Other·September 19, 2023

42 CFR § 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. 42 CFR §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. 22 CCR § 72520 – Bed Hold. (c) A licensee who fails to meet these requirements shall offer to the patient the next available bed appropriate for the patient's needs. This requirement shall be in addition to any other remedies provided by law. 22 CCR § 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 8/7/2023, the California Department of Public Health (CDPH) received a complaint regarding the facility’s refusal to readmit Resident 1 following his stay at a General Acute Care Hospital (GACH). On 8/8/2023, the CDPH conducted unannounced visits to the facility to investigate the complaint. The facility failed to: 1. Permit Resident 1 to return to the facility to the first available bed following the resident’s stay at a General Acute Care Hospital (GACH). As a result, Resident 1 was transferred to another facility which had the potential to negatively affect the resident’s psychosocial well-being. Resident 1 was a 71-year-old male originally admitted to the facility on 2/6/2021 and readmitted on 6/16/2023. Resident 1’s diagnoses included chronic obstructive pulmonary disease [(COPD], lung disease that causes blocked airflow from the lungs), Parkinson’s disease (a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination) and chronic kidney disease ([CKD], condition which the kidneys are damaged and cannot filter blood as well as they should). A review of Resident 1’s History and Physical (H&P), dated 6/17/2023, indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1’s Minimum Data Set ([MDS] a standardized assessment and care screening tool) dated 5/21/2023, indicated Resident 1 was rarely/never understood and never/rarely made decisions. The MDS indicated Resident 1 was totally dependent on staff for toileting and needed extensive assistance for personal hygiene and dressing. A review of Resident 1’s Change of Condition (COC) note dated 7/5/2023 at 11:10 p.m., indicated Resident 1 was found to have shortness of breath, altered level of consciousness and a low oxygen saturation of 88% on room air. The COC indicated the paramedics were called and arrived at the bedside within minutes and Resident 1 was taken to GACH 1. The COC indicated Resident 1’s physician (MD1) ordered to transfer Resident 1 to GACH 1 and a bed hold (hold the resident’s bed for 7 days). The conservator was to be notified of the changes. A review of Resident 1’s GACH inquiry packet, dated 8/2/2023, inquiry packet indicated the packet was sent to the facility on 8/2/2023. The GACH inquiry packet indicated Resident 1 was admitted to the GACH on 7/15/2023 and Resident 1’s attending physician started discharge planning to the facility on 7/31/2023. During an interview on 8/8/2023 at 2:58 p.m. the Admissions Coordinator (AC) stated Resident 1 was discharged from the facility after his seven-day bed hold on 7/12/2023. The AC received an inquiry from the GACH to readmit Resident 1 on 8/2/2023. The AC stated a referral was given to the Director of Nursing (DON) to review the clinical portion to determine if Resident 1 could be readmitted. The AC stated the DON determined that Resident 1 could not be readmitted due to testing positive for Candida auris ([C. auris], a type of fungus that can cause severe illness and spreads easily in healthcare facilities). The AC stated C. Auris needed long term isolation and the facility did not have an available private room to accommodate Resident 1’s needs. During an interview on 8/8/2023 at 3:35 p.m. the DON stated, he reviewed the referral packet for Resident 1 and denied readmission to the facility, due to Resident 1 testing positive for C. auris. The DON stated, the facility could not risk the staff or residents getting the disease. The DON stated he received the referral packet on 8/2/2023 and denied readmission due to Resident 1 having C. auris. During a concurrent interview and record review on 8/8/2023 at 3:45 p.m. with the DON, the facility Census for 8/2023, was reviewed. The census indicated a room was empty from 8/1 to present. The DON stated the room was kept empty, for possible COVID ([Covid-19], an infectious disease that can cause symptoms including fever and cough which can easily be transferred from person to person) confirmed residents. The DON stated there was no COVID confirmed residents in the facility at this time. A review of the facility’s undated policy and procedure (P&P) titled, "Bed Hold," the P&P indicated, "The facility shall allow residents, who, because of medical necessity, are transferred to an acute hospital, to have the option of having the facility hold their bed open for up to seven (7) days or more, upon request." A review of the facility’s undated P&P titled, "Permitting a Resident to Return to facility" the P&P indicated, the facility should allow a resident, whose hospitalization or therapeutic leave exceeded the bed-hold period (7 days), to be readmitted to the facility immediately upon the first availability of a bed in a semi-private room provided. A review of the facility’s P&P titled, "Enhanced Standard Precautions," dated 8/22/2019, indicated, Admissions would be based on whether or not the facility can provide appropriate care for the medical/surgical condition and denial of admission should not be based on positive MDRO (Multidrug-resistant bacteria, bacteria [tiny, single-celled living organisms] that are resistant to one or more classes of antimicrobial) test results. The facility failed to: 1. Permit Resident 1 to return to the facility to the first available bed following the resident’s stay at a GACH. As a result, Resident 1 was transferred to another facility which had the potential to negatively affect the resident’s psychosocial well-being. This violation presented a direct or immediate relationship to the health, safety, security, or welfare of Resident 1.