§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 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 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.
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Observations:
Based on a review of the clinical records, facility policy and document review, and staff interviews, it was determined that the facility failed to permit a resident to remain in the facility and not discharge the resident, except for defined necessary reasons for discharge, for one of three residents reviewed (Resident 1).
Findings include:
Review of the facility document titled "Notification Bed Hold Confirmation" dated May 19, 2022, revealed the residents have the right to hold their current bed while out of the building; if the resident is receiving benefits from Medicaid, the program will hold the resident's bed for 15 days.
Review of facility policy titled "Bed Holds and Returns", revealed "if a Medicaid resident exceeds the state's bed hold period, he or she will be permitted to return to the facility, to his or her previous room (if available) or immediately upon the first availability of a bed semi-private room".
Review of Resident 1's medical record on June 30, 2022, revealed the Resident was admitted to the facility on November 6, 2015, with diagnoses that include Quadriplegia (paralysis of all four limbs) and flaccid neuropathic bladder (unable to urinate when the bladder is full).
Further review of Resident 1's medical record, revealed the Resident was sent to the hospital on May 17, 2022 for possible abscess/sepsis (blood stream infection). The facility issued a notification of bed hold confirmation on May 19, 2022.
Review of Resident 1's Minimum Data Set assessment revealed a discharge assessment was completed on May 19, 2022. The assessment initially stated the Resident's return to the facility was anticipated, and then was modified later that same date to state the Resident's return was not anticipated.
During an interview with the Nursing Home Administrator (NHA) on June 30, 2022 at 10:15 AM, he revealed the facility was not permitting the Resident to return to the facility due to being in the hospital greater than 15 days. He further stated the facility issued the Resident with a bed hold notification. When the bed hold of 15 days was exhausted, the facility informed the case manager at the hospital and the Resident's brother that the facility would be discharging the Resident. The NHA reports the facility is in a staffing crisis and unable to readmit the Resident. The NHA stated the facility has stopped taking all admissions as of June 7, 2022. The NHA further revealed that he informed the Hospital Case Manager that she would need to locate a new facility for the Resident.
Review of the current facility census on June 30, 2022, revealed the facility has since accepted three new residents since June 7, 2022, when the NHA stated all admissions into the facility were stopped.
The Resident's clinical record contained no physician documentation of the specific reasons why the Resident could not be treated at the facility, and no documented evidence of the facility's attempts to meet this Resident's needs. There was no documentation of the level of services provided by the receiving facility, which could not be provided at the long term care facility.
28 Pa. Code 211.12(a) Physician's services
28 Pa. Code 211.5(f)(g)(h) Clinical records
28 Pa. Code 201.29 (f)(g) Resident rights
| | Plan of Correction - To be completed: 07/12/2022
R1 was safely discharged to Garden Spring Nursing & Rehabilitation Center on 6/26/2022.
For like residents who have been discharged to hospital or have exhausted bed hold, facility will conduct an audit to ensure they have been readmitted or safely been discharged.
Nursing Home Administrator will educate the Director of social services on Bed Hold and Returns Policy and discharge letter with appeal rights.
Nursing Home Administrator will ensure residents will be issued an appropriate discharge letter with appeal rights if the facility can not meet the level of care residents for the residents.
Nursing Home Administrator or designee will conduct a weekly random audit to ensure residents discharged to hospitals or being readmitted or safely admitted to another nursing facility.
Results of the audit will be reviewed at monthly quality assurance and performance improvement meeting for further review and/or recommendations to ensure compliance.
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