Other·December 7, 2018

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during the investigation of one complaint during an abbreviated standard survey. Complaint number: CA00603191 Representing the Department of Public Health: Health Facilities Evaluator Nurse ID: 39643 The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. Two deficiencies were written as a result of complaint number CA00603191.

F623 SS=D Notice Requirements Before Transfer/Discharge CFR(s): 483.15(c)(3)-(6)(8)

F623 09/06/2018 §483.15(c)(3) Notice before transfer. Before a facility transfers or discharges a resident, the facility must(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State LongTerm Care Ombudsman. (ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE section; and (iii) Include in the notice the items described in paragraph (c)(5) of this section. §483.15(c)(4) Timing of the notice. (i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged. (ii) Notice must be made as soon as practicable before transfer or discharge when(A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section; (B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section; (C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section; (D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or (E) A resident has not resided in the facility for 30 days. §483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following: (i) The reason for transfer or discharge; (ii) The effective date of transfer or discharge; (iii) The location to which the resident is transferred or discharged; (iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request; 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE (v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman; (vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and (vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act. §483.15(c)(6) Changes to the notice. If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available. §483.15(c)(8) Notice in advance of facility closure In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at § 483.70(l). This REQUIREMENT is not met as evidenced by: Based on interview and record review, the 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE facility failed to implement its policy and procedure on Transfer/Discharge documentation and notification information to the resident in writing, 30 days prior to a facility-initiated transfer for one of three sampled residents (Resident 1). The Notice of Proposed Transfer/Discharge was provided to the resident and signed by the facility's Director of Staff Development (DSD) on 8/31/18 on the day Resident 1 was discharged to an assisted living facility (ALF). This deficient practice violated the residents' rights to be informed of where and how to appeal the proposed transfer. Findings: A review of Resident 1's Admission Face Sheet indicated the resident was initially admitted to the facility on 6/12/18 and re-admitted on 8/22/18 with diagnoses that included chronic obstructive pulmonary disease ([COPD] a progressive lung disease, which blocks air flow making breathing difficult) and asthma (a chronic lung disease that inflames and narrows the airways). A review of Resident 1's Minimum Data Set (MDS), a standardized assessment and carescreening tool, dated 6/19/18, indicated Resident 1 was severely impaired in cognitive skills (ability to think and reason) for daily decision making. The MDS indicated Resident 1 could not walk, and required extensive assistance (resident involved in activity, staff provided weight-bearing support) with bed mobility, dressing, eating toilet use, personal hygiene and transfer with 2 persons assist. A review of Resident 1's Physician's Telephone Orders, dated 8/31/18 at 10:00 a.m., indicated the physician ordered to transfer the resident to 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE an ALF on 8/31/18. A review of Resident 1's clinical record indicated the Notice of Proposed Transfer/Discharge was signed by the facility's DSD on 8/31/18 on the day of Resident 1's discharge. The Notice of Proposed Transfer/Discharge was signed by Resident 1 but there was no date indicated. The day of the month was left blank on the notification date of the Notice of Proposed Transfer/Discharge. The notification date on the Notice of Proposed Transfer/Discharge for Resident 1 was written as follows: 8/ /18. On 9/11/18 at 12:30 p.m., an interview was conducted with Registered Nurse 1 (RN1) who confirmed that the day of the month was left blank on the notification date on the Notice of Proposed Transfer/Discharge for Resident 1. RN 1 was unable to give a reason why it was left blank. RN 1 also stated that the DSD completed/signed the Notification or Proposed Transfer/Discharge on 8/31/18, the day Resident 1 was transferred to the assisted living facility. A review of the facility's policy and procedure, revised November 2016, titled "Transfer/Discharge Policy and Procedure," indicated to document in the resident's clinical record that the SSD complete the Notice of Proposed Transfer/Discharge form and give it to the resident and it must be provided thirty days prior to transfer/discharge.

F660 SS=G Discharge Planning Process CFR(s): 483.21(c)(1)(i)-(ix)

