Health inspection·February 17, 2024

§ 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 Patients to return to facility. A facility must establish and follow a written policy on permitting Patients to return to the facility after they are hospitalized or placed on therapeutic leave. The policy must provide for the following. (i) A Patient, 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 Patient— (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 Patient 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 12/28/2023 at 10:05 AM to investigate a complaint regarding an allegation of refusal to readmit patient. The facility failed to permit Patient 1 back to Skilled Nursing Facility 1 (SNF 1) on 12/26/2023 when patient was cleared to be discharged back to SNF 1 after being hospitalized at the General Acute Care Hospital (GACH). Patient 1 was transferred to Acute Rehabilitation Unit (inpatient rehabilitation facility that helps patients who have experienced some major injury, disorder, or illness to regain the skills needed to return to everyday living) on 12/28/23. This deficient practice resulted to the displacement of Patient 1 from her residence and potential to cause psychosocial harm. A review of Patient 1's Admission Record indicated Patient 1 was admitted to the facility on 12/20/2023 with the diagnoses of respiratory failure (a serious condition that makes it difficult to breathe on your own and lungs cannot get enough oxygen into the blood), hemiplegia (muscle weakness on one side of the body), and hemiparesis (one side muscle weakness). A review of Patient 1's History and Physical, dated 12/21/2023, indicated Patient had the capacity to understand and make decisions. A review of Patient 1's Progress Notes, dated 12/23/2023, timed at 11:30 AM, indicated Patient 1 had low oxygen level and was transferred to GACH. A review of Patient 1's Physician Orders, dated 12/23/2023, indicated the following: 1. Transfer to GACH Emergency Room (ER) for further evaluation via 911 (phone number used to contact the emergency services). 2. Bed hold (holding or reserving a resident’s bed while the resident is absent from the facility for therapeutic leave or hospitalization ) for seven (7) days. A review of Patient 1's GACH Nurses Notes, dated 12/26/2023 at 10:26 AM, indicated a referral was sent to SNF 1 for patient to be readmitted back to the facility. A review of Patient 1's GACH Nurses Notes, dated 12/26/2023 at 2:07 PM, indicated GACH called the facility and spoke to the facility Admission's Coordinator. The GACH Nurses Notes indicated the Admission's Coordinator stated there were no available beds for a patient on isolation (patient is separated from others to prevent the spread of infectious diseases). During an interview on 12/28/2023 at 10:15 AM, the Administrator (ADM) stated, "We are able to admit patients but cannot admit a patient who has Candida auris (C. auris, a type of yeast that can cause severe illness and spreads easily among Patients) isolation because the patient could have it forever and it will lock up the facility's bed capacity." During an interview on 12/28/2023 at 11:32 AM, the GACH Case Manager stated to have spoken to the SNF 1 Admission's Coordinator on 12/26/2023. The GACH Case Manager stated according to the facility Admission's Coordinator, there were no available beds for a patient on isolation. The GACH Case Manager also stated a referral for Patient 1 to be readmitted back to SNF 1 was sent on 12/26/2023. The GACH Case Manager also stated GACH Discharge Planner informed SNF 1 Admission's Coordinator that Patient 1 has C. auris and was ready to be discharged back to the facility. During a record review of the facility's census, dated 12/26/2023, and interview with the Director of Nursing (DON) on 12/28/2023 at 12:50 PM, the DON stated there were three open beds for Patient 1 to be placed in. During an interview on 12/28/2023 at 12:59 PM, the Admission's Coordinator stated, the DON had notified her that there were no isolation beds available for Patient 1 because Patient 1 has C. auris. The Admission's Coordinator also stated she told the GACH Case Manager there were no isolation bed available on 12/26/2023. The Admission's Coordinator stated Patient 1 was still on bed hold. During an interview on 12/28/2023 at 1:05 PM, the DON confirmed that she told the Admission's Coordinator on 12/26/2023 that there were no isolation beds available. During an interview on 12/28/2023 at 1:49 PM, the DON stated Patient 1 should have been admitted on 12/26/2023 when the patient was ready to be discharged back to the facility from GACH. A review of the facility's Policy and Procedure (P&P) titled, "Bed-Holds and Returns," revised 3/2017, indicated Patients may return to and resume residence in the facility after hospitalization or therapeutic leave. Policy also 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 return to the previous distinct part when a bed becomes available. A review of the facility's undated P&P titled, "Admission Policies," indicated written policies and procedures governing admissions to the facility will be maintained on a current basis to ensure fair and impartial admission practices. The facility failed to permit Patient 1 back to Skilled Nursing Facility 1 (SNF 1) on 12/26/2023 when patient was cleared to be discharged back to SNF 1 after being hospitalized at the General Acute Care Hospital. Patient 1 was transferred to Acute Rehabilitation Unit on 12/28/23. This deficient practice resulted to the displacement of Patient 1 from her residence and potential to cause psychosocial harm. The above violation had a direct or immediate relationship to the health, safety, or security of Patient 1.