Health inspection·May 5, 2023

F626 CFR § 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. CCR § 72521. Administrative Policies and Procedures. (b) All policies and procedures required by these regulations shall be in writing and shall be carried out as written. They shall be made available upon request to patients or their agents and to employees and the public. Policies and procedures shall be reviewed at least annually, revised as needed and approved in writing by the governing body or licensee. On 4/11/2023, the Department of Public Health made an unannounced visit to the facility to investigate a complaint regarding the facility (Skilled Nursing Facility 1 [SNF 1]) refused to readmit Patient 1. The facility failed to readmit Patient 1 back to the facility after the patient was transferred to General Acute Care Hospital 1 (GACH 1) for a 5150 (the number of the section Welfare and Institutions Code, which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a seventy-two hours psychiatric hospitalization when evaluated to be a danger to others, or to himself/herself or gravely disabled) on 4/9/2023 as indicated in the facility’s Policy and Procedure for Bed-holds and Return. As a result, the facility violated Patient 1's right to resume Patient 1's residency. Patient 1 remained at GACH 1 longer than necessary (4/9/23 to 5/5/23 and still remaining in GACH 1) and had the potential to affect the Patient 1's psychosocial wellbeing. AF review of Patient 1’s Admission Record indicated Patient 1 was initially admitted to the facility on 4/15/2020 with the diagnoses included diabetes mellitus (DM, a disease that the blood sugar is uncontrolled and high), depressive disorder (a mood disorder), psychosis (a mental condition that affects the thoughts and emotions that causes loss of contact to reality). A review of Patient 1's History and Physical (H&P), dated 8/8/2022, indicated Patient 1 had the capacity to understand and make decisions. A review of Minimum Data Set (MDS, a Patient assessment and care plan screening tool), dated 1/26/2023, indicated Patient 1's cognitive skill (Patient ability to understand, remember and make decision) was moderately impaired. The MDS indicated Patient 1 was independent on bed mobility, toilet use, personal hygiene walking in and off the unit and required supervision on dressing. A review of the facility's record titled, "Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment," dated 4/8/2023, indicated Patient 1 was transferred on 5150 to due to psychotic (severe mental disorder which a person loses the ability to recognize reality or relate to others) and disorganized with assaulting (making physical attack) behavior as evidence by threatening staff with a screwdriver. A review of Patient 1's GACH Emergency Department (ED) records, dated 4/8/2023, indicated Patient 1 was brought in by ambulance (a vehicle equipped with medical devices used to transport sick and or injured people to the hospital) on a 5150 hold for threatening staff with a screwdriver and locking himself in the rest room. A review of Patient 1's GACH records titled "Telepsychiatry Note" (a type of telemedicine or telehealth evaluation from a psychiatrist providing health care from a distance through the use of technology), dated 4/9/2023, indicated Patient 1 was referred due to 5150 paranoias (a mental illness characterized by irrational and persistent feeling that people are out to get you). The note indicated during the examination, Patient 1 was distressed (worried or troubled), affectively reactive (body's response to a behavioral challenges), could well relate and cooperative. Additionally, the notes indicated Patient 1 declined further medical management, declined need for help with sleep, mood and or other issues. The note indicated Patient 1 would be appropriate to received outpatient care treatment with a psychiatric (medical doctor specialized in mental health including substance use disorder) follow up within a week. Further review of the notes, Patient 1 medication management included increasing Risperidone (an antipsychotic medication that treats mental health conditions). A review of Patient 1's GACH Progress Notes records, dated 5/3/2023 timed 15:22, indicated Patient 1 was cleared via telepsychiatry consultation for discharge back to the facility and recommended follow-up with psychiatrist. In addition, the notes indicated Patient 1 had an unclear disposition of going back to the facility due to pending court order result. During an interview on 4/11/2023 at 2:01 p.m., the Admission Coordinator (AC) stated that over the weekend (4/9/2023), the facility received a call from the hospital informing Patient 1 readmission. She stated she was instructed by the facility's Administrator that Patient 1 was on a 5150 hold and was not safe to return to the facility. The AC stated the facility will assist the hospital for appropriate and suitable placement because Patient 1 posed a danger to himself and to other patients. During an interview on 4/11/2023 at 3:30 p.m., the facility's Administrator stated she decided not to readmit Patient 1 because of Patient 1's continuous aggressive behavior. The ADM stated the facility will assist the hospital for Patient 1's right placement appropriate for Patient 1's need. The ADM stated the facility did not offer bed-hold notice (a facility document given to the patient and or family representative to retain a bed or room for the Patient during the time that the patient is temporarily absent from the facility) to Patient 1 nor Patient 1's family representative. A review of the facility's P&P "titled Bed-Hold and Returns", revised date 03/2022, indicated that Patients and or representative are informed (in writing) of the facility and the state (applicable) bed-hold policies. The document indicated the patient will be permitted to return to an available bed in the location of the facility that he or she previously resided. The facility failed to re admit Patient 1 back to the facility after the patient was transferred to GACH 1 for 5150 on 4/9/2023 as indicated in the facility’s Policy and Procedure for Bed-holds and Return. As a result, the facility violated Patient 1's right to resume Patient 1's residency. Patient 1 remained at GACH 1 longer than necessary and had the potential to affect the Patient 1's psychosocial wellbeing. This violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 1.