|§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).
Based on staff interviews and clinical record review, it was determined that the facility failed to send notice of facility initiated emergency transfers to the Office of the State Long Term Care Ombudsman for two of 24 clinical records reviewed. (Residents R8, R44)
Resident R8 was admitted to to facility on July 22, 2019 with the diagnoses included, but not limited to, osteoporosis (decreased bone density and softening of the bone), cerebral vascular accident (CVA-stroke) and anxiety disorder.
Review of the clinical record revealed that Resident R8 was hospitalized from September 3, 2019 to September 10, 2019 and treated for congested heart failure (excessive body/lung fluid caused by a weakened heart muscle). There was no documented evidence that the Office of the State Long Term Ombudsman was notified of transfer.
Resident R44 was admitted to the facility on September 27, 2019 with the diagnoses include hypertension
(elevated blood pressure), cerebellar ataxia (progressive loss of coordination and difficulties with
balance and gait) and right hip fracture. Review of the clinical record revealed that resident R44 was hospitalized three times: October 3 to October 21, 2019 for surgical repair of right hip fracture; October 28 to November 4, 2019 for anemia (reduction of red blood cells) and December 2 to December 4, 2019 for elevated temperature.
There was no documented evidence that the Office of the State Long Term Ombudsman was notified
of the facility initiated transfers to the hospital.
Interview of the Administrator, Employee E1 on January 28, 2020 at 12:12 p.m. confirmed that the facility
did not notify the State Ombudsman Office of facility initiated emergency transfers to the hospital.
The facility failed to send notifications of facility initiated emergency transfers to the Office of the
State Long Term Care Ombudsman.
28 Pa. Code 201.18 (b)(3) Management
| ||Plan of Correction - To be completed: 03/16/2020|
What corrective action will be accomplished for those residents found to have been affected by the deficient practice:
As the transfers of two residents (Residents R8, R44) occurred in the past, those notifications cannot be amended. Going forward, the facility will send notifications of facility-initiated emergency transfers to the Office of the State Long Term Care Ombudsman, as required.
How will you identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken:
What measures will be put in place or what systemic changes you will make to ensure the deficient practice does not recur:
The Admission Department, who are responsible for notification of the State Ombudsman Office of facility-initiated emergency transfers to the hospital were educated on required notification procedures. The decision tree titled, "Involuntary Discharge and Transfer Notices: When and what to send to the PA Long Term Care Ombudsman State Office" was utilized for this education.
How the corrective actions will be monitored to ensure the deficient practice will not recur. ie, what quality assurance program will be put in place:
The Administrator, or designee, will audit the Ombudsman notification log monthly for accuracy for three months. Results of the audit will be reported monthly to the facility Quality Assurance committee for three months.