Health inspection·July 18, 2024

F626 §483.15(e)(1) Permitting residents to return to facility. (Rev. 208; Issued:10-21-22; Effective: 10-21-22; Implementation:10-24-22) 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; and (B) Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. (ii) If the facility that determines that a Patient 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 § 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 5/30/24 at 2:30 PM the Department of Public Health conducted an onsite visit at the facility to investigate a complaint regarding allegations admissions, transfers, and discharge. The facility failed to readmit Patient 1 back to the facility on 5/22/24 after Patient 1 was hospitalized at the General Acute Care Center (GACH) in accordance to the facility’s policy and procedure. As a result, Patient 1 was not readmitted back to the facility which violated patient rights and had the potential to negatively affect the patient’s quality of life and quality of care. A review of Patient 1's Admission Record indicated Patient 1 was originally admitted to the facility on 1/27/2022 and readmitted on 3/6/2024 with diagnoses that included type 2 diabetes mellites (DM2 - condition that results in too much sugar circulating in the blood), hemiplegia (paralysis of one side of the body) and hemiparesis (inability to move one side of the body) affecting right dominant side, acute kidney failure (the sudden and rapid loss of kidney's ability to filter waste and balance fluid in blood), acute respiratory failure (a sudden condition in which not enough oxygen passes from the lungs into the blood), and amyotrophic lateral sclerosis (ALS - a progressive nervous system disease that affects nerve cells in the brain and spinal cord, eventually causing the loss of muscle control). A review of Patient 1's History and Physical, dated 2/2024, indicated Patient 1 did not have the capacity to understand and make decisions and bedridden (confined to bed because of illness or injury). A review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 4/22/2024, indicated Patient 1 was moderately impaired with cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decision making. Patient 1 needed moderate assistance (staff does less than half the effort to complete activity) with dressing, toileting, bathing, and personal hygiene and independent with eating. Patient 1's MDS also indicated Patient 1 was always incontinent of bowel and bladder. A review of Patient 1's Order Summary Report, dated 4/25/2024, indicated an order to transfer Patient 1 to GACH 1 with bed hold (the right of the patient to resume facility residency after being away from the facility due to hospitalization) for seven days. A review of Patient 1's GACH discharge order, dated 5/21/2024, indicated an order for Patient 1 to be discharged.[YG1] A review of facility's "Patient Room Roster," dated 5/21/2024, indicated three (3) available beds in rooms A and B. A review of the facility's "Daily Census," dated 5/21/2024, indicated facility had 3 available (open) beds with one patient room change. A review of the facility's "Daily Census," dated 5/22/2024, indicated facility had 1 discharge, four (4) available beds and 3 patient room changes. A review of Patient 1's GACH progress notes written by GACH Case Manager (GCM), dated 5/22/2024, indicated: 1. At 9:54 AM, GCM was provided a bed in Room B for Patient 1's readmission by Admissions (AD). 2. At 10:19 AM, Responsible Party (RP) was told by Director of Nursing (DON), Patient 1 would need to be on hospice (care designed to give supportive care to patients in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure) before being readmitted into facility. 3. At 1:39 PM, per facility, a bed was no longer available for Patient 1. A review of Patient 1's GACH progress notes written by GACH Social Worker (GSW), dated 5/29/2024, indicated GSW spoke with DON and the DON initially stated Patient 1 could not be readmitted back to the facility until Patient 1's hospice consents are signed. During an interview on 5/30/2024 at 4 PM with Administrator (ADM), ADM stated the facility's "Patient's Room Roster," used by facility will indicate the calendar day prior to the [actual] current day. The Admin also stated neighboring rooms can be housed with patients of different sexes (males and female) if all patients in the rooms are bedbound and not using the shared bathroom. During an interview on 5/30/2024 at 5:31 PM with the DON, the DON stated the facility was full (no open bed available) and the facility could not designate an entire room to Patient 1 for a single occupancy [rooms can occupy two - four patients]. The DON stated Patient 1 required on isolation and the facility could not give one room to accommodate Patient 1's isolation status every time he gets transferred to GACH and returns to the facility. The DON stated if Patient 1 returns to facility on hospice, Patient 1 will not need to go back and forth to the hospital. During an interview on 5/30/2024 at 5:41 PM with the ADM, the ADM stated, "The patient's physician recommended hospice because the infection is a part of his body. Every time he goes out, he comes back on isolation, and there are a lot of things we have to supply." The ADM also stated at the time Patient 1 wanted to return to the facility, there was no bed available. During an interview on 5/31/2024 at 4:55 PM with GACH CM, GACH CM stated that the facility was made aware on 5/21/2024 of Patient 1's MD order to discharge the patient "home" and Patient had been living at the facility since 1/2022, and the facility was considered Patient 1's "home." CM stated the DON agreed to accept Patient 1 back to the facility for readmission and provided CM a bed in Room B for Patient 1, but after a few hours, the facility rescinded the acceptance stating the patient can only be accepted back to the facility if under hospice care since the patient always get sick and gets transferred to the hospital. A review of the facility's undated policy and procedure (P&P) titled, "Bed-Holds and Returns," indicated: 1. Patients may return to and resume residence in the facility after hospitalization or therapeutic leave as outlined in the policy. 2. A Medicaid (a public health insurance program were most or all of health care services are paid for by United States federal, state, and local governments) patient who exceeds the state bed-hold period, will be permitted to return to the facility to his or her previous room (if available) or immediately upon first availability of a bed in a semi-private room provided that the patient requires the facility's services and is eligible for Medicare skilled nursing services or Medicaid nursing services. 3.The patient will be permitted to return to an available bed in the location of the facility that he or she previously resided. A review of the facility's P&P titled, "Admission Criteria," revised 3/2019, indicated Skilled Nursing Facility (SNF) can adequately treat conditions including diabetes and neuromuscular disorders [amyotrophic lateral sclerosis, affects nerve cells in the brain and spinal cord that control voluntary muscle movement and breathing], and adequately meet medical needs including medication management, limited mobility, and incontinence. The P&P also indicated the admission policies apply to all patients admitted to the facility regardless of race, color, creed, national origin, age, sex, religion, handicap, ancestry, marital or veteran status, and/or payment source. The facility failed to readmit Patient 1 back to the facility on 5/22/24 after Patient 1 was hospitalized at the GACH in accordance to the facility’s policy and procedure. As a result, Patient 1 was not readmitted back to the facility which violated patient rights and had the potential to negatively affect patient’s quality of life and quality of care. The above violation had a direct or immediate relationship to the health, safety or security of Patient 1 and all other patients in the facility.