§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 clinical record reviews, interviews with staff, reviews of hospital records and facility policies and procedures, it was determined that the facility failed to permit one of four residents to return to the facility after they were hospitalized. (Resident R1)
Findings include:
Review of the undated policy titled readmission to the facility revealed that it was the responsibility of the administrator and the director of nursing to ensure that all residents who have been discharge from the facility would be readmitted to the facility regardless of race, color, creed, national origin or payment source.
Review of the undated policy titled Coronavirus Disease-identification and management revealed that it was the responsibility of the facility to follow the Centers for Disease Control and Prevention guidelines for screening, monitoring, rapid identification and management of this virus. The policy indicated that information about residents being transferred to the facility with suspected or confirmed cases of SARS-CoV-2 infection would be clearly communicated to the facility by the outside personnel before the transfer into the facility. The policy also indicated that residents with suspected or confirmed SARS-CoV-2 infection would be accepted for admission and were to be placed in a single person room or with another who was COVID-19 postive. Empiric Transmission- Based Precautions would be followed at the facility for this new admission/readmission.
Clinical record review for Resident R1 revealed that this resident was admitted from home to the facility on May 16, 2024 with diagnoses of anxiety, dementia (a group of symptoms that affects memory, thinking ability and interferes with daily life as a result of a decline in mental capacity, diabetes mellitus (a metabolic disorder in which the body has high blood glucose levels for prolonged periods of time), hypertension (high blood pressure) and depression.
The nusing note dated May 16, 2024 indicated that Resident R1 was of Korean decent. The nurse indicated that the resident met with other Korean (relating to North or South Korea or its' people or language) residents and staff at the facility. The physician note dated May 16, 2024 indicated that the physician spoke with Resident R1's son and that care planning for Resident R1 was for long term care. The social worker indicated on May 17, 2024 that Resident R1 was care planned for long term care because the resident needed more supervision and assistance; than the family could provide at home.
Clinical record review revealed that Resident R1 was transferred to the hospital for evaluation and treatment for a change in mental status on May 21, 2024.
Hospital record review revealed that on May 22, 2024, the physician treated and evaluated Resident R1. The physician indicated that Resident R1 had diagnoses of dementia with behavioral disorder, depression and anxiety. The physician adjusted medications for better efficacy for Resident R1. The physican indicated that he wanted to start Seroquel (an anti-psychotic medication used to treat certain mental/mood disorders such as schizophrenia, bipolar disorder, sudden episodes of mania or depression associated with bipolar disorder) and continue evening dose of Trazodone a medication used to treat depression. The physician also indicated that the resident was testing positive for Cov-19 infection; however had not had any signs and symptoms of the virus.
Clinical record review for Resident R1 indicated that there was no documentation to indicate that the facility staff contacted the Resident R1's responsible party related to readmission plans, to return to the facility, during Resident R1's entire hospital stay. Resident R1 and her responsible party were not permitted to return to the facility post hospital stay.
Interview with the Nursing Home Administrator, Employee E1, the Director of Nursing, Employee E2 and the Admissions Director, Employee E5 between 9:30 a.m, and 11: 00 a.m., on June 4, 2024 confirmed that the facility failed to document in the clinical record any communication with the responsible party for Resident R1 after the hospitalization on May 22, 2024.
Interview with the administrator, Employee E1 between 9:30 a.m., and 11: 00 a.m., on June 4, 2024 confirmed that the facility had available beds and the resident's previous bed room available to occupy on May 22 through June 4, 2024.
28 PA. Code 201.14(a)(b) Responsibility of licensee
28 PA. Code 201.29(a)(4) Resident rights
28 PA. Code 211.5(f)(vi)(ix)(x) Medical records
28 PA. Code 211.12(d)(1)(3) Nursing services
| | Plan of Correction - To be completed: 07/09/2024
1. The facility cannot retroactively correct cited deficiency.
2. Facility NHA/Designee will ensure that residents who wish to return to the facility are permitted to return to the facility unless there is a clearly documented reason as to why they can't return.
3. Re-education will be completed by the NHA/Designee to ensure that the Admissions Staff/IDT members are aware that residents who wish to return to the facility are permitted to return unless there is a clearly documented reason as to why we are unable to accommodate their needs at our facility.
4. Audits will be conducted weeklyx4 then monthlyx3 to ensure that residents that wish to return to Gwynedd from the hospital are readmitted unless we cannot accommodate their needs.
5. Audits will be reviewed and discussed at the facility QAPI meetings x3 to ensure compliance.
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