Health inspection·October 31, 2024

§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 (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 9/12/2024, the California Department of Public Health (CDPH) received a complaint alleging a resident (Resident 1), who was transferred to a General Acute Care Hospital (GACH), was refused readmission to the Skilled Nursing Facility (SNF), where the resident was transferred from. On 9/13/2024, CDPH conducted an unannounced visit to the facility to investigate the complaint allegation. During the investigation CDPH determined on 3/27/2024, Resident 1 was transferred to a GACH for evaluation due to aggressive behaviors, increased agitation, and refusal of care. On 5/9/2024, the GACH cleared Resident 1 to return to the facility, but the facility refused to readmit Resident 1. The facility failed to: 1. Re-admit Resident 1 to the facility on 5/9/2024 after the resident was evaluated, treated, and cleared by the GACH to return to the facility. 2. Ensure the facility followed its policy and procedure (P/P), titled "Bed Hold and Notice" that indicated when a resident's hospital or therapeutic leave exceeds the bed-hold period, the facility will readmit a Medicaid resident requiring SNF services to their previous room if available or immediately upon the first availability of a bed in a semi-private room. This deficient practice resulted in Resident 1 remaining at the GACH for over five months after being transferred from the SNF on 3/27/2024 and had a potential for Resident 1's continued displacement. A review of Resident 1's Admission Record (Face Sheet) indicated Resident 1 was admitted to the facility on 1/16/2023 with diagnoses including schizoaffective disorder (a chronic mental illness that causes a person to experience dramatic changes in their thoughts, mood, and behavior) with a gastrostomy tube ([GT] a tube inserted through the abdomen into the stomach which allows for the delivery of nutrition, fluids, and medications directly to the stomach) in place. A review of Resident 1's Minimum Data Set ([MDS] ([MDS] a federally mandated resident assessment tool) dated 1/26/2024 indicated Resident 1's cognitive (the mental process involved in knowing, learning, and understanding things) skills for daily decision making were severely impaired and Resident 1 required substantial to maximal assistance (helper does more than half the effort) to complete her activities of daily living ([ADLs] task such as bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet and eating). A review of Resident 1's Physician's Orders dated 3/27/2024 indicated an order to transfer Resident 1 to a GACH for further evaluation due to aggressive behavior, increased agitation, refusing medication and GT feedings. A review of Resident 1's Physician's Discharge/Transfer Note, dated 3/27/2024 indicated, under the section titled "Transfer/Discharge Was Necessary Due To" there was no documentation to indicate why Resident 1 was being transferred from the facility. A review of Resident 1's Notice of Transfer/Discharge, dated 3/27/2024 (the same day Resident 1 was transferred), indicated Resident 1's transfer/discharge was necessary for her welfare and her needs could not be met at the facility. Continued review of the Notice of Transfer/Discharge indicated no signature from Resident 1 and/or her representative to indicate Resident 1 received this notice. A review of the facility's Daily Census dated 5/9/2024, indicated there were four available beds. A review of the GACH's Psychiatric Progress notes, dated 5/9/2024, indicated Resident 1 intermittently (occurring at irregular interval, not continuous or steady) responded to internal stimuli (changes or feelings that occur within the body, such as hunger, thirst, or emotional states) but was not distressed and was more redirectable. The Psychiatric Progress notes indicated Resident 1 was compliant with taking her medication, was able to make simple needs known and was partially cooperative. During an interview on 9/13/2024 at 12:29 p.m., Social Services staff at the GACH stated on 5/9/2024 she spoke to the Admissions Coordinator (AC) at the facility who told her Resident 1 was unable to return to the facility, there was no reason given why. During an interview on 9/13/2024 at 2:51 p.m., the AC stated Resident 1 was sent to the GACH due to behavioral reasons and the Director of Nursing (DON 1), who was the DON during the time Resident 1 was transferred (3/27/2024), was adamant about not readmitting Resident 1 to the facility because the facility could not meet Resident 1's psychosocial needs. The AC stated when the GACH called to have Resident 1 readmitted to the facility, DON 1 reviewed Resident 1's social services notes from the GACH and found that Resident 1 was still combative, and refused care, and she (DON 1) would not allow Resident 1 readmission to the facility. During an interview on 9/13/2024 at 4:59 p.m., DON 2, who began working at the facility on 9/3/2024, stated prior to readmitting a resident to the facility, she reviews clinical information from the GACH to determine if the facility could meet the resident's needs. DON 2 stated, if a resident was yelling and refused care, per the GACH's records, the resident would not be readmitted to the facility because the resident's behavior would disturb the other residents at the facility. A review of the facility's P/P titled "Bed Hold and Notice" dated 8/2018, indicated when a resident's hospital or therapeutic leave exceeds the bed-hold period, the facility will readmit a Medicaid resident requiring SNF services to their previous room if available or immediately upon the first availability of a bed in a semi-private room. The facility failed to: 1. Re-admit Resident 1 to the facility on 5/9/2024 after the resident was evaluated, treated, and cleared by the GACH to return to the facility. 2. Ensure the facility followed its policy and procedure (P/P), titled "Bed Hold and Notice" that indicated when a resident's hospital or therapeutic leave exceeds the bed-hold period, the facility will readmit a Medicaid resident requiring SNF services to their previous room if available or immediately upon the first availability of a bed in a semi-private room. This deficient practice resulted in Resident 1 remaining at the GACH for over five months after being transferred from the SNF on 3/27/2024 and had a potential for Resident 1's continued displacement. This violation had a direct relationship to the health, safety, or security of the resident.