Other·March 2, 2023

§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. 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- Requires the services provided by the facility; and Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. 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 Section 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. On 1/11/2023, the Department received a complaint regarding resident admission, transfer, and discharge rights. On 1/12/2023 an unannounced visit was conducted at the facility to investigate a complaint allegation. The facility failed to re-admit Resident 1, a 70-year-old-male, who had been residing at the facility since 1/21/2017, after Resident 1 was discharged from the Long-Term Acute Care Hospital (LTACH) and was ready to come back to the facility. As a result, Resident 1 was unnecessarily delayed from returning to his home for six years and had the potential for psychosocial harm. During a review of Resident 1's Admission Record (face sheet), the face sheet indicated Resident 1 was initially admitted to the SNF on 1/17/2017 and readmitted on 7/11/2022 with diagnoses including gastrostomy tube (a soft tube surgically placed in the stomach for feeding and hydration), chronic obstructive pulmonary disease ([COPD] chronic lung disease that affects breathing), and cerebral vascular accident ([stroke], blockage of flow of blood in the brain causing tissue damage or tissue death). During a review of Resident 1's History and Physical (H&P) Report dated 7/10/2022, the H&P indicated Resident 1 was able to make decisions for activities of daily living ([ADLs], activities related to personal care). During a review of Resident 1's Minimum Data Set (MDS), a standardized assessment and care screening tool, dated 9/20/2022, the MDS indicated Resident 1 was totally dependent on staff to complete all activities of daily living. During a review of Resident 1's Discharge Summary Report (DSR), the DSR report indicated Resident 1 was transferred from the facility to a general acute care hospital (GACH) on 11/19/2022. During a review of Resident 1's H&P from the LTACH dated 12/2/2022, the H&P indicated Resident 1 was admitted to LTACH on 12/2/2022 following his stay at the GACH. The H&P indicated Resident 1 was transferred to the LTACH from GACH for continuation of medical services. The H&P indicated Resident 1's admitting diagnoses to the LTACH included Corona virus 19 ([COVID-19] a highly contagious infection, caused by a virus that can easily spread from person to person) pneumonia (an inflammatory condition of the lungs), acute hypoxic respiratory failure (impairment of gas exchange in lungs). The H&P indicated Resident 1 was not able to follow commands. During a review of Resident 1's Treatment Team Communication (TTC) form the LTACH dated 12/20/2022, the TTC indicated the discharge planner from the LTACH notified the skilled nursing facility (SNF) about Resident 1's additional diagnosis of Candida Auris ([C. Auris] an infection that is treatment resistant to one or more classes of a antibiotics [MDRO]). The TTC note indicated the SNF would have their director of nursing (DON) review the referral. Another TTC note from LTACH dated on 12/20/2022, indicated the DON was unable to accept Resident 1 back due to not having an isolation room (bed/ room designated to keep Residents with infectious diseases separate from residents who are not infected). A TTC note dated on 1/6/2022 indicated the SNF refused to readmit Resident 1 because Resident 1 had C. Auris. During a review of Resident 1's Admission Inquiry Note (AIN) faxed from the LTACH to the SNF, dated 1/6/2023 indicated the facility received all necessary information from LTACH1 to begin Resident 1's readmission, including the most recent clinical results (patient information, diagnoses, needs, and test results). The AIN had a handwritten note indicating the SNF was waiting for Resident 1 to be re-tested for C. Auris. During an interview on 1/11/2023, at 1:50 p.m., with the case manager (CM1) from the LTACH, CM 1 stated Resident 1 was ready to return to the SNF on 1/6/2022 when the second inquiry was sent. CM 1 stated Resident 1 could not return to the facility due to the facility not having any isolation beds. During an interview on 1/12/2023, at 9:40 a.m., the infection preventionist nurse (IPN) stated it was the SNF's policy for the admissions department to receive inquiries for admissions and send to the DON for review of the resident's clinicals and determine if the resident could return to SNF. During an interview on 1/12/2023, at 9:45 a.m., the admissions coordinator (ADM 1) stated the SNF received the admission inquiry from the LTACH, but Resident 1 had "some kind of virus" and the DON would not approve Resident 1 to return until there was a negative test result. During an interview on 1/12/2023, at 10:04 a.m., the IPN stated the SNF had rooms available during the time of inquiry, if the DON would have accepted to readmit Resident 1. IPN stated the staff could have provided isolation and met Resident 1's care needs. During an interview on 1/12/2023, at 10:14 a.m., the DON stated it was the SNF' s policy to accept a resident who was stable to return to the facility unless there was a problem in which the facility was not capable to take care of the resident. The DON stated when the SNF received the inquiry from the LTACH, she informed the LTACH they (the SNF) were unable to accept Resident 1 back because the SNF did not have an isolation room. The DON stated the SNF asked the LTACH for recent laboratory test results including a new test for C. Auris prior to allowing Resident 1 to return to the SNF. The DON stated If Resident 1 tested negative the SNF would not have to place Resident 1 in an isolation room. During an observation on 1/12/2023, at 12:05 p.m., a tour of the SNF revealed there were two empty rooms in the facility. During a record review and concurrent interview on 1/12/2023 at 1:33 p.m., the facility census from 1/6/2023 to 1/12/2023 were reviewed with the DON. The DON stated there were two available empty rooms in the SNF from 1/6/2023 to 1/12/2023. The DON stated nothing was wrong with the rooms. The DON stated the SNF kept one room open to house confirmed COVID-19 residents. The DON stated the facility did not readmit Resident 1 to the other open room because Resident 1's admission would "tie up" the entire room (SNF would not be able to admit residents to the rooms' maximum capacity). The DON stated it was important to readmit their resident's when the first bed was available because the SNF was their home. During a review of the SNF's policy and procedure (P/P) titled "Procedures for Bed Hold Policy and Readmission" undated, the P/P indicated the SNF was to offer the resident the first available bed that meet their needs for a resident returning from a hospital and their bed hold (a reservation that allows one to stay in, or return to, a care facility) is over. During a review of Los Angeles County Department of Public Health's guidelines from "Transferring Guidance for MDROs," indicated facilities could not refuse a resident's admission because they were positive for a MDRO, like C. Auris. The guidelines also indicated accepting facilities could not require a negative MDRO test before transfer (LACDPH_TransferringGuidanceforMDROs.pdf (lacounty.gov) During a review of the California Department of Public Health (CDPH) titled "All Facilities Letter (AFL) 19-22" dated 6/10/2019, the AFL indicated CDPH required nursing facilities to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. The AFL indicated all skilled nursing facilities (SNFs) in compliance with state statute and federal regulations must be able to provide care for residents with MDROs. The facility failed to re-admit Resident 1, a 70-year-old-male, who had been residing at the facility since 1/21/2017, after Resident 1 was discharged from the LTACH and was ready to come back to the facility. As a result, Resident 1 was unnecessarily delayed from returning to his home for six years and had the potential for psychosocial harm. These violations, jointly, separately or in any combination, had a direct or immediate relationship to the health, safety, or security of patients or residents.