Health inspection·August 22, 2023

F623 §483.15(c)(3) Notice before transfer. Before a facility transfers or discharges a resident, the facility must- (i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman. (ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with paragraph (c)(2) of this section; and (iii) Include in the notice the items described in paragraph (c)(5) of this section. §483.15(c)(4) Timing of the notice. (i) Except as specified in paragraphs (c)(4)(ii) and (c)(8) of this section, the notice of transfer or discharge required under this section must be made by the facility at least 30 days before the resident is transferred or discharged. (ii) Notice must be made as soon as practicable before transfer or discharge when- (A) The safety of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of this section; (B) The health of individuals in the facility would be endangered, under paragraph (c)(1)(i)(D) of this section; (C) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (c)(1)(i)(B) of this section; (D) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (c)(1)(i)(A) of this section; or (E) A resident has not resided in the facility for 30 days. §483.15(c)(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this section must include the following: (i) The reason for transfer or discharge; (ii) The effective date of transfer or discharge; (iii) The location to which the resident is transferred or discharged; (iv) A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request; (v) The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman; (vi) For nursing facility residents with intellectual and developmental disabilities or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with developmental disabilities established under Part C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified at 42 U.S.C. 15001 et seq.); and (vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address and telephone number of the agency responsible for the protection and advocacy of individuals with a mental disorder established under the Protection and Advocacy for Mentally Ill Individuals Act. 22 CCR § 72519. Patient Transfer. (a) The licensee shall maintain written transfer agreements with other nearby health facilities to make the services of those facilities accessible and to facilitate the transfer of patients. Complete and accurate patient information, in sufficient detail to provide for continuity of care shall be transferred with the patient at time of transfer. (b) When a patient is transferred to another facility, the following shall be entered in the patient health record: (1) The date, time, condition of the patient and a written statement of the reason for the transfer. (2) Informed written or telephone acknowledgement of the patient, patient's guardian or authorized representative except in an emergency or as provided in Section 72527(a)(5). 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. Patients' 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: (6) To be transferred or discharged only for medical reasons, or the patient's welfare or that of other patients or for nonpayment for his or her stay and to be given reasonable advance notice to ensure orderly transfer or discharge. Such actions shall be documented in the patient's health record. On 7/26/2023, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint about the transfer and discharge of Resident 1,2 and 3. The facility failed to ensure Residents 1, 2, and 3 had the right to remain in the facility and not transfer or discharge the residents unless the transfer or discharge was necessary, and the residents’ or responsible party were provided the Notice of Proposed Transfer / Discharge. On 5/11, 5/12 and 5/15/2023, the facility did not provide Residents 1, 2, and 3 the Notice of Proposed Transfer/Discharge per the facility policy titled, "Transfer or Discharge of the Resident,” or provide documentation to show that the State Long Term Care Ombudsman (public advocate) was notified of the transfer/discharge from the facility for Resident 3. As a result, Residents 1, 2 and 3 were placed at risk to be discharged against their wishes and denied the residents of being informed of their rights to protect residents from transfer/discharge without the due process. a. A review of Resident 1's Admission Record indicated the facility admitted the resident on 1/20/2022 with diagnoses including hypertension (HTN - elevated blood pressure), major depressive disorder (mood disorder that causes a persistent feeling of sadness and loss of interest), hemiplegia (weakness on one side of the body) and hemiparesis (paralysis on one side of the body). A review of Resident 1's Minimum Data Set (MDS- a standardized assessment and care screening tool) dated 2/5/2023 indicated the resident was cognitively intact (decisions consistent/reasonable) and required extensive assistance with one person assist for bed mobility, dressing, and personal hygiene. A review of Resident 1's Physician's Order dated 5/12/2023 indicated may transfer resident to Facility 2. According to a review of Resident 1's Notice of Transfer/Discharge dated 5/12/2023, there was no reason for the Transfer/Discharge, and no date and signature of the resident or representative to acknowledge receipt of the notice and understanding of their rights. During an interview on 7/27/2023 at 9:20 AM, Resident 1 stated he was staying at Facility 1 and did not want to come to Facility 2. He stated he was not given a choice to transfer to Facility 2 from Facility 1 and he was not given any document that informed him of his rights about the transfer. Resident 1 stated he did not receive and did not sign the Notice of proposed transfer/discharge document, and if given a choice he would have remained at Facility 1 and appealed the transfer. During an interview on 7/28/2023 at 10:27 AM, Registered Nurse 1 (RN 1) stated it was her name on the Notice of Proposed Transfer/Discharge for Resident 1, but she did not sign or date the notice. RN 1 stated someone else put her name and date on the document. RN 1 stated no one informed her of her name being placed on the Notice of Transfer/Discharge dated 5/12/2023 for Resident 1. RN 1 stated she did not provide information to Resident 1 regarding his rights for transfer/discharge. RN 1 stated the notice of proposed transfer/discharge was not complete or accurate. RN 1 stated the document was missing the reason for discharge, the date and signature of Resident 1 or representative, and notification to the Ombudsman Office. RN 1 stated the document must be complete and have the signature of the resident or representative to confirm the resident received and understood their rights before being transferred or discharged. RN 1 stated without the signature there was no evidence Resident 1 was provided his rights before he transferred to another facility. b. A review of Resident 2's Admission Record indicated the facility admitted the resident on 1/6/2022 with diagnoses including dysphagia (difficulty swallowing), unspecified