F660 11/19/2018 §483.21(c)(1) Discharge Planning Process The facility must develop and implement an 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to postdischarge care, and the reduction of factors leading to preventable readmissions. The facility's discharge planning process must be consistent with the discharge rights set forth at 483.15(b) as applicable and(i) Ensure that the discharge needs of each resident are identified and result in the development of a discharge plan for each resident. (ii) Include regular re-evaluation of residents to identify changes that require modification of the discharge plan. The discharge plan must be updated, as needed, to reflect these changes. (iii) Involve the interdisciplinary team, as defined by §483.21(b)(2)(ii), in the ongoing process of developing the discharge plan. (iv) Consider caregiver/support person availability and the resident's or caregiver's/support person(s) capacity and capability to perform required care, as part of the identification of discharge needs. (v) Involve the resident and resident representative in the development of the discharge plan and inform the resident and resident representative of the final plan. (vi) Address the resident's goals of care and treatment preferences. (vii) Document that a resident has been asked about their interest in receiving information regarding returning to the community. (A) If the resident indicates an interest in returning to the community, the facility must document any referrals to local contact agencies or other appropriate entities made for this purpose. (B) Facilities must update a resident's comprehensive care plan and discharge plan, as appropriate, in response to information received from referrals to local contact 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE agencies or other appropriate entities. (C) If discharge to the community is determined to not be feasible, the facility must document who made the determination and why. (viii) For residents who are transferred to another SNF or who are discharged to a HHA, IRF, or LTCH, assist residents and their resident representatives in selecting a postacute care provider by using data that includes, but is not limited to SNF, HHA, IRF, or LTCH standardized patient assessment data, data on quality measures, and data on resource use to the extent the data is available. The facility must ensure that the post-acute care standardized patient assessment data, data on quality measures, and data on resource use is relevant and applicable to the resident's goals of care and treatment preferences. (ix) Document, complete on a timely basis based on the resident's needs, and include in the clinical record, the evaluation of the resident's discharge needs and discharge plan. The results of the evaluation must be discussed with the resident or resident's representative. All relevant resident information must be incorporated into the discharge plan to facilitate its implementation and to avoid unnecessary delays in the resident's discharge or transfer. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to ensure adequate preparation and a safe discharge for one of three sampled residents (Resident 1). Resident 1, who needed a Hoyer lift (brand name of a transfer lift, an assistive device used by caregivers to facilitate safe transfers from or to bed and chair), and was dependent on oxygen, was discharged to a lower level of care, an Assisted Living Facility (ALF) which did not have oxygen and mechanical lift for transfers. 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE As a result, on 8/31/18, five hours after transferring Resident 1 to the ALF with a portable oxygen tank, the oxygen ran out, and Resident 1 became short of breath. The ALF staff called paramedics, and Resident 1 required transferring to General Acute Care Hospital 1 (GACH 1) where she was admitted with a diagnosis of acute respiratory distress (a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood). Finding: A review of the Admission Record indicated Resident 1 was admitted to the facility on 6/12/18 and re-admitted on 8/22/18 with diagnoses including chronic obstructive pulmonary disease (COPD - a progressive lung disease that makes breathing difficult). A review of the Minimum Data Set (MDS standardized assessment and care-planning tool) dated 6/19/18, indicated Resident 1 had severely impaired cognition (ability to think and reasoning), was unable to walk, and required extensive assistance by staff with bed mobility, dressing, eating, toilet use, and personal hygiene. Resident 1 needed two-person physical assistance with transfers (from and to bed or wheelchair). The MDS indicated Resident 1 used a wheelchair as a mobility device. A review of the care plan dated 6/13/18 indicated Resident 1 was at risk for activities of daily living (ADL) decline related to Resident 1 being non-ambulatory (not walking). The goal was for ADL decline be minimized with interventions daily. The approaches identified were to assist with activities of daily living (ADLs - such as dressing, eating, and personal 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE hygiene) as needed and monitor for any decline and provide physical therapy (PT) / occupational therapy (OT) as ordered. A review of Resident 1's Physical Therapy Plan of Care (Evaluation Only) dated 6/14/18 indicated the resident required total assistance (100% assist) with transfers, bed/chair. A review of Resident 1's Respiratory Care Plan, dated 6/21/18 indicated the resident was at risk for respiratory complications due to COPD. The goal was for complications related to respiratory status/diagnosis will be minimized with interventions daily for three months. One of the identified interventions was to monitor oxygen saturation as ordered; oxygen therapy if ordered. A review of the Social Work Progress Note dated 8/30/18 indicated Resident 1 was approved