Failure to Provide Required Transfer, Bed Hold, and Ombudsman Notifications
Penalty
Summary
Surveyors identified that the facility failed to provide required documentation and notifications related to resident transfers, discharges, and bed-hold policies for multiple residents. Specifically, for several residents who were transferred to hospitals or went on therapeutic leave, the facility did not complete or provide adequate Notice of Transfer, Bed Hold Notices, or notifications to the Office of the State Long-Term Care Ombudsman. In several instances, the forms were incomplete, missing critical information such as the number of bed-hold days remaining, the reason for transfer, or the names of individuals notified. Some forms were only partially filled out, with staff signing in multiple required signature spaces or failing to document verbal notifications appropriately. In addition, there was no evidence that the required notifications were sent to the Ombudsman, as confirmed by facility leadership during interviews. The deficiency was found across multiple resident records reviewed during the annual survey, with five out of six records lacking proper documentation and notification. The facility's Person In Charge and DON confirmed the absence of required notifications and attributed some missing documentation to lost records during an office move. The failures included not notifying residents and their representatives in writing and in a manner they could understand, as well as not sending copies of transfer or discharge notices to the Ombudsman, as required by regulation.