Other·April 8, 2022

F564 §483.10(f)(4)(vi) A facility must meet the following requirements: (A) Inform each Patient (or Patient representative, where appropriate) of his or her visitation rights and related facility policy and procedures, including any clinical or safety restriction or limitation on such rights, consistent with the requirements of this subpart, the reasons for the restriction or limitation, and to whom the restrictions apply, when he or she is informed of his or her other rights under this section. (B) Inform each Patient of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse (including a same-sex spouse), a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time. (C) Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. (D) Ensure that all visitors enjoy full and equal visitation privileges consistent with Patient preferences. § 72527 Patients' Rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (2) To be fully informed, prior to or at the time of admission and during stay, of services available in the facility and of related charges, including any charges for services not covered by the facility's basic per diem rate or not covered under Titles XVIII or XIX of the Social Security Act. (14) To associate and communicate privately with persons of the patient's choice, and to send and receive personal mail unopened. (15) To meet with others and participate in activities of social, religious and community groups. (18) To have daily visiting hours established. (19) To have visits from members of the clergy at any time at the request of the patient or the patient's representative. (20) To have visits from persons of the patient's choosing at any time if the patient is critically ill, unless medically contraindicated. On 1/26/22, the Department of Public Health conducted a complaint investigation regarding Patient rights. The facility’s Administrative Staff requested Patients, 1’s, 2’s, 3’s, 4’s and 5’s family members to pay for a rapid antigen Covid-19 test (a diagnostic test used to detect specific proteins from Covid-19 virus) before visiting the patients in the facility. The facility failed to ensure that the visitation rights of five patients (Patients 1, 2, 3, 4, and 5) were not violated by: 1. Ensuring Patients 1, 2, 3, 4, and 5 had the right to have visitors in the facility without condition that was acceptable to the patients' families. The facility required a negative Covid-19 (Coronavirus, a severe respiratory illness caused by a virus and spread from person to person) test prior to entry and charged the Patients' visitors a monetary fee for a rapid antigen Covid-19 test before visitation. 2. Ensuring all visitors received full and equal visitation privileges consistent with patients’ preferences for Patients 1, 2, 3, and 5. These deficient practices had the potential to discourage patient visitations which could result in Patients 1, 2, 3, 4 and 5 feeling lonely and isolated. A review of Patient 1's Admission Record indicated the facility admitted the Patient on 12/3/21. The patient was an 89-year-old female with diagnoses including sequelae of unspecified cerebrovascular disease (residual effects produced after the acute phase of a brain injury has ended), hypertension (high blood pressure), and major depressive disorder. A review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care planning tool) dated 12/15/21, indicated the patient was able to communicate and had moderately impaired cognitive skills (ability to think, understand, learn, and remember). The MDS indicated the patient required limited to extensive assistance with activities of daily living and was on hospice care. A review of Patient 2's Admission Record indicated the facility admitted the patient on 1/31/22. The patient was an 81-year-old male with diagnoses including cerebral infarction (also known as stroke and refers to tissue damage in the brain due to a loss of oxygen) and chronic respiratory failure. A review of Patient 2's MDS dated 1/20/22, indicated the Patient was able to communicate and was cognitively intact. The MDS indicated the patient required limited assistance with most activities of daily living. A review of Patient 3's Admission Record indicated the facility admitted the Patient on 7/31/21. The patient was a 93-year-old female with diagnoses including adult failure to thrive and chronic pain syndrome. A review of Patient 3's MDS dated 11/13/21, indicated the Patient was able to communicate and had moderately impaired cognitive skills. The MDS indicated the patient required limited assistance with most activities of daily living. A review of Patient 4's Admission Record indicated the facility admitted the Patient