Failure to Allow Resident Return and Provide Required Discharge Notice
Penalty
Summary
A deficiency occurred when the facility failed to allow a resident, who was hospitalized, to return to the facility and did not provide a required 30-day discharge notice to the resident's family representative. The resident, who had vascular dementia with psychotic disturbances and a history of behavioral symptoms including aggression and elopement attempts, was transferred to the hospital for evaluation due to increased confusion, unsteady gait, and other medical concerns. The facility sent a bed hold notice and transfer paperwork to the resident's brother but did not include discharge paperwork in the mailing. After the resident was medically cleared for return and met the facility's stated requirements (restraint-free for 24 hours), the hospital case manager repeatedly contacted the facility regarding bed availability. The facility declined the resident's return, citing lack of available beds, specifically a private room near the nurse's station, despite documentation that there were two empty male beds and a private room under bed hold. The facility also communicated to the hospital and the Ombudsman that they could not meet the resident's care needs and considered the resident a danger to others, but did not initiate the formal 30-day discharge process as required. Throughout the process, the facility's staff confirmed that the resident was a Medicaid recipient and that the facility's policy allowed for a seven-day bed hold. Despite the expiration of the bed hold, the facility did not provide the required 30-day discharge notice to the resident's representative and continued to decline the resident's return, leaving the resident hospitalized. The surveyor confirmed these findings during interviews and record review.