Failure to Readmit Hospitalized Resident and Omission of Required Bed-Hold/Discharge Procedures
Summary
The deficiency involves the facility’s failure to comply with federal and state transfer and discharge requirements by not permitting a resident to return following an emergency hospital transfer and by not following its own policies and procedures. The facility’s written policy, “Transfer/Discharge Notification & Right to Appeal,” states that residents sent emergently to an acute care setting must be permitted to return to the center, and that if the center initiates a discharge while the resident is in the hospital, it must show evidence that the resident’s status at the time of return meets specific regulatory criteria. The policy also incorporates federal and Florida requirements that govern when a transfer or discharge may be initiated by the facility. The resident at issue had been admitted with multiple psychiatric and behavioral diagnoses, including a problem with social environment, history of [R], mild [R] of unknown origin, [R] due to known [R], condition with mixed features, [R], and adjustment with mixed [R] and depressed [R]. A quarterly MDS showed intact cognition with a BIMS score of 15 and no physical or verbal behavioral symptoms directed toward others, and the resident’s care plan documented a wish to remain in LTC at the facility. The care plan also identified behaviors of verbal aggression, including yelling at other residents and telling them to “Shut your [R].” Progress notes show that on [R], a [R] provider documented that the resident had been [R], responding to internal stimuli, presenting with bizarre and tangential behavior, refusing all medications and staff care, and being aggressive and impulsive to the point of being considered a danger to self. The provider stated that the resident had failed all staff interventions to keep him safe and required a higher level of care, and ordered an involuntary emergency examination ([R]). The DON later documented in a late entry that the resident had a burst of anger with uncontrolled behavior, including screaming, kicking the entrance door of his room, creating holes in the wall, and damaging the area near his TV. Following this episode, the resident was transferred emergently to the hospital. The DON verified that there was no documentation that a bed hold was offered to the resident at the time of transfer, although she stated that the resident’s emergency contact declined the bed hold. The DON also confirmed that when the hospital later notified the facility that the resident was ready for discharge, the facility refused to accept the resident back, and she stated she thought the resident would be better off in a group home due to his age and volatile behavior. The Admissions Director reported that 4–5 days after the transfer, the hospital notified the facility that the resident was ready to return, but her regional leader instructed her not to accept the resident and not to accept him at any sister facilities. The Administrator confirmed that a bed hold was not offered and that there was no documentation of the basis for discharge of the resident. Because the facility refused readmission, the resident’s emergency contact reported that the resident was placed in another nursing home approximately 73 miles away, and that he later called her in the middle of the night screaming for help, leading her to take him home. She reported that this caused her distress, missed work, and emotional problems because she did not know how to manage his care, and that the resident was not doing well at home. The surveyors concluded that the facility failed to allow the resident to return post-hospitalization and did not follow required transfer/discharge procedures and documentation requirements.
Plan Of Correction
This plan of correction is submitted as required under Federal and State regulations and statutes applicable to long term care providers. This plan of correction does not constitute an admission of liability on the part of the facility, and such liability is hereby specifically denied. The submission of this plan does not constitute agreement by the facility that the surveyors' findings or conclusions are accurate, that the findings constitute a deficiency, or that the scope or severity regarding any of these deficiencies cited are correctly applied. 1. The identified resident's #2 discharge documentation was reviewed. Resident no longer resides in facility. 2. A 100% audit of all transfers/discharge forms and bed hold within the past 30 days was conducted to verify compliance with F627 requirements. Any discrepancies identified were immediately corrected, including issuance of proper notices and documentation updates. Residents under consideration for transfer/discharge will be reviewed to ensure full compliance with regulatory requirements. 3. A discharge checklist was developed to ensure all required steps are completed prior to any transfer or discharges. Education completed with all licensed nurses on discharge checklist and transfer/discharge forms and bed hold education. All planned discharges will be reviewed by IDT prior to discharge to ensure compliance. 4. Social Services Director or designee will conduct 4x/week audits of all transfers/discharges for 4 weeks, then 3x/week x 4 weeks; then, 2x/week x 4 weeks; then, weekly x 4 weeks to ensure regulatory compliance. The findings of these quality reviews will be reported to the Quality Assurance/Performance Improvement Committee monthly x 3 or until committee determines substantial compliance has been met.
Penalty
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