on 9/17/21. The patient was an 85-year-old male with diagnoses including sepsis (life-threatening condition that occurs when the body's response to an infection damages its own tissues), urinary tract infection, and acute kidney failure. A review of Patient 4's MDS dated 12/31/21, indicated the Patient was able to communicate and was cognitively intact. The MDS indicated the patient required extensive assistance with most activities of daily living. A review of Patient 5's Admission Record indicated the facility admitted the Patient on 1/12/22. The patient was an 87-year-old female with diagnoses including Alzheimer's disease (a brain disease that affects memory, thinking and behavior) and fracture of the left femur (thigh bone) and left ulna (inner of two bones of the forearm). A review of Patient 5's MDS dated 1/19/21, indicated the Patient was able to communicate and was cognitively intact. The MDS indicated the patient required limited assistance with most activities of daily living. During an observation and concurrent interview on 1/26/22 at 3:32 pm, Receptionist 1 was observed outside the facility screening visitors for signs and symptoms of Covid-19 and asking questions prior to entering the facility. Receptionist 1 stated she would screen the visitors, instruct them to sign-in, and would test them for Covid-19 with the rapid antigen test before entry. During an interview on 1/26/22 at 3:29 pm, the Infection Prevention Nurse (IPN) stated if the visitor can show a negative polymerase chain reaction (PCR, a highly accurate test that detects genetic material from a specific organism, such as a virus) Covid-19 test result within 48 hours prior to visit, the visitor would not be required to have a rapid antigen Covid-19 test at the door. During an interview on 1/26/22 at 3:36 pm, Family Member 4 (FM 4) stated she got tested with the rapid antigen Covid-19 test at the facility every time she visited Patient 4. FM 4 stated Patient 4 was a private pay patient. (Private pay-a term used to describe when someone pays for Services & Supports, housing, healthcare or activities with their own resources). The facility charged her $5 for the rapid antigen Covid-19 test instead of $25. FM 4 stated she understood the importance of testing. FM 4 stated $5 was reasonable to pay compared to $25. During an interview on 1/26/22 at 3:49 pm, the Administrator stated the facility was charging visitors a fee for the staff's time to conduct the rapid antigen Covid-19 test and not for the test kit. During an interview on 1/26/22 at 3:51 pm, Visitor 1 stated the facility screened her and tested her with the rapid antigen Covid-19 test every time she visited 5. Visitor Patient 1 stated she paid $25 when she visited Patient 5 on 1/25/22 and paid another $25 for her visit on 1/26/22. During an interview on 1/26/22 at 3:54 pm, the IPN stated visitors of private pay patients had to pay $5, visitors of Patients under Health Maintenance Organization (HMO, a health insurance plan that provides health services through a network of doctors for a monthly or annual fee) and Patients on skilled rehabilitation therapy and antibiotics had to pay $25, and visitors of patients on hospice had to pay $5 for the testers. The IPN stated he did not know where the money from the visitors went. The IPN stated if the visitor was unable to pay or unwilling to pay the fee, the facility would still allow the visitor to enter. The IPN stated if the visitor would bring his or her own rapid antigen Covid-19 test kit, the facility would let the visitor test in front of the staff for verification and it would be accepted for 24 hours. During an interview on 1/26/22 at 4:30 pm., the Business Office Manager (BOM) stated the money collected from the rapid antigen Covid-19 testing was deposited to the facility's account. The BOM stated if the visitor did not have the money to pay for the testing, the visitor could come back with the money. The BOM stated the facility has not had that problem. The BOM stated the facility started charging the visitors on 12/15/21. During an interview on 1/26/22 at 4:55 pm, FM 3 stated she did not want to pay the $25 for the rapid antigen Covid-19 test to be able to visit Patient 3. FM 3 stated she had argued with the facility about it, and it had been frustrating for her. During an interview on 1/26/22 at 4:58 pm, the Director of Nursing (DON) stated the facility was charging for the rapid antigen Covid-19 test because the facility had to pull out licensed nurses to conduct the test. The DON stated they were charging the visitors per the instruction of the administrator and the BOM. During a telephone interview on 2/1/22 at 11:50 am, FM 2 stated the facility