for discharge the next day (8/31/18) to an ALF after an evaluation but did not include who evaluated Resident 1. The note did not include who made the determination an ALF was appropriate for Resident 1. A review of the facility's Social Work Progress Note dated 8/31/18, indicated Resident 1 would be discharged to an ALF and would be followed up by Home Health. There was no information about the Home Health Agency (HHA) and what services the HHA would provide to Resident 1. A review of the physician's order dated 8/31/18, timed at 10 a.m., indicated to transfer Resident 1 to an ALF on the same day, 8/31/18. The physician ordered Home Health Agency services and no medical equipment. A review of the Post-Discharge Plan of Care dated 8/31/18, indicated Resident 1 was on 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE oxygen inhalation, as needed, at two liters per minute (L/min) via nasal cannula (device used to deliver supplemental oxygen or increased airflow. It consists of a lightweight tube which on one end splits into two prongs placed in the nostrils). A review of the Discharge Summary/Comprehensive Assessment for Resident 1 dated 8/31/18 did not include Resident 1's need of a mechanical lift and twoperson assist with transfers. A review of the Nurses' Note dated 8/31/18, timed at 10 a.m., indicated the Social Services Designee (SSD) informed Registered Nurse 1 (RN 1) the ALF staff was aware Resident 1 needed assistance with transfers using the Hoyer lift and was on oxygen. The note did not indicate which ALF staff the DSD spoke with and made arrangement for Resident 1's transfer. There was no documentation the SSD informed the ALF staff about Resident 1's need of a Hoyer lift for transfers and dependence on oxygen. At 4 p.m., the note indicated the facility discharged Resident 1 via transportation van with a portable oxygen tank. There was no documentation the licensed nurses communicated with the ALF's staff about Resident 1's needed care before Resident 1's discharge. A review of the Paramedics Prehospital Care Report Summary Note dated 8/31/18, indicated the ALF called at 9:30 p.m. and arrived at the ALF at 9:33 p.m., due to a chief complaint of Resident 1 having shortness of breath. Resident 1 was found sitting in a wheelchair, complaining of shortness of breath for 30 minutes. The AFL staff stated Resident 1 transported to them without authorization. A review of GACH 1's Emergency Department (ED) Provider Report dated 8/31/18 timed at 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE 10:21 p.m., indicated Resident 1 had prolonged expiratory phase (moving air out of the lungs), diffused rhonchi (low pitched rattling lung sounds) and diffusely scattered wheezes (continuous, coarse, whistling lung sound). Resident 1 was stabilized and transported to inpatient services (admitted to the hospital). A review of GACH 1's History and Physical (H&P) Examination dated 9/1/18, indicated Resident 1 was admitted with acute respiratory distress with hypoxia (deficiency in the amount of oxygen reaching the tissues) and COPD in acute exacerbation (sudden worsening of COPD symptoms). Resident 1 received intravenous (inside the veins) steroids (medication to decrease swelling), breathing treatment and a short course of antibiotics. GACH 1 discharged Resident 1 on 9/6/18 back to the facility. On 9/11/18 at 12:10 p.m., during an interview, the Director of Nursing (DON) confirmed there was no documented evidence of evaluation of Resident 1's discharge to the ALF. There was no assessment of Resident 1's medical and physical needs would be met at the ALF. The DON also confirmed there was no documentation about the HHA and if the HHA would be able to provide the necessary care to Resident 1. On 9/11/18 at 12:30 p.m., during an interview, RN 1 stated the SSD verbally informed her on 8/31/18 at around 10:00 a.m. the ALF accepted Resident 1 and would be leaving at 3:00 p.m. the same day. RN 1 stated she did not call the ALF to report Resident 1's discharge because SSD arranged it. On 9/11/18 at 1:50 p.m., during an interview, Resident 1 stated she could not remember the discharge to the ALF. 056446 11/09/2018 PARAMOUNT CONVALESCENT HOSPITAL 8558 Rosecrans Ave Paramount, CA 90723 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE On 9/11/18 at 1:58 p.m., during an interview, the Administrator stated he received a call from the administrator of the ALF on 8/31/18 at 8:47 p.m. (four hours after arrival to the ALF) indicating they could not care for Resident 1. The Administrator stated when he called the ALF back at around 10:00 p.m., Resident 1 was already at GACH 1. On 9/14/18 at 2:15 p.m., during a telephone interview, the Assistant Administrator of the ALF stated they were not aware Resident 1 needed oxygen or needed a lift for transfers. The AFL did not have a lift or oxygen. Resident 1 arrived with one portable oxygen tank, and when the oxygen ran out Resident 1 was short of breath, and they called paramedics (911). A review of the facility's policy titled, "Transfer/Discharge Policy and Procedure," dated 11/2016, indicated before the transfer or discharge occurs, the facility must notify the physician, the receiving provider or facility, the resident and if known, the resident's representative, of the transfer, the reason for the transfer or discharge, and document in the resident's clinical record. Social Services will complete the Notice of Proposed Transfer/Discharge form and give it to the resident before the transfer or discharge. The Social Services will document the discharge plan and services per the facility's Discharge Planning Policy and Procedure. A review of the facility's policy titled, "Discharging the Resident," revised October 2010 indicated if the resident is being discharged to a hospital or another facility, ensure that a transfer summary is complete and telephone report made to the receiving facility.