§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 interview, it was determined that the facility failed to ensure that written notices of emergency transfers to the hospital were provided to the Office of the State Long Term Care Ombudsman for 6 of 24 residents reviewed (Resident 78, 111, 112, 119, 126 and 146).
Findings include:
Review of Resident 78's clinical record revealed Resident 78 was hospitalized on February 5, 2024 and was readmitted to the facility on February 9, 2024. No documentation was provided indicating the Office of the State Long Term Care Ombudsman was notified.
Review of Resident 111's clinical record revealed Resident 111 was hospitalized on December 27, 2023 and was readmitted to the facility on January 8, 2024. No documentation was provided indicating the Office of the State Long Term Care Ombudsman was notified.
Review of Resident 112's progress note of October 28, 2023, revealed that the resident wanted to go to the hospital. The on-call physician was notified and ordered that the resident be sent to the hospital.
Review of Resident 119's progress note of January 8, 2024, revealed that the CRNP ordered the resident to be sent to the hospital secondary to wound/drainage and elevated temperature. Resident was admitted with early stage osteomyelitis (bone infection).
Review of Resident 126's clinical record revealed a progress note indicating that the resident was sent to the hospital on January 20, 2024, for seizure like activity. No further documentation stating that the Office of the State Long Term Care Ombudsmans was notified.
Review of Resident 146's progress note of January 13, 2024, revealed resident was unresponsive and was transported to the hospital.
Interview with Nursing Home Administrator on March 3, 2024, at 1:00 p.m. confirmed that the facility did not send notifications to the Office of the State Long Term Care Ombudsman's office when residents were transferred to the hospital.
28 Pa. Code 201.14(a) Responsibility of Licensee
28 Pa. Code 201.18(e)(1) Management
| | Plan of Correction - To be completed: 04/26/2024
1.Notice was sent to the Office of the State Long Term Care Ombudsman Office for Residents 78, 111, 112, 119, 126, and 146. 2.A Comprehensive review to be completed of all discharges in the last two weeks to ensure that documentation was sent to the Office of the State Long Term Care Ombudsman's Office as required. 3.The facility will take the further steps to ensure that the problem does not recur by in-servicing the IDT Team on FTAG 623 with a focus on notification of the State Long Term Care Ombudsman upon discharge. 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 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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