§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 review of clinical records and written notices of facilit initiated transfers and staff interview it was determined that the facility failed to provide sufficiently detailed written notices of facility initiated transfers to the resident and the residents' representative for three out of three residents reviewed (Residents 1, 2, and 3) by failing to identify the reasons for the move in writing and in a language and manner they understand.
Findings include:
A review of the clinical record of Resident 1 revealed that the resident was transferred to the hospital on January 30, 2024, and returned to the facility on January 30, 2024.
A review of the clinical record of Resident 2 revealed that the resident was transferred to the hospital on February 7, 2024, and returned to the facility on February 11, 2024.
A review of the clinical record of Resident 3 revealed that the resident was transferred to the hospital on February 5, 2024, and returned to the facility on February 9, 2024.
Further review of these residents' clinical records revealed that the written transfer notices lacked the reason for the transfer. All three written notices indicated that the residents needed a "higher level of care."
During an interview with the Nursing Home Administrator and Director of Nursing on March 5, 2024, at approximately 1:50 PM, the facility failed to provide documented evidence of the provision of written transfer notices, which identified the reasons for the move in writing and in a language and manner the residents and their representatives understand.
28 Pa. Code 201.29 (a) Resident rights
| | Plan of Correction - To be completed: 03/21/2024
1.) Residents #1, 2 & 3 were sent out and returned, not able to correct.
2.) The facility will audit residents that were discharged to the hospital for the past 30 days to check if proper communication occurred with receiving hospital.
3.) BOM will be educated by the NHA/designee regarding filling out the transfer paperwork correctly.
4.) The DON/designee will audit the residents' charts who discharge to another health care facility for proper notations of communication with the receiving facility. These audits will occur weekly for four weeks to ensure adherence. The results of these audits will be reviewed by the QAPI committee.
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