Failure to Notify Residents of Bed-Hold Policy During Transfers
Penalty
Summary
The facility failed to notify residents or their representatives of the bed-hold policy during hospital transfers for three residents. The policy requires that residents or their representatives receive written information about the bed-hold policy before a transfer and at the time of transfer. However, for Residents R70, R76, and R115, there was no documented evidence that such notifications were provided at the time of their respective hospital transfers. Resident R70, diagnosed with cancer, depression, and peripheral vascular disease, was transferred to the hospital and returned without receiving the required notification. Similarly, Resident R76, with high blood pressure, depression, and diabetes, and Resident R115, with renal insufficiency, atrial fibrillation, and heart failure, were also transferred to the hospital without being informed of the bed-hold policy. Interviews with the Nursing Home Administrator and the Director of Nursing confirmed the failure to notify the residents or their representatives.
Plan Of Correction
Resident R70 returned to the facility 1/7/25. Resident R76 returned to the facility on 8/29/24. Resident R115 did not return to the facility. Residents were not charged any bed-hold fees and as a result had no negative outcome. A retroactive 14-day review of all hospital/leave transfers will be completed to ensure residents/representatives have been provided information regarding the facility bed-hold policy. The NHA or designee will educate all licensed nurses on the facility bed-hold policy and communicating information at the time of transfer. The NHA or designee will audit all hospital/leave transfers daily x3, then five resident transfers weekly x8. Results will be reviewed through QAPI for further recommendation.