Health inspection·February 10, 2025

F626 42 CFR §483.15 Admission Transfer Discharge 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. 22 CCR § 72521. Administrative Policies and Procedures. (a) Written administrative, management and personnel policies shall be established and implemented to govern the administration and management of the facility. (b) All policies and procedures required by these regulations shall be in writing and shall be carried out as written. They shall be made available upon request to patients or their agents and to employees and the public. Policies and procedures shall be reviewed at least annually, revised as needed and approved in writing by the governing body or licensee. 22 CCR §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. 22 CCR § 72527. Patient Rights (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (12) To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care of personal needs. On 1/3/2025, the Department conducted an unannounced visit to the facility regarding the complaint for Admission, Transfer and Discharge Rights of the resident. The facility failed to allow Resident 1 to return to the facility following hospitalization at the General Acute Care Hospital (GACH). Resident 1, who had a bipolar disorder (associated with mood swings), was deemed medically stable to return to the facility but remained at the GACH for over three weeks. As a result, Resident 1 was at risk for discharge from the facility against her needs or wants and had a potential for psychosocial harm of not returning to her primary residence at the facility. A review of the admission record indicated Resident 1 was a 59-year-old female, who was re-admitted to the facility on 2/6/2024 with diagnoses including schizoaffective disorder bipolar type (combination of symptoms of schizophrenia and mood disorder), bipolar disorder, and anxiety disorder (intense, excessive, and persistent worry and fear about every day). A review of Resident 1's quarterly Minimum Data Set (MDS - a resident assessment tool) dated 12/11/2024, indicated the resident was cognitively intact (having the ability to think, learn, and remember clearly) for decision making and had the ability to understand and be understood. The MDS indicated Resident 1 required some help with self-care and there were no indications of psychosis or behavioral symptoms noted, which indicated a discrepancy. A review of the Nursing Progress note dated 12/17/24 at 8:15 am indicated the Psychiatric Emergency Team (PET, a mobile team that provides psychiatric evaluations and crisis intervention for individuals experiencing a mental health crisis) was called for Resident 1, as the resident was yelling and screaming. The Nursing Progress Note indicated Resident 1 was on 1:1 supervision. According to a review of the Nursing Progress Notes dated 12/17/2024 at 2:50 pm, a mental health worker assessed Resident 1 as she had behaviors of yelling and screaming. The note indicated Resident 1 remained on 1:1 supervision for safety. A review of the Physician's Order dated 12/17/2024 indicated to transfer Resident 1 via 5150 (the number of the section of the Welfare and Institutions Code, which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a 72- hour psychiatric hospitalization [potentially three days] when evaluated to be a danger to others, to herself, or gravely disabled) due to damaging medical equipment (Resident 1's bedframe) with a lighter. A review of the GACH psychiatry inpatient progress note dated 12/20/2024 indicated Resident 1 could discharge back to the skilled nursing facility. According to a review of the GACH inpatient progress note dated 12/21/2024, Resident 1 was medically stable at this time for placement. A review of Resident 1's medical record indicated there was no documentation regarding specific needs of Resident 1 that could not be met at the facility. On 1/3/2025 at 9 am during an interview with the GACHs Social Worker (SW 1, a trained professional who helps people, families, and communities deal with challenges in their lives, including mental health, substance abuse, homelessness, and domestic violence), he stated the facility Resident 1 had come from would not allow Resident 1 to return to the facility. SW 1 stated he made several attempts since Resident 1 was medically cleared to return to the facility since 1/21/2025. SW 1 stated that he has not received any confirmation about Resident 1 returning to the facility and now the facility was not returning his calls. During an interview on 1/3/2025 at 10 am, the Administrator (ADM) stated Resident 1 could not return to the facility because the facility did not have the level of care needed to keep the resident safe. The Administrator stated Resident 1, "Required a higher safety standard that we do not possess here at the facility." During an interview on 1/3/2025 at 10:45 am, the Director of Nursing (DON) stated Resident 1 could not return to the facility because of the fire risk the resident posed, and that the facility tried tirelessly to place Resident 1 at another facility with better care, but she understands how difficult it was for conserved residents to find placement. On 1/3/25 at 11 am, an interview was attempted with Resident 1. Resident 1 did not answer any questions. A review of the facility's policy dated 7/2017 titled, "Bed Hold," indicated that upon admission, the facility advices residents and/or their representatives in writing that the facility has a bed hold policy and would hold the resident's bed for up to seven days if the resident was transferred to an acute care hospital or went on therapeutic leave of no more than the state allowed overnights per calendar year, as long as the resident or his/her representative notified the facility within twenty four hours of the transfer that they wish to have the facility hold the resident's bed. A review of the facility's policy dated 1/31/2024 titled, "Transfer or Discharge, Emergency," indicated the requirement that residents be permitted to return to the facility following hospitalization or therapeutic leave applies to all residents regardless of payer source. The facility failed to allow Resident 1 to return to the facility following hospitalization at the GACH. Resident 1, who had a bipolar disorder was deemed medically stable to return to the facility but remained at the GACH for over three weeks. As a result, Resident 1 was at risk for discharge from the facility against her needs or wants and had a potential for psychosocial harm of not returning to her primary residence at the facility. The above violation had a direct relationship to the health, safety, or security of Resident 1.