Health inspection·February 27, 2024

F 626 §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 Title 22- 72520 - Bed Hold (a) (b) (c) (a) If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed hold of seven (7) days, which may be exercised by the patient or the patient's representative. (b) Upon admission of the patient to the skilled nursing facility and upon transfer of the patient of a skilled nursing facility to a general acute care hospital, the skilled nursing facility shall inform the patient, or the patient's representative, in writing of the right to exercise this bed hold provision. No later than June 1, 1985, every skilled nursing facility shall inform each current patient or patient's representative in writing of the right to exercise the bed hold provision. Each notice shall include information that a non-Medi-Cal eligible patient will be liable for the cost of the bed hold days, and that insurance may or may not cover such costs. (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. Title 22 - § 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. The California Department of Public Health (CDPH) received a complaint on 1/25/2024 regarding the facility’s refusal to re-admit a resident (Resident 1) due to the resident’s isolation status of Candida auris (C. Auris, a type of fungus that grows as yeast that can cause severe illness and spreads easily among patients in healthcare facilities). On 1/26/2024, an unannounced investigation was conducted at the facility. The facility failed to readmit Resident 1 from the general acute care hospital (GACH) after Resident 1 was cleared by the GACH to return to the facility on 1/25/2024. This resulted in the denial of Resident 1’s right to return to the facility. A review of Resident 1’s Admission Record (Face Sheet) indicated Resident 1, was a 64 year-old male, initially admitted to the facility on 10/23/2023 and readmitted on 11/22/2023 with diagnoses including diabetes (high blood sugar), muscle weakness (a lack of strength in the muscles), dysphagia (swallowing difficulties), chronic kidney disease ([CKD] a condition in which the kidneys are damaged and cannot filter blood), and heart failure (a condition when heart doesn’t pump enough blood for body’s needs). A review of Resident 1’s History and Physical (H&P) dated 11/27/2023 indicated Resident 1 had the capacity to make medical decisions. A review of Resident 1’s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 11/29/2203, indicated Resident 1 was able to make self-understood and understand others. The MDS indicated Resident 1 required maximal assistance from staff for showering, grooming, bed mobility, and transfer. A review of Resident 1’s Progress Note dated 12/17/2023 at 11 AM, indicated Resident 1 was admitted to the GACH due to acute kidney injury (when kidneys have stopped working well enough for you to survive), and pneumonia (an infection that effects one or both lungs). During a telephone interview on 1/26/2024 at 11:10 AM with the GACH Case Manager (GACH CM), the GACH CM stated the facility would not re-admit Resident 1 back to the facility because Resident 1 was positive for C. Auris. The GACH CM stated she was told by the facility’s Director of Nursing (DON) Resident 1 could not return to the facility because of the isolation status. During an interview on 1/26/2024 at 12:57 PM with the DON, the DON stated the facility would not readmit Resident 1 to the facility because Resident 1 was positive for C. Auris. The DON stated Resident 1 would require isolation, but the facility did not have an isolation room available. During a concurrent interview and record review on 1/26/2024 at 3:33 PM, with the DON, the facility’s census dated 1/25/2024 was reviewed. The census indicated on 1/25/2024, there was a total of 112 in-house residents with eight residents on bed hold. The total in-house residents including bed holds was 120. The DON stated the facility's bed capacity was 133. The DON stated there was an available room to readmit Resident 1 back to the facility. During a telephone interview on 1/30/2024 at 9:48 AM with the facility’s Admission Coordinator (AC), the AC stated she stopped the readmission of Resident 1 because Resident 1 was positive for C. Auris. The AC stated the facility did not currently have any other residents on C. Auris isolation or a C. Auris isolation room available . The AC stated Resident 1 would require isolation for an extensive period. A review of the facility’s Policy and Procedure (P&P) titled, “Bedhold”, undated, indicated the facility shall allow residents, who, because of medical necessity, are transferred to the acute hospital, to have the option of having the facility hold their bed open for up to seven (7) days or more, upon request. The facility shall allow a resident, whose hospitalization or therapeutic leave exceeds 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. A review of the facility’s P&P titled, “Readmission”, revised 10/1/2013, indicated the facility will provide readmission of residents who require services provided by the facility. A review of the All Facilities Letter 23-37 (AFL, a letter from the Center for Health Care Quality [CHCQ], Licensing and Certification [L&C] Program to health facilities that are licensed or certified by L&C which contain information that include changes in requirements) dated 12/22/2023, indicated skilled nursing facilities (SNFs) must provide residents with equal access to quality care regardless of diagnosis, severity of condition, or payment source. The facility failed to readmit Resident 1 from the GACH after Resident 1 was cleared by the GACH to return to the facility on 1/25/2024. This resulted in the denial of Resident 1’s right to return to the facility. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to a patient.