Health inspection·July 24, 2024

CFR §483.15 Permitting residents to return to facility. (e)(1) 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 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— Requires the services provided by the facility; and Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. 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. CCR §72520(c) – 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. CCR §72523 - 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 7/12/2024 the California Department of Public Health (CDPH) received a complaint regarding failure to readmit a resident. On 7/13/2024, CDPH conducted an announced visit to the facility to investigate a complaint allegation. The facility failed to: 1. Readmit Resident 1, who was ready to return to the facility on 7/12/2024 after the resident’s transfer to a General Acute Care Hospital (GACH) on 6/30/2024 for evaluation and treatment due to behavioral symptoms, agitation, aggression, and psychosis (mental disorder, disconnection from reality). 2. Follow its policy and procedure (P&P) titled, “Bed-Holds and Returns,” which indicated “residents who seek to return to the facility after the state seven-day Bed-Hold period has expired are allowed to return to their previous room, if available, or immediately to the first available bed in a semi-private room.” 3. Follow its P&P titled, "Readmission to the Facility” which indicated that “residents, who have been discharged to the hospital or for therapeutic leave, will be given priority in readmission to the facility.” This deficient practice resulted in Resident 1 remaining at the GACH for additional seven days after Resident 1 was ready to be discharged back to the facility on 7/12/2024 but was denied readmission. Resident 1 has remained at the GACH unnecessarily for additional seven days, placing Resident 1 at risk for confusion, disorientation and psychosocial harm related to being displaced from the facility, a place that was considered Resident 1's home since initial admission on 1/25/2024. The facility readmitted Resident 1 back on 7/19/2024 after CDPH investigation. A review of Resident 1's Admission Record, indicated Resident 1 was admitted to the facility on 1/25/2024 with diagnoses including dementia (memory loss, thinking abilities that interfere with daily life), metabolic encephalopathy (problem in the brain caused by chemical imbalance), depression (a constant feeling of sadness and loss of interest in activities of daily living), and anxiety disorder (excessive worry and feelings of fear, dread, and uneasiness) A review of Resident 1's Minimum Data Set ([MDS] - a standardized assessment and care screening tool), dated 6/30/2024, indicated Resident 1 had moderately impaired cognitive skills for daily decision making. A review of Resident 1’s Physician’s Order dated 6/1/2024 indicated Resident 1 was incapable of understanding rights, responsibilities, and informed consent. A review of Resident 1's Change of Condition ([COC] a facility tool to document a resident’s sudden change from baseline) dated 6/29/2024, indicated Resident 1 had behavioral symptoms of aggressive behavior and psychosis, talking to self, and was verbally aggressive towards staff. A review of Resident 1's Physician's Order dated 6/30/2024 indicated to transfer the resident to the GACH for further psychiatric evaluation with a seven-day Bed-Hold (facility reserves bed for resident who is emergently transferred out). A review of Resident 1's Nurse’s Progress Notes dated 6/30/2024 and timed 7:00 pm indicated Resident 1 was transferred to a GACH via ambulance for further evaluation on 6/30/2024. A review of Resident 1's Notice of Transfer/Discharge dated 6/30/2024, indicated Resident 1 was transferred to the GACH on 6/30/2024, because it was “necessary for the resident.” A review of the GACH’s Admission Records indicated Resident 1 was admitted to the Emergency Room on 6/30/2024 with diagnoses of dementia with psychosis, worsening agitation, and aggression, and was subsequently admitted to the inpatient behavioral unit for behavior management. A review of Resident 1’s GACH’s Discharge Plan Records dated 7/9/2024 and timed at 11:28 pm indicated the psychiatrist’s plan was for Resident 1’s discharge back to the facility on 7/12/2024. The GACH’s Discharge Plan Records indicated the social worker called the facility and had to leave a voice message due to no answer. A review of the GACH’s Discharge Plan Records dated 7/10/2024 and timed at 9:38 pm indicated the social worker called the facility to inquire about Resident 1’s return to the facility. The GACH’s Discharge Plan Records indicated the facility’s Marketer stated Resident 1 was off his seven-day Bed-Hold and the facility was unable to take him back. A review of the GACH’s Discharge Plan Records dated 7/12/2024 and timed at 1:10 pm, indicated that the social worker talked to Resident 1, and the resident stated he would like to return to the facility. During an interview on 7/13/2024 at 11:35 a.m., the registered nurse supervisor (RN 1) stated the facility was a special-focus-facility (a facility under monitoring due to a record of poor state inspection results) under Centers for Medicare and Medicaid Services ([CMS] – a federal agency that provides the nation’s major health coverage program) and are unable to readmit residents who exceed the seven day Bed-Hold, because they are considered a new admission. During an interview on 7/13/2024 at 12:15 pm, the Administrator (ADM), stated they could not readmit Resident 1. The ADM stated that per the interim manager’s guidance, once Resident 1 had exceeded the seven-day Bed-Hold, Resident 1 would be considered a new admission and the facility would not be reimbursed by CMS for services rendered. During an interview on 7/15/2024 at 9:30 am, the social worker from the GACH stated that on 7/10/2024, the facility’s response to Resident 1 returning back was that the facility was unable to accept Resident 1 back due to Resident 1 being off his seven-day Bed-Hold. During a review of the facility’s P&P titled, “Bed-Holds and Returns,” revised 10/2022, the P&P indicated that residents are permitted to return to the facility following hospitalization or therapeutic leave regardless of payer source. The P&P indicated that residents who seek to return to the facility after the state seven-day Bed-Hold period has expired are allowed to return to their previous room, if available, or immediately to the first available bed in a semi-private room. During a review of the facility's (P&P titled "Readmission to the Facility” revised 3/2017, the P&P indicated that residents, who have been discharged to the hospital or for therapeutic leave, will be given priority in readmission to the facility. The facility failed to: 1. Readmit Resident 1, who was ready to return to the facility on 7/12/2024 after the resident’s transfer to a General Acute Care Hospital (GACH) on 6/30/2024 for evaluation and treatment due to behavioral symptoms, agitation, aggression, and psychosis (mental disorder, disconnection from reality). 2. Follow its policy and procedure (P&P) titled, “Bed-Holds and Returns,” which indicated “residents who seek to return to the facility after the state seven-day Bed-Hold period has expired are allowed to return to their previous room, if available, or immediately to the first available bed in a semi-private room.” 3. Follow its P&P titled, "Readmission to the Facility” which indicated that “residents, who have been discharged to the hospital or for therapeutic leave, will be given priority in readmission to the facility.” This deficient practice resulted in Resident 1 remaining at the GACH for additional seven days after Resident 1 was ready to be discharged back to the facility on 7/12/2024 but was denied readmission. Resident 1 has remained at the GACH unnecessarily for additional seven days, placing Resident 1 at risk for confusion, disorientation and psychosocial harm related to being displaced from the facility, a place that was considered Resident 1's home since initial admission on 1/25/2024. The facility readmitted Resident 1 back on 7/19/2024 after CDPH investigation. These violations, jointly, separately or in any combination, had a direct or immediate relationship to the health, safety, or security to Resident1.