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F0628
D

Failure to Provide Written Notification of Appeal Rights During Resident Transfers

Costa Mesa, California Survey Completed on 06-04-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide required written information regarding residents' appeal rights, including the name, address (mailing and email), and telephone number of the entity that receives such requests, as well as information on how to obtain and complete an appeal form, to residents and/or their representatives upon transfer to an acute care hospital. This deficiency was identified for three residents who were reviewed for discharge. In each case, the medical records did not contain evidence that the necessary written notifications were given to the residents or their responsible parties at the time of transfer or after the transfer. For one resident who lacked decision-making capacity, there was no documentation that the family member received the required written information about appeal rights. The family member confirmed in an interview that she did not receive any such information and was unaware that the resident would not be readmitted to the facility after discharge to the hospital. The responsible nurse acknowledged filling out the Notice of Transfer/Discharge form but did not provide or mail a copy to the family or resident. For the other two residents, one of whom also lacked decision-making capacity and another who required assistance with decision-making, the medical records similarly lacked documentation of written notification regarding appeal rights. Staff interviews confirmed that while the Notice of Transfer/Discharge forms were completed and copies were placed in the medical records or sent to the hospital, no copies were provided or mailed to the residents or their representatives. Family members also reported not receiving the required information, and staff were unable to verify that the notifications had been provided.

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