|§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 review of the clinical record of a resident who was provided with a 30 day Discharge Notice initiated by the facility and staff interview, it was determined the facility failed to provide a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman, failed to include the location to which the resident is to be transferred or discharged for one of one residents reviewed (Resident 65) and failed to ensure that a written notice of facility initiated transfer to the hospital was provided to the resident and the residents' representative for three of six residents transferred to the hospital (Residents 46, 3, and 40).
Review of Resident 65's clinical record revealed that on January 29, 2020, the nursing home administrator met with the resident representative to notify the representative that the facility was providing a 30-day notice of their intent to discharge the resident for the safety of individuals in the facility that would otherwise be endangered due to the resident's clinical or behavioral status. The notice indicated that the resident was to be discharged/transferred from the facility on February 29, 2020.
Interdisciplinary team meeting progress note documentation dated January 30, 2020, indicated that the resident's behavior of yelling at residents and staff, making fun of residents and the alcohol in her room was discussed with the family. The director of nursing explained that the resident could have alcohol, but a doctor's order would be necessary to ensure the safety of the resident. The administrator explained the interventions implemented for the resident's behaviors, but the behaviors continued and were progressively getting worse (no description noted). The resident's family acknowledged the resident's behaviors and the alcohol. The resident's family inquired about other facilities that would better suit the resident. The family was made aware of personal care homes and memory care facilities and requested that social services look into those facilities. The resident's family consented for the social services director to contact any facility that would be better to manage the resident's behaviors. The family agreed and would inform social services if they locate a facility they would like.
Interview with the nursing home administrator (NHA) on February 20, 2020, at approximately 10:00 AM confirmed the facility failed to provide a copy of the discharge notice to a representative of the Office of the State Long-Term Care Ombudsman. The NHA confirmed that there was no proposed location for the resident to be discharged and failed to include the location to which the resident was to be transferred/discharged on the notice.
A review of the clinical record revealed that Resident 46 was transferred to the hospital on February 10, 2020, and returned to the facility on February 12, 2020.
A review of the clinical record revealed that Resident 3 was transferred to the hospital on October 6, 2019, and returned to the facility on October 15, 2019, and was also transferred to the hospital on October 17, 2019, and returned November 9, 2019.
A review of the clinical record revealed that Resident 40 was transferred to the hospital on January 30, 2020 and returned February 3, 2020.
Further review of these residents' clinical records revealed no evidence that written notice was provided to the resident and their representatives regarding the transfer that included the required contents: reason for the transfer in manner and language they understand, 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; the name of the State Long-Term Care Ombudsman.
An interview with the Regional Director of Clinical Services on February 20, 2020, at approximately 10:30 a.m. confirmed that written notices of the facility initiated transfer, were not provided to the residents and residents' representatives.
28 Pa. Code 201.14(a) Responsibility of Licensee
28 Pa. Code: 201.29(f) Resident rights
28 Pa. Code 201.29(g) Resident rights
28 Pa. Code 201.29(h) Resident rights
| ||Plan of Correction - To be completed: 03/24/2020|
1. R# 46, R# 3, and R# 40 and resident representatives were provided copies of the written notice of transfer. R#65 30 day discharge was revoked by the facility.
2. To identify residents with the potential to be effective the NHA/designee completed an audit from 2/14/20 – 3/2/20 on residents who required a written notice of transfer to ensure the documentation was provided to the resident and the resident representative. Resident #65 was the only resident who resides in the facility that has received a 30 day discharge notice.
3. To prevent this from recurring current licensed nursing staff, Social Services, and BOM were educated by the DON/designee on the written notice of transfer and the need to provide documentation to the resident and the resident representative. The RVPO educated the NHA on the documentation of location, notification to State Ombudsman, and required documentation by resident's physician when providing residents with a 30 day facility initiated transfer.
4. To monitor and maintain ongoing compliance the NHA/designee will audit 3 transfers weekly x4 then monthly x2 to ensure that residents requiring a written notice of transfer were provided with documentation in a language or manner that could be understood for the reason for transfer. Any negative findings will be immediately corrected. The NHA/designee will review all residents that receive a 30 day facility initiated transfer to ensure appropriateness of the discharge and that documentation clearly reflects what needs of the resident cannot be met at this facility. The NHA/designee will ensure the State Ombudsman and Department of Health are notified of residents receiving a 30 day facility initiated discharge. Any negative findings will be immediately correct.
5. The results of the audit will be forwarded to facility QAPI committee for further review and recommendations.