Lack of Transfer Agreements with Hospitals
Summary
The facility failed to ensure that transfer agreements with hospitals certified by Medicare or Medicaid were in place, which had the potential to affect all 99 residents residing in the facility. A review of the facility's 2024 Tabletop Disaster Drill document revealed that the facility had agreements to transfer residents to two sister facilities in the event of an emergency. However, it was confirmed through interviews with the Director of Nursing and the Administrator that a written transfer agreement was not executed until August 26, 2024. Prior to this date, the facility did not have a transfer agreement in place, which was a requirement to ensure residents could be moved quickly to a hospital when they needed medical care.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
Expired Hospital Transfer Agreement: The facility failed to maintain a current transfer agreement with an area hospital. Review of the transfer agreement showed it was signed by the facility and the hospital and was only effective for two years unless terminated earlier. The Administrator confirmed the agreement had not been renewed and stated he did not realize it had a two-year limit.
The facility failed to have a written transfer agreement with a local hospital. During the survey, the DON and NHA were unable to provide documentation showing an agreement with a hospital, and the papers later given to surveyors were transfer agreements with other SNFs instead. By the end of the survey process, no hospital transfer agreement had been produced.
The facility did not maintain or provide a written transfer agreement policy or documentation of formal arrangements with a Medicare- or Medicaid-certified hospital to ensure timely transfer of residents needing acute care. During surveyor review, no written policy outlining the process for hospital transfers could be produced. The Administrator reported that important document binders had been relocated during a recent facility-wide evacuation and the requested policy and transfer agreement documentation could not be located or verified.
The facility failed to maintain a written transfer agreement with at least one Medicare/Medicaid-certified hospital. During record review, surveyors requested the agreement from the Interim NHA, who confirmed that no written transfer agreement was in place. The findings were reviewed with the Interim NHA and DON during the exit conference.
Facility staff did not provide evidence of a current hospital transfer agreement, as the only agreement on file was with the previous owner and no updated contract had been established under the new ownership. This deficiency was identified through staff interviews and document review, potentially affecting all residents.
Missing Hospital Transfer Agreement: The facility failed to provide a written transfer agreement with one or more local hospitals after it was requested from the Administrator. No documentation was produced, and the Administrator stated the facility was expected to have the required agreement with local hospitals.
Expired Hospital Transfer Agreement
Penalty
Summary
The facility failed to have a current transfer agreement with an area hospital. Review of the facility document titled Transfer Agreement showed an agreement between Community Skilled Healthcare Center and Mercy Health Youngstown LLC doing business as Saint [NAME] Hospital, stating that it would take effect when signed by both parties and continue for two years unless terminated with 30 days written notice. The document was signed by the facility on 06/01/17 and by the hospital on [DATE], and an interview with the Administrator on 04/13/26 at 4:15 P.M. confirmed the agreement was finalized on 06/13/17. The Administrator stated he did not realize the agreement had a two-year limitation and confirmed it had not been renewed with the hospital.
Missing Hospital Transfer Agreement
Penalty
Summary
The facility failed to have a transfer agreement with a local hospital, as required to ensure residents can be moved quickly to the hospital when medical care is needed. During the survey, the surveyor asked the DON to review the transfer agreement with a local hospital, and the NHA was contacted by phone because he was not present in the facility. The DON stated that the NHA asked whether the information could be sent to the survey team the next day. The DON later provided transfer agreements, but they were with other skilled nursing facilities rather than with a hospital. By the close of business on 2/23/26, the facility had not provided documentation showing a written transfer agreement with a hospital.
Failure to Maintain Written Hospital Transfer Agreement Policy and Documentation
Penalty
Summary
The facility failed to maintain and provide a written transfer agreement policy and documentation of formalized arrangements with a Medicare- or Medicaid-certified hospital to ensure residents could be transferred when medically necessary. During document and policy review, surveyors were unable to obtain a written transfer agreement policy outlining the process for transferring residents to a hospital for acute care. In an interview, the Administrator stated she could not provide the requested transfer agreement policy at the time of survey, explaining that binders containing important documents had been relocated during a recent facility-wide evacuation and the documentation could not be produced. The facility also could not provide evidence of a current written transfer agreement or other documentation verifying formal transfer arrangements with a hospital for timely resident transfers. No specific residents, medical histories, or clinical conditions at the time of the deficiency were described in the report.
No Written Hospital Transfer Agreement
Penalty
Summary
The facility failed to ensure that it had a written transfer agreement in effect with one or more hospitals approved for participation in Medicare/Medicaid programs. Review of facility documents showed that a sale between the former owner and the new owner was entered into on 12/15/25. On 1/12/26 at 9:00 AM, surveyors requested the facility's written transfer agreement from the Interim NHA, and at 2:46 PM the Interim NHA confirmed that the facility did not have a written transfer agreement. The findings were reviewed with the Interim NHA and the DON during the exit conference at 3:30 PM.
Lack of Updated Hospital Transfer Agreement
Penalty
Summary
Facility staff failed to provide evidence of an updated hospital transfer agreement, as required for ensuring residents can be transferred quickly to a hospital when necessary. Document review showed that the only available agreement was with the previous owner, a company that no longer exists, and there was no current contractual agreement with a hospital under the new ownership. During staff interviews, the executive director explained that the process of updating contracts with all vendors, including hospitals, had been slow due to the recent acquisition of multiple facilities by the new company. No updated agreement was presented prior to the survey exit, potentially affecting all 86 residents in the facility. No specific residents or their medical conditions were mentioned in the report, and the deficiency was identified through staff interviews and document review.
Missing Hospital Transfer Agreement
Penalty
Summary
The facility failed to have a written transfer agreement with one or more local hospitals as required. Hospital transfer agreements were requested from Staff A, the Administrator, on 09/15/2025 at 8:53 AM and again at 12:11 PM, but no documentation was provided. In an interview on 09/15/2025 at 1:51 PM, Staff A stated they expected the facility to have a transfer agreement with the local hospitals as required.
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