Health inspection·December 5, 2023

The following reflects the findings of the California Department of Public Health during the investigation of complaint number CA00866191. Representing the Department, HFEN # 36395. A Class "B" Citation was written. REGULATORY VIOLATIONS: Title 42 Code of Federal Regulations: F622 Transfer and Discharge Requirements §483.15(c) (1) (i) (A-D) 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 status of the resident; (D) The health of individuals in the facility would otherwise be endangered; Title 22 California Code of Regulations: 22 CR § 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 10/31/2023, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint regarding Resident Rights. The facility failed to meet the requirements for the facility-initiated discharge for Residents 1 and 2. The facility issued an Eviction Notice to Residents 1 and 2 on 10/18/2023 indicating that Residents 1 and 2 had to vacate the facility and remove all their personal belongings on the 30th day from the date of when the eviction notice was issued. The facility failed to ensure: 1. To implement their Policy and Procedure for Transfer and Discharge. 2. Residents 1 and 2 had a place to go to once discharged from the facility. 3. The location where Residents 1 and 2 will be discharged will be based on Residents 1 and Resident 2's choices and best interest. As result, Resident 1 stated feeling sad, unable to sleep, tearful and worried for her and her husband (Resident 2). During a review of the Admission Record indicated the facility admitted Resident 1 on 11/19/2022 with diagnoses including hypertension (high blood pressure), muscle weakness and difficulty walking. During a review of the Minimum Data Set (MDS, standardized care and health screening tool) dated 9/3/2023 indicated Resident 1 was cognitively intact (ability to think and make decisions). Resident 1 needed set-up (help only) with eating and one-person physical assistance with bed mobility, transfer, dressing, toilet use, personal hygiene, and bathing. During a review of the Multidisciplinary Care Conference dated 10/18/2023 at 2:00 p.m., indicated Resident 1 expects to stay at the facility. During a review of the Social Service Note dated 10/18/2023 at 3:32 p.m., indicated the social service director (SSD) and the business office manager presented Resident 1 with a 30 days' notice (Eviction Notice). The Notes indicated Resident 1 refused to sign the Eviction Notice. During a review of the Physician Order dated 10/31/2023 at 11:24 a.m., indicated a telephone order to "...discharge (Resident 1) to a lower level of care as per physician all goals met". During a review of the Admission Record indicated the facility admitted Resident 2 on 1/22/2015 with diagnoses including cerebrovascular disease (stroke, a group of conditions that affect blood flow in the brain) and hypertension. During a review of the MDS dated 9/29/2023 indicated Resident 2 was cognitively impaired. Resident 2 had unclear speech (slurred or mumbled words) and responds adequately to simple direct communication only. Resident 2 needed set-up with eating, one-person physical assistance with bed mobility, dressing, toilet use, personal hygiene, bathing, and two or more-person physical assistance with transfer. During a review of the SSD Notes dated 10/18/2023 at 3:58 p.m., indicated the SSD and the business office manager presented Resident 2 with a 30 days' notice (Eviction Notice) and Resident 2 refused to sign. At 4:04 p.m., the Notes indicated Resident 2's next of kin (NOK) was notified of the 30 days' notice (Eviction Notice). During a review of the Physician Order dated 10/31/2023 at 11:26 a.m., indicated a telephone order to "...discharge (Resident 2) to a lower level of care as per physician all goals met". During a review of the Eviction Notice dated 10/18/2023 given to Resident 1 and Resident 2 indicated "Please take notice that the expiration of thirty (30) days after you have been served this notice, resident will vacate the facility and remove all his personal belongings. This Notice shall serve to terminate the residency effective thirty days after receipt of this Notice". The Eviction Notice indicated "refuse to sign" across Resident 1 and Resident 2's signature line. During observation and interview on 10/31/2023 at 10:33 a.m., Resident 1 stated she and Resident 2 (husband) were given an Eviction Notice. Resident 1 was observed with tears in her eyes. Resident 1 stated she does not know why the facility wants to discharge her and her husband (Resident 2). Resident 1 stated ''I feel sad and worried...I can't sleep". Resident 1 stated she doesn't know where she will be going. Stated she wants to stay in this facility because it is close to her family. Resident 1 stated the facility gave her "paper to sign and they insist I sign the paper; they forced me to sign". Resident 1 further stated her husband (Resident 2) had a stroke seven years ago and unable to speak. During an interview with the social service director (SSD) on 10/31/2023 at 11:42 a.m., the SSD stated Resident 1 and Resident 2 agreed to be discharged to a lower level of care and Resident 1 signed the application for the Assisted Living Waiver (ALW, program that provide members with the choice to reside in an assisted living setting as an alternative to long-term placement in a nursing facility). SSD stated Resident 1 and Resident 2's application for the ALW were approved and a placement agency is finding place for Resident 1 and Resident 2. SSD stated the placement agency have not found a place yet. SSD stated Resident 1 and Resident agreed initially with the ALW then changed their mind. The SSD stated the discharge is necessary because Resident 1 and Resident 2 have improved based on the information from the nurses. SSD further stated Resident 1 and Resident 2 were issued the Eviction Notice on 10/18/2023. During an interview on 10/31/2023 at 1:31 p.m., the administrator (ADM) stated Resident 1 and Resident 2 "were approved for lower level of care. We don't have a place for them to go yet, but they have no choice. They have to leave. I gave them the Eviction Notice. Their discharge is based on the doctor's needs, there is no definite place for them to go to yet. They agreed for the ALW now they are refusing to leave? They have no choice. The doctor gave order on 10/31/2023 for the discharge to a lower level of care". During a review of the facility's policy and procedures titled Transfer or Discharge Notice revised on 12/2016 and reviewed on 10/19/2023 indicated the facility shall provide a resident and/or resident's representative (sponsor) with a thirty-day written notice of an impending transfer or discharge. The resident and/or representative will be notified in writing of the following information that included: a. the reason for the transfer or discharge b. the effective date of the transfer or discharge c. the location to which the resident is being transferred or discharge. The same policy indicates the reasons for the transfer or discharge will be documented in the resident's medical record. At the time of the notification, the facility will provide each resident and responsible party with the following information: a. The plan for the transfer and adequate relocation of the resident b. The date by which the transfer/relocation will be completed and c. assurances that the resident will be transferred to the most appropriate facility or setting to meet his or her needs in terms of quality, service, and location. In determining the transfer location for a resident, the decision to transfer to a particular location will be determined by the needs, choices, and best interest of that resident. The facility failed to meet the requirements for the facility-initiated discharge for Residents 1 and 2. The facility issued an Eviction Notice to Residents 1 and 2 on 10/18/23 indicating that Residents 1 and 2 had to vacate the facility and remove all their personal belongings on the 30th day from the date of when the eviction notice was issued. The facility failed to ensure: 1. To implement their Policy and Procedure for Transfer and Discharge. 2. Residents 1 and 2 had a place to go to once discharged from the facility. 3. The location where Residents 1 and Resident 2 will be discharged will be based on Residents 1 and Resident 2's choices and best interest. As result, Resident 1 stated feeling sad, unable to sleep, tearful and worried for her and her husband (Resident 2). The above violations had a direct or immediate relationship to the health, safety, or security of Residents 1 and 2.