F0627

E

Failure to Provide NOMNC, Adequate Discharge Planning, and Safe IV/Foley Management at Discharge

North Hollywood, California Survey Completed on 01-12-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to follow its own discharge planning and Medicare Notice of Non-Coverage (NOMNC) policies for a resident discharged home. The resident was originally admitted with diagnoses including a periprosthetic fracture around an internal prosthetic left knee joint, type 2 diabetes mellitus, history of falling, difficulty in walking, and urinary retention. A history and physical indicated the resident had capacity to understand and make decisions, while an MDS assessment documented moderate cognitive impairment and a need for substantial/maximal assistance with toileting, bathing, and lower-body dressing. A physician’s order directed discharge home with home health services, and a NOMNC dated two days before the last covered day stated that Medicare coverage for the SNF stay would end and provided instructions and a phone number for filing an appeal.

The NOMNC form itself showed that the resident did not sign because she was documented as “Temporarily incapacitated,” and there was no signature from a representative. Admissions staff progress notes stated that a responsible party was informed by phone of the last covered day, the planned discharge date, options including discharge home and caregiver resources, and the right to appeal, and that the responsible party said she would appeal. The same note stated that a copy of the NOMNC and the appeal number was left at the resident’s bedside. However, the responsible party later reported that no information on how to appeal was received, and the Admissions Director and ADON acknowledged that there was no signed documentation from the resident or responsible party to demonstrate receipt of the NOMNC. The ADON stated that, because the family never received the NOMNC letter, they could not dispute the termination decision or attempt to extend the resident’s stay and coverage.

The facility also failed to provide and document adequate discharge instructions and individualized care planning. The responsible party reported that no discharge instructions were given to anyone and described the discharge as unorganized and unsafe. The ADON’s review of the record found that discharge documentation focused only on Foley catheter teaching on the day of discharge, with no documentation of IV-related teaching, no evidence that the resident or family understood any teaching, and no documentation that caregiver capacity and availability were assessed as required by the discharge planning policy. The resident’s care plan for Foley catheter use included monitoring for UTI signs and symptoms but did not address catheter care or family teaching, and the discharge care plan noting the resident’s wish to return home did not include education or involvement of the family to prepare them for discharge.

In addition, the facility discharged the resident home with an IV still in place. An LVN who performed the discharge recalled sending the resident home with an IV and acknowledged that an IV access site could lead to infection or bleeding requiring emergency care. The discharge order summary did not include that the resident was being discharged with an IV or with a Foley catheter, and the transfer/discharge report lacked information about the Foley catheter and IV. The ADON stated there was no documentation to show that the discharge planning process considered caregiver/support person capacity, or that return demonstration and understanding of required care were obtained, despite policy requirements. The facility’s Resident Rights policy also required appropriate advance written notice, usually 30 days, for any involuntary transfer or discharge, and the Admissions Director stated unfamiliarity with the 30-day notice requirement. Overall, the survey findings show that the facility did not implement its NOMNC, comprehensive care plan, resident rights, and discharge planning policies for this resident’s discharge.

The facility’s own policies required that the NOMNC be delivered in a way that ensures the beneficiary or representative signs and dates the notice to demonstrate receipt and understanding that the termination decision can be disputed. The ADON and Admissions Director both confirmed that this did not occur for the resident, and that the lack of a signed NOMNC meant the resident and family effectively could not file an appeal. The discharge planning policy required sufficient preparation and orientation in a form and manner the resident can understand, identification and timely development of a discharge plan, regular reevaluation and updating of the plan, consideration of caregiver capacity, involvement of the resident and representative, and documentation that the resident was asked about interest in returning to the community. The ADON stated there was no documentation to prove caregiver capacity assessment, return demonstration, or understanding, and that the resident and family were not provided enough instructions to prepare them for discharge. These documented inactions and omissions formed the basis of the cited deficiency.