Health inspection·August 4, 2023

§ 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. § 72521. 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 patient 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. (3) Policies and procedures for admission or discharge of a patient which state that a patient shall not be admitted or discharged based on race, color, religion, ancestry, national origin, sexual orientation, disability, medical condition, marital status, or registered domestic partner status, except: F626- §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. An unannounced visit was conducted by California Department of Public Health on 7/25/23 at 9:50 AM to investigate a facility reported incident regarding an allegation of employee- to- patient abuse. The facility failed to permit one of two sampled patients (Patient 1) back to the facility who was transferred to Emergency Room (ER) on 7/10/23 for evaluation. On 7/18/23, the patient had an order to be readmitted, but the skilled nursing facility declined to take the patient back. As of 7/26/23, the patient remains in the General Acute Hospital (GACH). This deficient practice had the potential to cause psychosocial harm from displacement and incurred unnecessary hospital days (8 days) at the GACH, from 7/18/23-7/26/23). A review of Patient 1’s Admission Record indicated Patient 1 is a 46- year- old- female who was admitted on 10/19/2022 with the following diagnosis of chronic pain (persistent pain that lasts weeks to years) and chest pain. A review of Patient 1’s Minimum Data Set (MDS; a standardized assessment and care screening tool), dated 4/27/2023, indicated the patient is cognitively intact. MDS also indicated the patient required one-person extensive assistance (patient involved in activity, staff provide weight-bearing support) with bed mobility, transfer, dressing and personal hygiene. Patient 1 also required one-person total dependence (full staff performance every time during entire 7-day period) with locomotion (where the patient move to and from) on and off unit and toilet use. A review of Patient 1’s physician order dated 7/10/23 at 3:55 PM, indicated to transfer the patient to the hospital Emergency Room (ER) for further evaluation and treatment and chest pain via 9-1-1 (emergency services). A review of the GACH Social Service Notes, dated 7/18/23 (eight days from when patient was transferred to the GACH) at 2:32 PM, indicated the Social Worker called the facility to follow up on the patient’s placement. According to the Notes, the facility's Admission Coordinator stated she is not sure if the patient can return to the facility because the patient’s bed hold (holding or reserving a patient’s bed while the patient is absent from the facility for therapeutic leave or hospitalization) has ended. A review of the GACH Social Service Notes, dated 7/24/23, at 1:58 PM, indicated the Social Worker spoke to the facility. The facility stated they would not accept the patient back due to the patient being on Dilaudid (narcotic that can treat moderate to severe pain). During an interview on 7/25/23 at 11:30 AM, Medical Director of the Hospital (MDH) stated Patient 1 Had an order to be readmitted back to the skilled nursing facility on 7/18/23 at 12:13pm. MDH also stated the patient is still in the hospital. During an interview on 7/25/23 at 3:04 PM, the Director of Nursing (DON) stated she will not readmit the patient back to the facility. During an interview with GACH Admitting Department on 8/4/23 at 3:04 PM, Patient 1 is still in the hospital. A review of the facility’s policy and procedure titled “Readmission to the Facility”, revised 3/2017, indicated patients who have been discharged to the hospital or for therapeutic leave will be given priority in readmission to the facility. Policy also indicated patients who are not receiving Medicaid benefits will be readmitted to the facility upon the first availability of a bed if the patient needs care and medical treatment that can be provided by the facility. A review of the facility’s policy and procedure titled “Bed-Holds and Returns”, revised 3/2022, indicated the patient will be permitted to return to an available bed in the location of the facility that he or she previously resided. If there is not an available bed in that part, the patient will be given the option to take an available bed in another distinct part of the facility and returns to the previous distinct part when a bed becomes available. The above violation had a direct or immediate relationship to the health, safety, or security of Patient 1.