Health inspection·May 24, 2022

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. Title 22 § 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. The facility failed to permit Patient 1 to return to the facility after the patient was hospitalized at the general acute hospital (GACH). SW1 from the GACH was informed by the administrator that the facility was unable to care for Patient 1 and refused to readmit the patient. This deficient practice had the potential to cause psychosocial harm due to the patient not being able to return to the facility where he resided for two years, and the patient remained in the GACH for additional days after the patient was discharged to return to the facility. A review of Patient 1’s Admission Record indicated the facility initially admitted the patient on 11/13/2020 and readmitted on 6/25/21, with diagnoses that included diabetes mellitus (high sugar in the blood system), pressure ulcers (localized damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure), schizoaffective disorder (mental disorder in which a person experiences a combination of hallucinations, false beliefs, depression, or mania) and paraplegia (paralysis of the lower part of the body including the legs). A review of the most recent annual (yearly) Minimum Data Set (MDS-a standardized assessment and care planning tool) dated 11/22/21, indicated Patient 1 was unable to complete the Brief Interview for Mental Status (BIMS- a required screening tool used to determine or assess how well one is functioning cognitively [ability to think and reason]). The MDS also indicated Patient 1 was moderately impaired in decision making and required cues and supervision. The MDS also indicated Patient 1 was assessed being totally dependent with activities of daily living (ADLs). A review of Patient 1’s physician order dated 2/15/22, indicated an order to transfer Patient 1 to the GACH for further evaluation with bed hold for seven days. A bed hold is a reservation that allows one to stay in, or return to, a care facility, usually made just before relocation to the facility or during furloughs away from it (e.g., in hospital or on family visits). The facility’s Discharge Summary indicated Patient 1 tested positive for Covid-19 (a highly contagious disease caused by a virus that affects the respiratory system). On 5/6/22, at 2 pm, an interview was conducted with the director of Nursing (DON). The DON stated that the facility had not received any inquiry from the GACH regarding transferring Patient 1 back to the facility. The DON also stated readmitting Patient 1 was dependent on the administrator’s decision and the availability of the private room that Patient 1 had requested. The DON stated that only semi-private room (room shared by two people) was available, but Patient 1 had refused. During a telephone interview with the Ombudsman (a person in a government agency to whom people can go to for assistance with navigating the programs or policies of the agency and help resolve problems from a neutral standpoint to ensure that our members receive all medically necessary covered services and information for which plans are contractually responsible) on 5/6/22, at 2:25 pm, she stated SW1 had reached out to their office because the facility refused to re-admit the patient back. She stated Patient 1 had been transferred to several acute hospitals and had always been re-admitted back to the facility, but this time the facility refused to re-admit the patient. During an interview with the facility’s Marketer/Business Office Manager (BOM) on 5/6/2022, at 2:35 pm, she stated she visited Patient 1 at the GACH on 4/20/22. She stated Patient 1 agreed to return only to his old private room. The BOM stated that Patient 1 was informed that facility may not able to honor his request for a private room because a patient was already occupying his old room and only semi-private room was available. The BOM stated Patient 1 declined to be in a semi-private room. The Facility Census Lists from 4/20/22 to 5/5/22 were reviewed with the BOM on 5/6/22, at 2:40 pm. From 4/20/22 to 5/5/22, no private room was available and from time to time one semi-private male bed would be available. The BOM added that most of the semi -private rooms were in the facility’s Yellow Zone (an area for those who have been in close contact with known cases of COVID-19 (a highly infectious respiratory disease) for newly admitted or re-admitted patients. The BOM also stated that the GACH SW1 and the Discharge Planner had been in contact with the facility on several occasions with related to the patient returning to the facility and to check if a private room had opened. During a phone interview with SW1 on 5/10/22, at 11:50 am, she stated that Patient 1 was already cleared to return to the facility on 4/19/22, however, Patient 1 was requesting only private room. SW1 stated that the facility’s BOM informed them that there are no private rooms available and that the facility can only accommodate Patient 1 in a semi-private room. SW1 added that she was informed by the facility’s BOM that they were calling their sister facilities, but no private rooms were available to accommodate Patient 1’s request. SW1 also stated that the hospital was also seeking placement from other skilled nursing facilities (SNF) but had declined to admit Patient 1. During an interview with the administrator on 5/10/22, at 12:38, he stated Patient 1 had requested his old private room. The administrator added that the facility had semi- private room available for Patient 1. On 5/12/22, at 10 am, a phone call was received from the SW1 stating that according to the hospital’s Psychiatric Consult notes dated 4/1/22, it indicated, “From psych point of view, patient lacks the capacity for medical decision- making process at this time.” The SW1 added, ‘Therefore because of this, the hospital’s decision was to continue with Patient 1’s discharge plan to the facility.” On 5/12/22, at 11:23 am, a phone call was received from the SW1 informing the Surveyor that the facility was not able to accommodate Patient 1 and that no reason was provided. On 5/12/22, at 12:38 pm, during an interview with the administrator, he stated Patient 1’s former physician refused to care for the patient. The administrator then called his Medical Director who also declined to care for Patient 1. The administrator stated without a physician assigned, the facility was unable to admit Patient 1. A review of the facility's Admission Agreement, Section VII. Bed Holds and Readmission, dated 5/11, indicated if a patient is away from the facility for more than seven days due to hospitalization or other medical treatment, the facility will readmit the patient to the first available bed in a semi-private room if the patient needs the care provided by the facility and wish to be readmitted. The facility failed to permit Patient 1 to return to the facility after the patient was hospitalized at the general acute hospital (GACH). SW1 from the GACH was informed by the administrator that the facility was unable to care for Patient 1 and refused to readmit the patient. This deficient practice had the potential to cause psychosocial harm due to the patient not being able to return to the facility where he resided for two years, and the patient remained in the GACH for additional days after the patient was discharged to return to the facility. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 1.