verbally informed her and her son that they needed a Covid-19 test to visit Patient 2. FM 2 stated the facility told her the first rapid antigen Covid-19 test was free then it would be $25 each test and the negative Covid-19 test would be acceptable for 24 hours. FM 2 stated paying $25 to see Patient 2 was hard for her because she only gets a small amount of money from her social security. FM 2 stated her son liked to visit Patient 2 also and it cost too much to pay $50 for both to visit. FM 2 stated she stayed in the car at the facility's parking lot while her son visited Patient 2 and video called her from the patient’s room. FM 2 stated the son had paid a total of $75 for visiting Patient 2. During a telephone interview on 2/1/22 at 2:20 pm, FM 1 stated the facility required a negative Covid-19 test prior to visitation and charged $5 to get tested with a rapid antigen test prior to entry. FM 1 stated when she visited before Christmas, the facility staff verbally informed her that the fee for a rapid antigen test was raised to $25. FM 1 stated the facility was keeping family members from seeing their loved ones by charging $25. FM 1 stated she had 3 daughters who wanted to visit their grandmother but could not afford to pay $25. FM 1 stated she had paid over $200 during the holiday season to visit Patient 1 at the facility. FM 1 stated the facility would not allow Patient 1's hospice nurse to see Patient 1 in the facility on 1/8/22 and 1/9/22 unless the hospice nurse paid $25 for the Covid-19 testing. FM 1 stated she complained to the administrator about it. During a telephone interview on 2/2/22 at 3:20 pm, Receptionist 1 stated the facility was charging long-term patient’s visitors $5 and short-term Patient's visitors $25 for the rapid antigen Covid-19 test. Receptionist 1 stated she could not remember when the fee was increased from $5 to $25 for the short-term Patient's visitors. Receptionist 1 stated she was unaware of any visitors who complained about paying the fee. Receptionist 1 stated the DON trained her on how to do the test. Receptionist 1 stated she was assigned to conduct the rapid antigen Covid-19 test on the visitors. During a telephone interview on 2/3/22 at 3:21 pm, the Hospice Social Worker (HSW) stated she went to the facility three weeks ago to see Patient 1. The HSW stated Receptionist 1 informed her that she needed to pay $5 for a rapid antigen Covid-19 test before she can come inside the facility and see Patient 1. The HSW stated she told Receptionist 1 that she was part of the hospice team and showed her identification badge and proof of vaccination. The HSW stated she spoke with the facility's social services designee and was also informed that she had to pay $5 for the rapid test to be able to visit Patient 1. The HSW stated she refused to pay the $5. The HSW stated one of their hospice nurses paid $5 for the rapid test before the facility let her in to visit Patient 1. A review of the facility's Visiting Protocol updated on 12/2021, indicated all visitors regardless of vaccine status and/or symptoms status must have a PCR test taken within 72 hours prior to visit. The protocol indicated rapid test will be available in facility if not able to have a PCR test taken. Fee for rapid test is $25 and results will be good only for day of visit or 24 hours. The protocol indicated fully vaccinated visitors please bring proof of vaccine card. The facility will make a copy to keep on file for future visits. If not fully vaccinated, please be advised a Covid-19 test is required with proof of negative result within 72 hours prior to your visit. The facility can provide rapid test. Results are good for 72 hours. A review of the facility's undated policy and procedures, titled "Visitation, Infection Control During Covid-19," provided by Administrator 2 on 2/4/22, indicated for indoor visitation proof of vaccination will be copied at the front lobby. If no proof of vaccination is provided only outdoor visitation will be allowed. All visitors regardless of vaccination status must show proof of negative Covid rapid or PCR test. If a rapid test is provided by the visitor, it must be no less than 24 hours taken. If a PCR test is provided by the visitor, it must be no less than 48 hours taken. For convenience and for the nurses’ time a $25 donation is appreciated for all short-term patient visits. For long term patients a $5 donation is appreciated. This is subject to change. A review of the facility's undated policy and procedures, titled "Patient Rights," indicated employees shall treat all Patients with kindness, respect, and dignity. The policy indicated federal and state laws guarantee certain basic rights to all Patients o