Other·September 27, 2019

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during the investigation of a complaint. Complaint: CA00644533 Representing the Department of Public of Health: 38487 Health Facilities Evaluator Nurse The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. A deficiency was issued for complaint CA00644533. Amended date of 10/22/19 due to result of Informal Dispute Resolution.

F622 SS=D Transfer and Discharge Requirements CFR(s): 483.15(c)(1)(i)(ii)(2)(i)-(iii)

F622 §483.15(c) Transfer and discharge§483.15(c)(1) Facility requirements(i) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless(A) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; (B) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; (C) The safety of individuals in the facility is endangered due to the clinical or behavioral 056456 08/30/2019 PALAZZO POST ACUTE 5400 Fountain Ave Los Angeles, CA 90029 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE status of the resident; (D) The health of individuals in the facility would otherwise be endangered; (E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or (F) The facility ceases to operate. (ii) The facility may not transfer or discharge the resident while the appeal is pending, pursuant to § 431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to § 431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose. §483.15(c)(2) Documentation. When the facility transfers or discharges a resident under any of the circumstances specified in paragraphs (c)(1)(i)(A) through (F) of this section, the facility must ensure that the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider. (i) Documentation in the resident's medical record must include: (A) The basis for the transfer per paragraph (c) (1)(i) of this section. (B) In the case of paragraph (c)(1)(i)(A) of this section, the specific resident need(s) that 056456 08/30/2019 PALAZZO POST ACUTE 5400 Fountain Ave Los Angeles, CA 90029 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE cannot be met, facility attempts to meet the resident needs, and the service available at the receiving facility to meet the need(s). (ii) The documentation required by paragraph (c)(2)(i) of this section must be made by(A) The resident's physician when transfer or discharge is necessary under paragraph (c) (1) (A) or (B) of this section; and (B) A physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section. (iii) Information provided to the receiving provider must include a minimum of the following: (A) Contact information of the practitioner responsible for the care of the resident. (B) Resident representative information including contact information (C) Advance Directive information (D) All special instructions or precautions for ongoing care, as appropriate. (E) Comprehensive care plan goals; (F) All other necessary information, including a copy of the resident's discharge summary, consistent with §483.21(c)(2) as applicable, and any other documentation, as applicable, to ensure a safe and effective transition of care. This REQUIREMENT is not met as evidenced by:

F626 SS=D Permitting Residents to Return to Facility CFR(s): 483.15(e)(1)(2)

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 056456 08/30/2019 PALAZZO POST ACUTE 5400 Fountain Ave Los Angeles, CA 90029 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE 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 semiprivate 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. §483.15(e)(2) Readmission to a composite distinct part. When the facility to which a resident returns is a composite distinct part (as defined in § 483.5), the resident must be permitted to return to an available bed in the particular location of the composite distinct part in which he or she resided previously. If a bed is not available in that location at the time of return, the resident must be given the option to return to that location upon the first availability of a bed there. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to permit one of three residents (Resident 1) back to the facility after being transferred to the General Acute Care for allegedly having erratic and threatening behavior. Resident 1 was denied readmission to the skilled nursing facility (SNF) after the resident's threatening behaviors had been resolved. This deficient practice violated Resident 1's rights with the potential for a decline in psychosocial well-being. Cross-reference F622. 056456 08/30/2019 PALAZZO POST ACUTE 5400 Fountain Ave Los Angeles, CA 90029 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE Findings: On 7/12/19, an unannounced visit was made to the facility to investigate a complaint regarding admission, transfer, discharge rights. The facility allegedly refused to readmit Resident 1 back to the facility after the resident was transferred to the GACH. A review of the Admission Record, dated 7/2/19, indicated Resident 1 was admitted on 3/14/19 with diagnoses which included, but were not limited to paraplegia (impairment of sensation and movement to lower limbs), pressure ulcer to the sacral region, and hypertension (high blood pressure). A review of the Minimum Data Set, a standardized assessment and care-screening tool, dated 6/21/19, indicated Resident 1 had Brief Interview for Mental Status score of 15, indicating intact cognition. Resident 1 required limited assistance with eating and extensive assistance with bed mobility, transfer, dressing, eating, toilet use, and personal hygiene. A review of the Admission Noted, dated 3/14/19, indicated Resident 1 was calm and cooperative. A review of the Progress Note, dated 7/1/19, indicated Resident 1 was picked up by LAPD (Los Angeles Police Department) ambulance and was sent to the hospital under Police Hold (an emergency measure to detain an individual). A review of the GACH Psych (Psychiatric) Evaluation, dated 7/2/19, indicated Resident 1 denied of having any suicidal ideations (Thoughts of ending a person's own life, or of killing one's self).The plan was to discharge the 056456 08/30/2019 PALAZZO POST ACUTE 5400 Fountain Ave Los Angeles, CA 90029 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE resident back to the SNF (skilled nursing facility). On 7/12/19, at 12:45 p.m., the Director of Nursing (DON) was interviewed. The DON confirmed Resident 1 was calm and cooperative on admission, and was compliant with his treatment. The DON stated Resident 1 was transferred to the GACH on 7/1/19 because the resident's behavior got really erratic and his worsened. Resident 1 was allegedly throwing things on the floor. The DON stated on 7/3/19, (no time stated) the GACH attempted to transfer the resident back the skilled nursing facility, but the Administrator refused to readmit the resident. The DON stated the denial to readmit the resident was based on Resident 1's potential of developing threatening behavior. On 7/12/19, at 2:30 p.m., the Administrator was interviewed in the presence of the Assistant Administrator. The Facility Assessment Tool, dated October 2018, November 2018, and December 2018, was also concurrently reviewed with the Administrator. The Administrator confirmed the facility was able to accept and care for residents who have psychiatric and mood disorders. A review of the policy, Readmission to the Facility, dated April 2013, indicated residents who have been discharged to the hospital for therapeutic leave will be given priority in readmission to the facility.