Health inspection·March 11, 2021

F625 §483.15(d) Notice of bed-hold policy and return— §483.15(d)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the nursing facility must provide written information to the resident or resident representative that specifies— (i) The duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the nursing facility; (ii) The reserve bed payment policy in the state plan, under § 447.40 of this chapter, if any; (iii) The nursing facility’s policies regarding bed-hold periods, which must be consistent with paragraph (e)(1 ) of this section, permitting a resident to return; and (iv) The information specified in paragraph (e)(1) of this section. §483.15(d)(2) Bed-hold notice upon transfer. At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative written notice which specifies the duration of the bed-hold policy described in paragraph (d)(1) of this section. Tittle 22 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 hold of seven (7) days, which may be exercised by the patient or the patient's representative. b. Upon admission of the patient to the skilled nursing facility and upon transfer of the patient of a skilled nursing facility to a general acute care hospital, the skilled nursing facility shall inform the patient, or the patient's representative, in writing of the right to exercise this bed hold provision. No later than June 1, 1985, every skilled nursing facility shall inform each current patient or patient's representative in writing of the right to exercise the bed hold provision. Each notice shall include information that a non-Medi-Cal eligible patient will be liable for the cost of the bed hold days, and that insurance may or may not cover such costs. On 12/24/2020, an unannounced visit was made to the facility to conduct a complaint investigation regarding the facility failed to readmit Resident 1 after hospitalization. The facility failed to ensure the resident and/or family representative were informed of the facility's bed-hold policy, in writing, at the time of hospitalization for Resident 1. Resident 1 was transferred to a General Acute Care Hospital (GACH), while the resident was at the dialysis (treatment for kidney failure that rids your body of unwanted toxins, waste products, and excess fluids by filtering your blood) center, and the facility's staff did not inform the resident and resident's family's member regarding the seven (7) day bed-hold. As a result, Resident 1 was ready to return to the facility on 12/18/20, and the facility did not readmit the resident on the first available male bed due to the facility did not provide the resident a seven (7) day bed-hold. A review of Resident 1's Admission Record indicated the resident was a 63-year-old male, who was admitted to the facility, on 12/8/20, with diagnoses that included diabetes mellitus (DM, a condition which the blood sugar in uncontrolled), acute respiratory failure with hypoxia (an ongoing lung disease that causes breathing problems), and end stage renal disease (on ongoing kidney disease) and dependence on renal dialysis. A review of Resident 1's Minimum Data Set (MDS, a resident assessment and care planning tool), dated 12/31/20, Resident 1 had impairment in cognitive skills (ability to remember, understand, and make decisions). Resident 1's functional status was listed activity itself did not occur or family and or non-facility staff provided 100% of the time for the activity over the entire 7-day period. A review of Resident 1's Hemodialysis Physician's Order, dated 12/8/20, indicated Resident 1 was to have hemodialysis treatments three times per week - on Tuesdays, Thursday and Saturdays. Further review of the records, there was no written order regarding bed-hold for Resident 1. A review of the facility's record, titled "Bed Hold Notification - Informed Consent", dated 12/11/20, indicated the informed consent was signed. The confirmation of transfer and bed-hold provision and the 24-hour notification section was not filled out for Resident 1. A review of the facility's Admissions and Discharges list dated 11/20/20 to 1/15/21, indicated Resident 1 was admitted to the facility on 12/8/20 and had dialysis treatment on Saturday, 12/12/20. A review of Resident 1's Nurses Notes, dated 12/12/20, indicated the facility received a call from the dialysis center regarding Resident 1's blood pressure (BP) was at 73/53 and blood sugar (BS) of 376 mg/dl (critically high). Resident 1 was transferred to a GACH. The note did not indicate Resident 1 and/or the resident's family representative were notified about the seven (7) day bed-hold. A review of the facility's census dated from 12/18/20 to 12/24/20, indicated three available beds in Station 2 Sub-Acute Unit (special unit for resident with chronic/long term respiratory illness). A review of the GACH's Notes dated 12/18/20 and timed 11:54 a.m., indicated a discharge order for Resident 1 to return to the same rehabilitation/long term care facility. A review of the GACH's Notes, dated 12/18/20 timed 11:54 a.m., indicated the GACH’s Case Manager (CM) had faxed and called the facility about Resident 1's discharged clearance at 2:56 p.m., and the facility informed the CM that Resident 1 had no bed-hold. During a telephone interview on 1/26/21 at 12:20 p.m., Medical Record 1 (MR 1) stated the licensed staff (unidentified), who received the call from the dialysis center regarding Resident 1 transferred to the hospital, should have notified the physician and obtained a telephone order (TO) for Resident’s transfer and the seven (7) days bed-hold in the resident's medical record. MR 1 stated there was no written order in Resident 1's medical record. During a telephone interview on 1/26/21 at 12:41 p.m., the Director of Nursing (DON) stated the staff needs to document in Resident 1's medical record about resident and/or family notification regarding the transfer and discharge orders. The DON stated facility should offer the bed-hold to all residents and the family representative regardless of the resident’s insurance status. During a telephone interview on 1/26/21 at 4:24 p.m., Admission Coordinator 1 (AC 1) stated she did not inform Resident 1 or the resident's family representative about the seven (7) day bed-hold when Resident 1 was transferred to the GACH. A review of the facility's undated policy, titled "Resident Bed Hold," indicated for staff to provide the residents the right to secure a bed-hold during hospitalization or therapeutic leave from the facility. The policy indicated the right to exercise a bed-hold is applicable to all residents and may not be used as a condition for admission or re-admission. The policy indicated at the time or soon possible after time of transfer to an acute hospital, facility's staff need to complete the bottom portion of the bed-hold consent form. The policy indicated for staff to inform and send the form to the representative via United State (US) Mail/Express Mail. The facility failed to ensure the resident and/or family representative were informed of the facility's bed-hold policy, in writing, at the time of hospitalization for Resident 1. Resident 1 was transferred to a GACH while the resident was at the dialysis center, and the facility's staff did not inform the resident and/or resident's family's member, in writing, regarding the seven (7) day bed-hold. As a result, Resident 1 was ready to return to the facility on 12/18/20, and the facility did not readmit the resident on the first available male bed due to the facility did not provide the resident a seven (7) day bed-hold. These violations had a direct or immediate relationship to the health, safety, or security of Resident 1.