F0627

D

Failure to Readmit Hospitalized Resident and Lack of Documented, Organized Discharge

San Antonio, Texas Survey Completed on 01-21-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to permit a resident to return following a hospital transfer and failure to document sufficient preparation and orientation to ensure a safe and orderly transfer or discharge. The resident was an adult female with delusional disorder, borderline personality disorder, bipolar disorder, dementia, depression, and anxiety, who had been admitted for LTC. Her most recent annual MDS showed a BIMS score of 13, indicating no cognitive impairment, and Section Q indicated there was no active discharge planning for community return. A care plan entry dated and cancelled on the same day stated that her discharge planning would honor her personal wishes and that, based on care plan meetings and discussions, the expectation was for her to remain in the facility for LTC.

The facility issued a 30‑day discharge letter for nonpayment on 12/01/2025, citing failure to pay for the stay after reasonable and appropriate notice. The A/R statement showed an outstanding balance of $2017.60 and no payments since April 2025. Nursing notes documented that the administrator and another staff member delivered the discharge notice and that the resident responded by yelling, cursing, and stating she had a court order indicating she did not owe the facility anything. The discharge letter listed a home address or another nursing facility as the discharge locations, gave an effective discharge date of 01/01/2026, and informed the resident of her right to appeal through the state process within 90 days. The business office manager (BOM) stated that the resident was told she had 30 days to appeal and that she could have appealed any time between 12/01 and 12/31 to stop the discharge.

On 12/10/2025, nursing notes documented that the resident was picked up by EMS and sent to a hospital for a CT scan and evaluation of neck and upper spine pain. The DON stated the CT had been ordered a week or two earlier but the resident had repeatedly cancelled or refused the appointment. When the hospital later called to give report and return the resident, the DON reported being told by the administrator that the resident was not allowed back because the facility could not meet her needs, and the hospital had not been informed at the time of transfer that the facility would refuse readmission. The administrator confirmed that the corporate office directed that the resident not be readmitted, acknowledged that the resident had not been notified before transfer that she would be refused return, and believed the DON had informed the hospital, which the DON denied. The ombudsman reported that the BOM told her corporate had directed that the resident not be allowed to return, and that she informed the BOM this was not permissible because the resident had the right to appeal the discharge.

The facility’s own policies required that residents not be transferred or discharged while an appeal is pending unless remaining would endanger health or safety, and required documentation in the medical record of the reasons for any transfer or discharge, including specific unmet needs, facility attempts to meet those needs, and services available at the receiving facility. The survey record indicates that the facility did not document in the resident’s medical record the reason for not accepting her back after hospitalization. There is no documentation that the facility updated the discharge notice information when the decision was made not to readmit her from the hospital, nor is there documentation that the resident was prepared or oriented for a permanent discharge at the time she was sent out for a CT scan. Interviews with the resident, ombudsman, BOM, DON, and administrator consistently showed that the resident was transferred for diagnostic evaluation and then denied readmission based on a corporate directive, without prior notice to the resident or hospital and without the required documentation in the medical record.