dementia (decline in mental ability severe enough to interfere with daily functioning/life), and generalized muscle weakness (lack of physical or muscle strength and the feeling that extra effort is required to move your arms, legs, or other muscles). A review of Resident 2's MDS dated 1/19/2023 indicated the resident was cognitively moderately impaired (decisions poor; cues/supervision required) and required extensive assistance with one person assist for bed mobility, toilet use, and personal hygiene. According to a review of Resident 2's Notice of Transfer/Discharge dated 5/15/2023, there was no reason for the Transfer/Discharge per resident/representative request. The notice did not have a date and signature of the resident or representative to acknowledge receipt of the notice and understanding of their rights. A review of Resident 2's Physician's Order dated 5/16/2023 indicated may transfer resident to Facility 2 per resident request. During an interview on 7/27/2023 at 9:59 AM, Family Member 1 (FM 1) stated Resident 2 lived at Facility 1 for over six months. FM 1 stated the facility staff, Discharge Planner (DP), at Facility 1 told him Resident 2 had to go to another facility because Facility 1 was not a long-term care facility. FM 1 stated the conversation occurred over the phone on 5/13/2023 with the Discharge Planner. He stated he was not given information about his rights regarding discharge and rights to appeal the discharge. FM 1 stated he was not given or signed the Notice of Proposed Transfer/Discharge document, and the facility staff made it sound like he did not have a choice about moving Resident 2 to another facility. FM 1 stated he did not ask for Resident 2 to be moved to another facility and the Discharge Planner stated Facility 1 would no longer do long term care, and that they would be transferring Resident 2 to Facility 2. During an interview on 7/28/2023 at 10:59 AM, the Discharge Planner (DP) stated she spoke with FM 1 over the phone and informed him of the move. The DP stated she did not remember the exact date and time, nor did she remember telling FM 1 the facility was not a long-term care facility and would not be able to take care of Resident 2. The DP stated she was required to document in the resident medical records discussions regarding discharges and transfers. She stated she did not document the conversation she had with FM 1 and could not remember if she asked if FM 1 understood his rights to appeal the transfer/discharge. c. A review of Resident 3's Admission Record indicated the facility admitted the resident on 4/12/2023 with diagnoses including multiple sclerosis (a progressive disease involving damage to part of the nerve cells in the brain and spinal cord), HTN, and generalized muscle weakness (lack of physical or muscle strength and the feeling that extra effort is required to move your arms, legs, or other muscles). A review of Resident 3's MDS dated 4/24/2023 indicated the resident was cognitively mildly impaired (some difficulty in new situations only) and the resident required extensive assistance with one person assist dressing and personal hygiene. A review of Resident 3's Physician's Orders indicated there was no order to transfer/discharge Resident 3 on 5/11/2023. A review of Resident 3's Notice of Transfer/Discharge dated 5/11/2023 indicated no reason for the transfer/discharge. The notice indicated a verbal consent dated 5/11/2023 but did not indicate a copy of the notice was provided to the State Long Term Care Ombudsman (public advocate). During an interview on 7/27/2023 at 12 PM, Resident 3 stated he lived at Facility 1 before and then they moved him around 5/10/2023 or 5/11/2023 without his permission. Resident 3 stated no one asked him if he wanted to move or provided him information about his rights to move or not move to another facility. He stated he would have preferred to stay at Facility 1 because it was closer to his family home. Resident 3 stated he was not given, did not sign, or give verbal consent for the Notice of Proposed Transfer/Discharge document. He stated he did not want to be moved to Facility 3. During an interview on 7/28/2023 at 10:35 AM, RN 1 stated Resident 3 was alert, oriented, and able to make decisions. She stated resident was able to move and use his arms. RN 1 stated the Notice of Proposed Transfer/Discharge was provided to inform the resident for the reason for the discharge, inform the residents of their rights to refuse the transfer/discharge, and file an appeal. RN 1 stated there was no signature or date of the staff to show who provided Resident 3’s Notice of Transfer/Discharge dated 5/11/2023. She stated Resident 3 had the use of his hands and unsure why there was a verbal consent instead of the resident signature. RN 1 stated without a resident or responsible party signature there was no documented evidence the resident was provided the Notice of Proposed Transfer/Discharge. She stated the Notice of Transfer/Discharge for Resident 3 was incomplete and inaccurate. During an interview on 7/28/2023 at 10:47 AM, the Medical Records Director (MRD) stated she was unable to provide physician orders for discharge for Resident 3 on 5/11/2023. She stated there was no Physician's Order for discharge for Resident 3 and it was facility protocol to require a Physician's Order to discharge a resident. The MRD stated the notice of transfer/discharge for Resident 3 was not dated and not signed by facility staff. She stated all medical records documentation must be complete and accurate. The MRD stated she was unable to provide documents the Notice of transfer/discharge were sent to the State Long Term Care Ombudsman Office for Resident 3. During an interview on 7/28/2023 at 11:35 AM, the Director of Nursing (DON) stated the transfer/discharge process at Facility 1 was the resident would require Physician's Order for transfer/discharge, and resident or responsible party be involved and informed of the discharge planning. The DON stated the facility will conduct Interdisciplinary Team (IDT - a group of health care professionals from different fields who coordinate resident care) discharge planning, provide a notice of proposed transfer/discharge, and conduct a discharge summary. The DON stated the Notice of transfer/discharge was to notify residents of the reason for the discharge, and their rights to appeal the discharge. The DON stated the Notice of proposed transfer was required to be signed and dated by facility staff and by the resident or responsible party. She stated the signed notice of proposed transfer/discharge was submitted to the Ombudsman Office and she was not sure of the time frame requirement of notifying Ombudsman Office of proposed transfer/discharge of residents. The DON stated the Notice of Proposed Transfer/Discharge was required to be provided to every resident prior to transfer or discharge. She stated the Notice of Transfer/Discharge for Residents 1, 2, and 3 were incomplete and did not have the required signature and date. The DON stated withou