Health inspection·August 18, 2023

§ 72520. Bed Hold. (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. § 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. 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. On 07/12/2023, at 10:45 AM, an unannounced visit was made to the facility to investigate a complaint regarding an incident of admission, transfer, and discharge rights. Specifically, Patient 1 who was ready to be readmitted back to the facility on 07/06/2023. As a result of the investigation, the Department determined that the facility failed to readmit Resident 1 after being transferred out of the facility between the dates 07/06/2023 to 07/12/2023, in accordance with the facility's policy and procedure for “Readmission to the Facility.” During a review of Patient 1’s Admission Record indicated the facility admitted Patient 1 on 08/09/2022 and was readmitted on 12/01/2022. Patient 1's diagnoses included pressure ulcer (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure) of the sacral region (the portion of your spine between your lower back and tailbone) stage 4 (full thickness tissue loss with visible bone, tendon, or muscle) and acute and chronic respiratory failure. During a review of Patient 1’s, “Notice of Transfer/Discharge,” dated 06/09/2023, the notice indicated Patient 1 was transferred to the GACH because the patient’s needs could not be met at the facility. During a review of Patient 1’s, “Transfer Form,” dated 06/09/2023 at 1:55 PM, the form indicated Patient 1 was transferred to the GACH for further evaluation of vomiting. During a review of a Facility Fax Coversheet and Medical Records from the LTACH (Long-term Acute Care Hospital), dated 07/06/2023 at 1:21 PM, indicated Patient 1 was ready to be readmitted to the facility with no intravenous antibiotics needed. During a review of the facility’s daily census indicated the following: On 07/06/2023, indicated the facility had three vacant male beds. On 07/07/2023, indicated the facility had three vacant male beds. On 07/08/2023, indicated the facility had three vacant male beds. On 07/09/2023, indicated the facility had two vacant male beds. On 07/10/2023, indicated the facility had two vacant male beds. On 07/11/2023, indicated the facility had two empty rooms (4 beds). On 07/12/2023, indicated the facility had two empty rooms (4 beds). During an interview on 07/12/2023 at 12:13 PM, the Director of Nursing (DON) stated, when a patient was ready to be admitted or readmitted to the facility the hospital or sending facility would fax an inquiry to the facility. The facility admissions office would receive the inquiry and give it to the DON to review and decide if the patient could be admitted. The DON stated, once reviewed and accepted the admission’s office was responsible for finding a bed for the patient. During an interview on 07/12/2023 at 12:22 PM, the Admissions Director (AD) stated, the hospitals would fax inquiries for admission to the facility and the admission department would give the inquiries to the DON for review. The AD stated, once the DON informed the admissions department the patient was clinically accepted the admissions department would find a bed. The AD stated, if a bed was not available the admission department would stay in communication with the sending facility. The AD stated, she was off work the week prior and returned to work on 07/10/2023 and had not received an inquiry for readmission or had been endorsed an inquiry had been received for Patient 1. The AD was asked to check and verify no inquiry for readmission was received. During a follow up interview on 07/12/2023 at 12:36 PM, the AD returned with a fax coversheet and medical records dated 07/06/2023 at 1:21 PM, from the LTACH. The AD stated, she found the inquiry and confirmed the facility received the readmission inquiry for Patient 1 on 07/06/2023 at 1:21 PM. The AD was not sure what happened or why Patient 1 was not readmitted. The AD stated, “may have a been bed availability issue." During a concurrent interview and record review, on 07/12/2023 at 12:40 PM, the DON stated, Patient 1 was sent out to the hospital and when the patient was ready to come back there was no bed availability. The DON confirmed receiving and reviewing the readmission inquiry on 07/06/2023 and approving the patient for readmission. The DON stated, per admissions there was no bed available for Patient 1. The DON reviewed the facility’s daily census for 07/06/2023 and confirmed the facility had three vacant male beds. The DON reviewed the facility’s daily census for 07/07/2023 and confirmed the facility had three vacant male beds. The DON reviewed the facility’s daily census for 07/08/2023 and confirmed the facility had three vacant male beds. The DON reviewed the facility’s daily census for 07/09/2023 and confirmed the facility had two vacant male beds. The DON reviewed the facility’s daily census for 07/10/2023 and confirmed the facility had two vacant male beds. The DON reviewed the facility’s daily census for 07/11/2023 and confirmed the facility had two empty rooms (4 beds). The DON reviewed the facility’s daily census for 07/12/2023 and confirmed the facility had two empty rooms (4 beds). The DON stated, based on the facility daily census’ from 07/06/2023 to 07/12/2023 there was an opportunity to readmit Patient 1. The DON stated, the readmission was left up to the admissions office and there was likely a communication issue. During a review of facility's policy and procedure titled, “Readmission to the Facility,” not dated, indicated, Patients who have been discharged to the hospital for therapeutic leave will be given priority in readmission to the facility. Readmission procedures apply equally to all patients of race, color, creed, national origin, or payment source. As a result of the investigation, the Department determined that the facility failed to readmit Resident 1 after being transferred out of the facility between the dates 07/06/2023 to 07/12/2023, in accordance with the facility's policy and procedure. The above violation had a direct or immediate relationship to the health, safety, or security of Patient 1.