at the facility on those days. During a telephone interview on 8/22/2023 at 3:35 p.m. Resident 1’s responsible party (RP), stated the GACH informed him Resident 1 was ready to return to the facility on 8/19/2023, but the facility refused to readmit Resident 1 because of the resident’s need for an isolation room due to a positive C. Auris infection. The RP stated, the facility told him they do not have any residents with C. Auris in the facility and therefore cannot re-admit Resident 1 back to their facility. During a telephone interview on 8/23/2023 at 12:22 p.m. with the GACH case manager (CM [ healthcare worker who is trained to assess treatment need, create, and evaluate plan for patients]), the CM stated the facility would not re-admit Resident 1 back to the facility because Resident 1 was positive for C. Auris. The CM stated she was told by facility’s Infection Preventionist ([IP] person responsible for the facility’s activities aimed at preventing healthcare-associated infections) Resident 1 could not return to the facility because the resident required a contact isolation room due to be positive with C. Auris infection. During an interview on 8/23/2023 at 12:33 p.m. the IP, stated the facility could only admit Resident 1 back to the facility unless the facility would have had another resident that was positive for C. Auris and was on isolation to cohort Resident 1. The IP stated the facility did not have a private room for Resident 1 and currently had no residents positive for C. Auris who was on isolation. During an observation on 8/23/2023 at 1:00 p.m. on the facility’s sub-acute unit (inpatient care unit for patients with complex health problems) there were observed two double occupancy rooms with one empty beds per room available for Resident 1 readmission. However, Resident 1 was not readmitted back to the facility until 8/25/2023. During an interview and record review on 8/23/2023 at 1:12 p.m. with the Admission Coordinator (AC), the AC stated they can only take Resident 1 back if the facility had another resident who was positive for C. Auris. The AC stated, she was told not to readmit Resident 1 back to the facility because Resident 1’s needed an isolation. During an interview and record review on 8/23/2023 at 1:48 p.m. with the AC, the AC stated if the facility would have the available bed to cohort Reside t 1 with another resident with C. Auris, they would admit Resident 1 back to the facility. The AC stated there was available bed for Resident 1 on 8/21/2023. During an interview on 8/23/2023 at 2:48 p.m. with the Social Worker (SW), the SW stated she was informed Resident 1 could not return to the facility because the resident was positive for C. Auris and needed isolation. During an interview and record review on 8/23/2023 at 3:21 p.m. with the Director of Nurses (DON), the DON stated he stopped the admission of Resident 1 back to the facility because the resident was positive for C. Auris. The DON stated the facility does not currently have any other residents on isolation for C. auris. The DON stated Resident 1 would take up two beds in a double occupancy room because the facility does not have a private room available. The DON confirmed, during record review of the census dated 8/21/2023, there were two vacant beds available in the facility. According to the Center for Disease Control and Prevention (CDC) guidelines for Enhanced Barrier Precautions in Nursing Homes, residents with positive C. Arius do not require placement in a single person room (individual room). Single-person rooms (if available) should be prioritized for residents who have acute infection with a communicable disease (such as influenza, SARS-CoV-2, hepatitis A) or for residents placed on Contact Precautions for presence of acute diarrhea, draining wounds, or other sites of secretions or excretions that are unable to be covered or contained. Residents on Enhanced Barrier Precautions may share rooms with other residents; however, facilities with capacity to offer single-person rooms or create roommate pairs based on MDRO (bacteria that resist treatment with more than one antibiotic are called multidrug-resistant organisms (MDROs for short) colonization may choose to do so. When residents are placed in shared rooms, facilities must implement strategies to help minimize transmission of pathogens between roommates including: maintaining spatial separation of at least 3 feet between beds to reduce opportunities for inadvertent sharing of items between the residents, use of privacy curtains to limit direct contact, cleaning and disinfecting any shared reusable equipment, cleaning and disinfecting environmental surfaces on a more frequent schedule, and changing personal protective equipment (if worn) and performing hand hygiene when switching care from one roommate to another. https://www.cdc.gov/hai/containment/faqs.html A review of the facility’s policy and procedure (P&P) titled “Bed-Holds and Returns” revised 10/2022, the P&P indicated residents who seek to return to the facility after the state bed-hold period has expired are allowed to return to the first available bed in a semi-private room, provided the resident still requires the services provided by the facility and eligible for Medicare skilled services. The facility failed to readmit one of three sampled residents, Resident 1 from the GACH after Resident 1 was medically cleared by GACH to return to the facility on 8/19/2023. This violation(s) caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to a patient.