Other·January 11, 2023

F626 CFR § 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. 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 12/7/2022, an unannounced visit was made to the facility to investigate a complaint regarding the facility (Skilled Nursing Facility 1 [SNF 1]) refused to readmit Patient 1. The facility failed to readmit Patient 1 back to the facility after the patient was transferred to General Acute Care Hospital 1 (GACH 1) for a nephrostomy tube re insertion (small tube inserted through the skin into the kidneys to allow urine to drain from kidney into a collecting bag) on 12/1/22, as indicated in the facility’s Policy and Procedure for Bed-holds and Return. As a result, Patient 1 remained in GACH 1 from 12/3/2022 to 12/8/2022. A review of Patient 1's Admission Record indicated the facility admitted a 71 year old male on 8/8/2018 with diagnoses of diabetes (a chronic condition that affects the way the body processes blood sugar), abdominal aortic aneurysm (when an artery's wall weakens and causes an abnormally large bulge that can rupture and cause internal bleeding), and epilepsy (brain disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain). A review of Patient 1's History and Physical (H&P) dated 2/9/2022, indicated Patient 1 had the capacity to understand and make decisions. A review of Patient 1's Minimum Data Set (MDS, a comprehensive standardized assessment and care-screening tool) dated 9/13/2022, indicated Patient 1 had moderately impaired cognition (mental action or process of acquiring knowledge and understanding). The MDS indicated Patient 1 required extensive (patient involved in activity and staff provide non weight bearing support) assistance with one person assist for bed mobility, dressing, toilet use and personal hygiene. A review of Patient 1's Physician Order dated 12/1/2022, indicated to transfer Patient 1 to General Acute Care Hospital secondary to right nephrostomy tube dislodgement (removal). A review of Patient 1's signed Bed Hold Informed Consent dated 12/1/2022, indicated, it was the policy of the facility to provide patients the right to secure a bed hold during hospitalizations or therapeutic leave from the facility. The Bed Hold Informed Consent also indicated upon admission to GACH on 12/1/2022, Patient 1 acknowledged the right to exercise bed hold to keep a bed vacant and available for the patient to return to the facility for seven (7) days. A review of Patient 1's Transfer Form dated 12/1/2022, indicated the patient was transferred to GACH 1 on 12/1/2022 for dislodgement of right nephrostomy tube. A review of GACH’s inquiry for Patient 1 dated 12/5/2022, timed 10:30 am indicated Patient 1 was admitted in GACH on 12/2/2022 for a same day procedure, but the facility did not take Patient 1 back and requested to send Patient 1 back to the facility the following day, 12/3/2022. The GACH inquiry also indicated the facility refused to readmit Patient 1 back to facility on 12/3/2022 since Patient 1 was confirmed positive to COVID-19 (an illness caused by a virus that can spread from person to person). During a concurrent interview of the GACH’s Clinical Social Work Progress Notes dated 12/5/2022 timed at 11:10 am, and interview with Social Worker 1 (SW 1) on 12/9/2022 at 11:34 am, SW 1 stated Patient 1 was still in GACH 1 and SNF 1 refused to readmit Patient 1. SW 1 stated, she spoke with SNF 1's Case Manager 1 (CM 1) who stated SNF 1 did not have the capacity to take Patient 1 back due to Patient 1 tested positive for Corona Virus 19 (Covid 19, a mild to severe respiratory illness that spread from person to person). The note indicated Patient 1 felt sad SW 1 provided emotional support to the patient. During an interview on 12/9/2022 at 12:22 pm, the facility's Director of Nursing (DON) stated SNF 1 would not accept Patient 1 until the patient was cleared from Covid 19. The DON stated, SNF 1 could not accommodate and was not readmitting Patient 1. The DON stated, SNF 1 could not open a Covid 19 unit for only one patient. During an interview on 12/9/2022 at 1:37 pm, Patient 1's Responsible Party 1 (RP 1), stated Patient 1 wanted to go back to SNF 1 and did not want to go to other SNFs. During an interview on 12/9/2022 at 2:10 pm, Patient 1 stated, he wanted to go back to SNF 1. Patient 1 also stated he was used to be in SNF 1 and did not want to go to another facility. A review of the facility's Policy and Procedure (P&P), titled "Bed-holds and Returns," revised on 5/2022 indicated all patients/representatives are provided written information regarding the facility bed-hold policies which address holding or reserving a patient's bed during periods of absence (hospitalization or therapeutic leave). The P&P indicated the written information regarding bed-holds provided to the patients/representatives explains in detail the duration of the state bed-hold policy, if any, during which the patient is permitted to return and resume residence in the facility. A review of the facility's Policy and Procedure, titled "COVID-19 Mitigation Plan," revised on 9/6/2020 indicated the SNF will assign staff to work in the Red Section exclusively to the extent. The P & P indicated if the facility cannot maintain minimum standards for the safe care and treatment of Covid 19, they will evacuate positive patients to the nearest designated facility in conjunction with their Local Health Department. The facility failed to re admit Patient 1 back to the facility after the patient was transferred to GACH 1 for a nephrostomy tube re insertion on 12/1/22, as indicated in the facility’s Policy and Procedure for Bed-holds and Return. As a result, Patient 1 remained in GACH 1 from 12/3/2022 to 12/8/2022. This violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 1.