Health inspection·August 9, 2024

§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. (A) Requires the services provided by the facility; and (B) Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. § 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 6/27/2024, the California Department of Public Health (CDPH) received a complaint alleging the facility refused to readmit a resident (Resident 1) back to the facility. On 06/27/2024, CDPH conducted an unannounced visit to the facility to investigate the compliant allegation. Upon investigation, CPDH determined that Resident 1 was transferred from the facility to a GACH on 4/11/2024 for low blood pressure and a change in the resident's level of consciousness ([LOC] a person's awareness, alertness, and responsiveness to their surroundings and stimuli). After Resident 1 was stabilized at the GACH and was ready to go back to the facility on 6/10/2024, the facility refused to readmit Resident 1 back. The facility failed to: 1. Ensure Resident 1, who was transferred from the facility on 4/10/2024 to the GACH for evaluation and treatment after being found lethargic (a condition marked by drowsiness and an unusual lack of energy and mental alertness) and hypotensive (low blood pressure), was readmitted to the facility after Resident 1 was ready to return back from the GACH on 6/10/2024. 2. Ensure staff followed the facility's policy and procedure (P/P) titled, "Bed Hold and Returns," that indicated residents who seek to return to the facility after the State bed-hold period has expired (or when State law does not provide for bed-holds) were allowed to return to their previous room, if available, or immediately to the first available bed in a semi-private room, provided that the resident still requires the services provided by the facility These deficient practices resulted in Resident 1 remaining at the GACH for approximately 43-47 days after Resident 1 was deemed appropriate for discharge back to the facility (6/10/2024 - 6/14/2024) but was denied readmission by the facility. Resident 1 was subsequently transferred to a different facility placing the resident at risk for confusion, disorientation and psychosocial harm related to dislocation from a place that was considered Resident 1's home. A review of Resident 1's Admission Record (Face Sheet), the Face Sheet indicated Resident 1, a 76 year old female, was admitted to the facility on 2/8/2024, with diagnoses including acute respiratory failure (inability to breathe), sepsis (a life-threatening medical emergency that occurs when the body's immune system overreacts to an infection), dependence on mechanical ventilation (when a patient is unable to wean [detach from source of dependence] off a ventilator [a machine that assist with breathing] and breathe independently for more than six hours a day and for more than 21 days), and a tracheostomy (an opening surgically created through the neck into the windpipe to allow air to fill the lungs). A review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 2/14/2024, indicated Resident 1 had modified independence (difficulty in new situations only) in her cognitive skills for daily decision-making. A review of Resident 1's History and Physical (H&P) dated 2/9/2024 indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1's Change of Condition (COC) dated 4/11/2024 and timed at 11 a.m., indicated Resident 1 was lethargic with a blood pressure of 101/49 millimeters of mercury ([mmHg] a unit of measurement [normal range 120/80 mmHg]). The COC indicated a physician examined Resident 1 at her bedside with orders to transfer Resident 1 via 911 to the GACH. A review of Resident 1's Physician's Order dated 4/10/2024 and timed at 11:01 a.m., indicated "may transfer Resident 1 to an acute hospital for further evaluation and treatment due to hypotension and an altered level of consciousness ([ALOC] a change in a patient's state of awareness [ability to relate to self and the environment] and arousal [alertness]) with a 7 day bed hold." A review of Resident 1's GACH Admission Records, indicated Resident 1 was admitted to the Emergency Room on 4/10/2024, with diagnoses of leukocytosis (a high white blood count), hypotension, an altered mental status ([AMS] a changed level of awareness or mental state that falls short of unconsciousness), sepsis, and pneumonia (a lung infection). A review of the GACH's Treatment Team Communication, dated 6/27/2024, indicated the following: 1. On 6/10/2024 the facility was contacted and informed that the GACH was trying to discharge Resident 1 to the facility by the end of the week (6/14/202) but the facility replied they had no available beds. 2. On 6/11/2024 and 6/12/2024, the facility was unable to accept Resident 1 because there were no beds available. A review of the facility's Room Roster/Daily Census, the Room Roster/Daily Census dated 6/10/2024, 6/11/2024 and 6/12/2024 indicated there was one female bed available and the Room Roster/Daily Census dated 6/13/2024 and 6/14/2024 indicated there were two female beds available. A review of the facility's email correspondence (6/28/2024) to CDPH from the facility's Administrator (ADM), titled "Letter of Good Intention," indicated the following: 1. On 6/3/2024 the facility received an inquiry from the GACH regarding the availability of a bed for Resident 1 and how there was no bed available due to Resident 1 testing positive for Carbapenem-resistant Acinetobacter baumannii ([CRAB] a type of bacteria commonly found in the environment that can cause infection). 2. On 6/10/2024 the Case Manager from the GACH informed the facility that Resident 1 would need to be placed on isolation due to being positive for CRAB. The facility informed the GACH's Case Manager there were no available beds for a resident who was positive for CRAB. 3. On 6/12/2024 the GACH inquired again about the availability of a bed for Resident 1 and was informed again there were no available beds. During an interview on 6/27/2024 at 5 p.m., the Director of Nurses (DON) stated they did not have any available beds so they could not take Resident 1 back. During an interview on 6/27/2024 at 5:15 p.m., the ADM, stated they could not readmit Resident 1 to the facility because there were no available beds. During an interview on 6/27/2024 at 5:20 p.m., the Complainant stated she had been in contact with the facility for the past month and the facility continued to say they had no beds available. The Complainant stated, she explained to the facility that Resident 1 had been treated, was not on isolation at the GACH and had an order to return to the facility, but the facility still refused to readmit Resident 1. A review of an All Facility's Letter 24-15 (AFL 24-15), dated 6/13/2024, indicated as of 3/20/2024, all Skilled Nursing Facilities (SNFs) in compliance with the Centers for Medicare & Medicaid Services (CMS an agency that provides health coverage to more than 160 million) Enhanced Barrier Precautions ([EBP] an infection control strategy that uses personal protective equipment ([PPE] clothing and gear that medical professional wear to protect themselves from infection and injury to reduce the spread of Multidrug-resistant Organisms ([MDROs] bacteria that have become resistant to certain antibiotics in nursing homes) requirement, were able to admit and provide care for residents with MDROs. Thus, there was no basis for the facility to refuse admission of a Resident based on the resident's need for EBP or MDRO status. Residents on EBP do not require placement in a single-person room, even when known to be infected or colonized with an MDRO. A review of the facility's P/P titled "Bed Hold and Returns," revised 10/2022, indicated residents who seek to return to the facility after the State bed-hold period has expired (or when State law does not provide for bed-holds) are allowed to return to their previous room if available or immediately to the first available bed in a semi-private room, provided that the resident still requires the services provided by the facility. The facility failed to: 2. Ensure staff followed the facility's policy and procedure (P/P) titled, "Bed Hold and Returns," that indicated residents who seek to return to the facility after the State bed-hold period has expired (or when State law does not provide for bed-holds) were allowed to return to their previous room, if available, or immediately to the first available bed in a semi-private room, provided that the resident still requires the services provided by the facility These deficient practices resulted in Resident 1 remaining at the GACH for approximately 43-47 days after Resident 1 was deemed appropriate for discharge back to the facility (6/10/2024 - 6/14/2024) but was denied readmission by the facility. Resident 1 was subsequently transferred to a different facility placing the resident at risk for confusion, disorientation and psychosocial harm related to dislocation from a place that was considered Resident 1's home. These violations jointly, separately, or in any combination, presented had a direct relationship to the health, safety, or security of Resident 1.