Other·July 15, 2021

F626- 483.15 (e) (1) 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 72521 (C) (2) - Administrative Policies and Procedures (C) Each facility shall establish at least the following: (2) Policies and procedures for patient admission, leave of absence, transfer, pass and discharge, categories of patients accepted and retained, rates of charge for services included in the basic rate, type of services offered, changes for extra services, limitations of services, cause for termination of services and refund policies applying to termination of services. On 7/14/21, an unannounced visit was made to the facility to conduct a complaint investigation regarding the facility refusing to readmit Resident 1. The facility failed to readmit Resident 1 on the first available bed at the Skilled Nursing Facility 1 (SNF 1). As a result, Resident 1 remained in the Long-Term Acute Care Hospital 1 (LTACH 1) from 4/16/21 through 7/14/21, following a receipt of an inquiry from the LTACH 1 for resident to be transferred back to SNF1. A review of Resident 1’s Face sheet indicated the resident was admitted to SNF 1 on 11/11/17, with diagnoses including generalized muscle weakness, aphasia (loss of ability to understand or express speech), dysphagia (difficulty swallowing), and end stage renal disease (kidney disease. A review of Resident 1’s Physician Order dated 12/24/20, indicated to transfer Resident 1 to General Acute Care hospital (GACH) for evaluation and bed hold for 7 days. A review of History and Physical from LTACH 1, dated 3/8/21, indicated resident has a history of developmental delay, hydrocephalus (build-up of fluid within the brain), Covid-19, Arteriovenous (AV) shunt (connection that is made between an artery and vein for dialysis access) chronic infection, and colonization of Candida auris (species of fungus). A review of Decision and Order statement from the Office of Administrative Hearings and Appeals, dated 6/18/21, indicated the appeal is granted and SNF 1 must permit Resident 1 to return immediately upon the first availability of bed in a room that can accommodate her needs. During the interview on 7/14/21 at 11:35 a.m., the Administrator (ADM) stated Resident 1 would not be accepted back to SNF 1 due to facility’s inability to provide appropriate level of care due to her conditions. During an interview and concurrent record review of the facility’s available beds on 7/14/21 at 11:30 a.m., the ADM confirmed there is 9 female and 11 male available beds. During a review of the facility’s policy and procedure titled, “Readmission,” dated 10/1/2013, indicated “facility will allow residents who were previously residents of the facility to be readmitted to the facility.” The facility failed to readmit Resident 1 on the first available bed at the Skilled Nursing Facility 1 (SNF 1). As a result, Resident 1 remained in the Long-Term Acute Care Hospital 1 (LTACH 1) from 4/16/21 through 7/14/21, following a receipt of an inquiry from the LTACH 1 for resident to be transferred back to SNF1. This violation had a direct or immediate relationship to the health, safety, or security of Resident 1.