§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.
§483.15(c)(6) Changes to the notice. If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available.
§483.15(c)(8) Notice in advance of facility closure In the case of facility closure, the individual who is the administrator of the facility must provide written notification prior to the impending closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents of the facility, and the resident representatives, as well as the plan for the transfer and adequate relocation of the residents, as required at § 483.70(l).
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Observations:
Based on clinical record review and staff interviews, it was determined that the facility failed to notify the resident/resident representative of a resident's transfer in writing to include the reason for the transfer or discharge, date of transfer, location of transfer, statement of the resident's appeal rights, and name, address (mailing and email), and telephone number of the Office of the State Long-Term Care Ombudsman; and failed to notify a representative of the Office of the State Long-Term Care Ombudsman for three of three resident records reviewed for hospitalization (Residents 21, 84, and 297).
Findings include:
Review of Resident 21's clinical record on March 20, 2024, at 9:13 AM, revealed diagnoses that included type two diabetes mellitus (the body does not make enough insulin or cannot use it as well as it should) and atrial fibrillation (quivering or irregular heartbeat in the upper chamber of the heart).
Further review of Resident 21's clinical record revealed that on October 1 and 5, 2023; November 5, 2023; and January 14, 2024, Resident 21 was transferred out of the facility to the hospital and subsequently was admitted to the hospital.
During an interview on March 20, 2024, at 1:05 PM, with the Nursing Home Administrator (NHA) and Director of Nursing (DON), the surveyor requested a copy of the Resident Representative transfer notices and Ombudsman notifications for the aforementioned hospital transfers.
During an additional interview on March 21, 2024, at 11:43 AM, with the NHA, it was revealed that the facility had not been notifying the Ombudsman due to not having an Admissions Director. The NHA also revealed that the facility had not been aware that transfer notices needed to be sent, and they had not been done.
Review of Resident 84's clinical record on March 19, 2024, at 10:20 AM, revealed diagnoses that included dementia (progressive, irreversible degenerative brain disease that results in decreased contact with reality and decreased ability to perform activities of daily living) and Parkinson's disease (disorder of the brain that causes unintentional and uncontrollable movements of the body, stiffness, and difficulty with balance and coordination).
Further review of Resident 84's clinical record revealed that on December 8, 2023, Resident 84 was transferred and admitted to the hospital. Resident 84 subsequently returned to the facility on December 11, 2023.
As of March 21, 2024, at 12:15 PM, the facility was unable to provide a hospital transfer form nor evidence that the State Ombudsmans office was notified of Resident 84's transfer to the hospital.
During an additional interview on March 21, 2024, at 11:43 AM, with the NHA, it was revealed that the facility had not been notifying the Ombudsman due to not having an Admissions Director. The NHA also revealed that the facility had not been aware transfer notices needed to be sent, and they had not been done.
Review of Resident 297's clinical record on March 20, 2024, at 9:19 AM, revealed diagnoses that included protein-calorie malnutrition (not enough protein and calories are consumed to meet the body's needs) and dementia. Further review of Resident 297's clinical record revealed that on February 24, 2024, and on March 18, 2024, Resident 297 was transferred out of the facility to the hospital and subsequently was admitted to the hospital.
During an interview on March 20, 2024, at 1:05 PM, with the NHA and DON, the surveyor requested a copy of the Resident Representative transfer notices and Ombudsman notifications for the aforementioned hospital transfers.
During an additional interview on March 21, 2024, at 11:43 AM, with the NHA, it was revealed that the facility had not been notifying the Ombudsman due to not having an Admissions Director. The NHA also revealed that the facility had not been aware transfer notices needed to be sent, and they had not been done.
28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3) Management.
| | Plan of Correction - To be completed: 05/10/2024
1. Residents 21, 84, and 297 have had transfer forms filled out for the dates noted and the State Ombudsman has been notified of resident transfers.
2. A Comprehensive review of residents discharged in the last 2 weeks to be reviewed to ensure that transfer form and State Ombudsman notifications have been completed.
3. The facility will take the further steps to ensure the problem does not recur by In-servicing the IDT Team on F Tag 623.
4. Compliance will be monitored by the NHA/Designee through 4 audits weekly x 2 weeks to ensure residents who have been discharged have the transfer form and State Ombudsman notifications completed, with audit results being reported to the QAA committee to determine the need for further follow up/monitoring.
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