Failure to Implement Bed Hold Policy for Hospitalized Resident
Penalty
Summary
The facility failed to implement its Bed Hold Policy and Procedure for a resident who was transferred to a General Acute Care Hospital (GACH) for psychiatric evaluation following aggressive behavior. The resident, who had diagnoses including schizophrenia, psychosis, and dementia, was assessed as able to make her needs known and understand others. Upon transfer, the physician ordered a 7-day bed hold, and the resident's representative was notified and provided verbal consent for the bed hold. Documentation indicated that the Bed Hold Agreement was completed at the time of transfer. Despite these actions, facility records and census data showed that the resident's bed was given to a newly admitted resident immediately after the transfer, and no bed was held for the returning resident during the 7-day period as required by the facility's policy. Interviews with staff, including the Business Office Manager and Administrator, confirmed that the bed hold policy was not followed, and the resident did not have a bed available to return to during the designated period. The facility's policy required that a bed be reserved for up to seven days for residents transferred to an acute care hospital, but this was not implemented in this case.