F0627

D

Failure to Readmit Hospitalized Resident Within Bed-Hold Period Due to Behavioral Concerns

Fresno, California Survey Completed on 02-05-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to readmit a hospitalized resident within the facility’s bed-hold period despite the resident continuing to require the skilled services the facility was capable of providing. The resident had been admitted from an acute care hospital with multiple complex diagnoses, including muscle wasting and atrophy, muscle weakness, type 2 diabetes, bipolar disorder, schizophrenia, chronic kidney disease with dependence on dialysis, nephrotic syndrome, anemia, hypertensive heart disease, and acute kidney failure. Staff, including CNAs and LVNs, consistently described the resident as medically fragile, with significant needs for wound care to bilateral lower leg ulcers, regular wound treatments, multiple medications, dialysis, and frequent therapy to address muscle wasting. The facility’s own admission criteria policy stated that it only admits residents whose medical and nursing needs can be met, and the Admissions Director, DON, and Administrator all agreed at admission that the facility was well suited to meet this resident’s needs.

The resident was transferred to the hospital on the order of the physician after a critically low hemoglobin level of 4.6 was reported following dialysis. Staff interviews and record review showed that this transfer was for a medical issue related to low hemoglobin, not for behavioral reasons. The Social Services Director and Admissions Director stated that the hospital stabilized the resident and attempted to return him to the facility the next day, within the facility’s seven-day bed-hold period. The facility’s Bed-Holds and Returns policy indicated that residents who seek to return within the bed-hold period must be permitted to return, regardless of payer source, and allowed to return to their previous room if available. The Transfer or Discharge, Facility-Initiated policy further specified that if discharge is initiated by the facility after an emergency transfer to the hospital, the reason for discharge must be based on the resident’s status at the time the resident seeks to return.

Despite these policies and the resident’s ongoing need for skilled care, the Administrator communicated to the hospital case management department that the facility did not want the resident to return, citing his aggressive behaviors. Staff interviews revealed that the resident’s room was reassigned to other residents within days of his transfer, even though he remained within the seven-day bed-hold period and had been sent out for a medical issue. Multiple staff members, including CNAs and the restorative nurse assistant, observed that the resident’s room was already occupied and expressed that they did not think he would be returning. The Admissions Director and Administrator acknowledged that the facility did not follow up with the hospital after refusing readmission, and the Admissions Director stated that the facility should have ensured the resident found proper placement. As a result of these actions and inactions, the resident was not readmitted to the facility despite requiring the services the SNF provided and having a bed on hold under facility policy.

The facility’s own leadership confirmed that the resident had been appropriately admitted initially, that his medical and financial records had been reviewed, and that the facility had accepted responsibility for his care. The DON and Administrator reiterated that the resident was sent to the hospital for a medical issue that was subsequently resolved, and that he remained within the defined bed-hold period when the hospital attempted to return him. Nonetheless, the facility refused to accept him back based on behavioral concerns that were not the reason for his hospital transfer, and did not base the discharge decision on his status at the time he sought to return, contrary to the facility’s Transfer or Discharge policy. This sequence of decisions and the reassignment of his bed led directly to the resident not being readmitted to the facility after hospitalization.