Lack of Transfer Agreement with Medicare Hospital
Summary
The facility failed to develop and maintain an in-effect transfer agreement with a local Medicare participating hospital, which is necessary to ensure residents can be transferred quickly for medical care when needed. This deficiency was identified during an extended survey conducted from October 30, 2024, through November 6, 2024. During this period, the surveyors requested evidence of such an agreement, but the facility was unable to provide any documentation. The interim administrator, who began his role on October 9, 2024, acknowledged the absence of a transfer agreement and noted that the facility had experienced several administrative changes since the last survey. This lack of a transfer agreement had the potential to affect all 46 residents who might require hospitalization on an emergent basis.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
The facility failed to have signed patient transportation agreements with outside agencies and dialysis centers. Record review showed unsigned agreements with zTrip [NAME] and Oceans Drive Transportation, while the RDO said signed copies were in the survey binder and would be sent to the survey team. The DON confirmed there was no evidence of patient transportation agreements, and the survey team had still not received them.
A facility failed to maintain a transfer agreement with at least one Medicare- or Medicaid-certified hospital. Record review found no evidence of any hospital transfer agreement, and the ADM confirmed the facility did not have one. The facility had a census of 65 residents.
Missing Hospital Transfer Agreement: Record review showed no evidence of a transfer agreement between the facility and a Medicare- or Medicaid-certified hospital, and the ADM confirmed the facility did not have a hospital transfer agreement. The issue affected the facility census of 74 residents.
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.
Missing Signed Patient Transportation Agreements
Penalty
Summary
The facility failed to have patient transportation agreements with outside agencies and dialysis centers. Based on record review, the facility’s document titled Dialysis Transportation Services with an effective date of 01/2026 showed unsigned patient transfer agreements with zTrip [NAME] and Oceans Drive Transportation. In email communications on 7/16/2026, the RDO stated that signed copies of the patient transportation agreements were in the facility survey binder and that staff would obtain and scan them for the survey team, then later confirmed the signed agreements would be provided once access was available. During an interview on 7/16/2026, the DON confirmed there was no evidence of patient transportation agreements. On 7/21/2026, the survey team still had not received the signed patient transportation agreements. The facility identified a census of 46.
Missing Hospital Transfer Agreement
Penalty
Summary
The facility failed to have a transfer agreement with a hospital certified by Medicare or Medicaid. Record review showed no evidence of any transfer agreement between the facility and a hospital. During interview, the Administrator confirmed that the facility did not have a hospital transfer agreement. The facility had a census of 65 residents at the time of the finding.
Missing Hospital Transfer Agreement
Penalty
Summary
The facility failed to have a transfer agreement with at least one Medicare- or Medicaid-certified hospital to ensure residents could be moved quickly when medical care was needed. Record review showed no evidence of a transfer agreement between the facility and a hospital. During interview, the Administrator stated the facility did not have a hospital transfer agreement. The facility census was 74 residents.
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.
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