Health inspection·July 11, 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 § 72520. Bed Hold (a) If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed holds of seven (7) days, which may be exercised by the patient or the patient's representative. (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. On 6/13/2023, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint regarding the facility refused to readmit Patient 1. The facility failed to allow Patient 1 to return to the facility to the first available bed after Patient 1's hospitalization. The facility did not make a room adjustment to accommodate Patient 1 who required an isolation (is the act of separating a sick individual with a contagious disease from healthy individuals without that contagious disease) room for C. Auris (Candida Auris, a type of fungus that can cause infection and illness) infection. On 5/5/2023, the facility transferred Patient 1 to a General Acute Care Hospital (GACH), and Patient 1’s bed hold (a reservation that allows one to stay in a care facility) expired on 5/12/2023. Patient 1 was ready to return to the facility on 5/30/2023 and was not allowed to return. The facility had the opportunity to readmit Patient 1 from 6/10/2023 to 6/12/2023. As a result, Patient 1 remained in the GACH from 5/30/2023 to 6/19/2023. A review of Patient 1's Admission Record indicated the facility admitted a sixty-six-year-old-male patient on 9/23/2022, and readmitted Patient 1 on 1/13/2023, with diagnoses that included Type 2 diabetes mellitus (a medical condition characterized by the body's inability to regulate blood sugar levels) with skin complications, diabetic neuropathy (nerve damage that is caused by diabetes), peripheral angiopathy (narrowing of the arteries as a complication arising from chronic diabetes), and epilepsy (a brain disorder that causes recurring, unprovoked seizures [a sudden, uncontrolled electrical disturbance in the brain]). During a review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 2/3/2023, the MDS indicated Patient 1 had a clear speech and had the ability to make self-understood and understand others. The MDS indicated Patient 1 was totally dependent on staff and required one-person physical assist for bed mobility, dressing, toilet use, and bathing. Patient one also required extensive assistance for eating and personal hygiene. During a review of Patient 1's Order Summary Report (physician orders), dated 4/19/2023, the physician orders indicated to place Patient 1 in an “Enhanced Standard Barrier Isolation Precaution,” (use of gown and gloves during high contact patient care activities) due to C. Auris infection. A review of Patient 1's Order Summary Report, dated 5/5/2023, indicated to send Patient 1 out via emergency services to the GACH due to an altered level of consciousness (ALOC, change in a patient's state of awareness or ability to understand or react to the surrounding environment) and tachycardia (a heart rate of more than 100 beats per minute). The order indicated to hold Patient 1’s bed for seven days. During an interview with the Admission Director (AD) on 6/13/2023, at 11:45 AM, the AD stated Patient 1’s “Inquiry for Readmission,” was received on 5/30/2023. The AD stated she spoke with the GACH’s case manager for Patient 1 and told her there was no isolation room available. The AD stated she called Patient 1’s case manager again on 6/7/2023 and left her a voicemail to update her that there was still no room available. The AD stated that she checked the census daily for any available bed for Patient 1 and discussed the readmission with the Director of Nursing (DON) and Infection Preventionist (IP, facility staff responsible for the development, direction, implementation, management, and operation of the infection prevention in the facility). The AD stated the DON, and the IP would decide if there was a room available for Patient 1’s readmission. During a concurrent interview with the IP and the DON on 6/13/2023, at 11:51 AM, the IP stated Patient 1 was in Room A before Patient 1 was transferred to the GACH on 5/5/2023. The IP stated Room A was a single occupancy room and was used as an isolation room. The DON stated Patient 1’s bed hold expired on 5/12/2023 and that they did not have an isolation room available for Patient 1. The DON stated they did not make any room adjustments to accommodate Patient 1. During a review of the facility’s list of Patients on Isolation and the daily census from 5/30/2023 to 6/14/2023, indicated the facility could have made room adjustments to create an isolation room and accommodate Patient 1 on 6/10/2023, 6/11/2023, and 6/12/2023. During a review of the facility’s policy and procedure (P&P) titled “Readmission to Facility,” dated 12/19/2022, the P&P indicated the facility would protect the patient’s rights to readmission by initiating a bed-hold and permitting each patient to return to the facility after they are hospitalized or placed on therapeutic leave, regardless of payment source. The P&P’s compliance guideline indicated patients who seek to return to the facility after the expiration of the bed-hold period or when the state law does not provide for bed-holds, are allowed to return to their previous room if available or immediately to the first available bed in a semi-private room provided that the patient: a. Still requires the services provided by the facility; and b. Is eligible for Medicare skilled nursing facility or Medicaid nursing facility services. The P&P compliance guidelines further indicated that not permitting a patient to return following hospitalization or therapeutic leave (patient absences for purpose other than required hospitalization) constitute a facility-initiated discharge and the facility will not discharge a patient unless: 1. The discharge or transfer is necessary for the patient’s welfare and the facility cannot meet the patient’s needs. 2. The transfer or discharge is appropriate because the patient’s health has improved sufficiently so the patient no longer needs the services provided by the facility. 3. The patient’s clinical or behavioral status endangers the health of individuals in the facility. 4. The health of individuals in the facility would be endangered. 5. The patient has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) his or her stay in the facility. Nonpayment applies if the patient does not submit the necessary paperwork for third party payment or after the third party, including Medicare and Medicaid, denies the claim and the patient refuses to pay for his or her stay. 6. The facility ceases to operate. The facility failed to allow Patient 1 to return to the facility to the first available bed after Patient 1's hospitalization. The facility did not make a room adjustment to accommodate Patient 1 who required an isolation room for C. Auris infection. On 5/5/2023, the facility transferred Patient 1 was transferred to GACH, and Patient 1’s bed hold expired on 5/12/2023. Patient 1 was ready to return to the facility on 5/30/2023 and was not allowed to return. The facility had the opportunity to readmit Patient 1 from 6/10/2023 to 6/12/2023. As a result, Patient 1 remained in the GACH from 5/30/2023 to 6/19/2023. This violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 1.