F0627

D

Failure to Follow Readmission Process and Improper Denial of Return from Hospital

Compton, California Survey Completed on 02-03-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to follow its established readmission process for a hospitalized resident who had been medically cleared to return from a general acute care hospital (GACH). The resident had diagnoses including peripheral vascular disease, PTSD, and major depressive disorder, and had been initially admitted and later readmitted to the facility prior to the hospitalization. An MDS dated 1/5/2026 documented modified independence in cognitive skills for daily decision making, no physical or verbal behavioral symptoms directed toward others, and a need for moderate assistance with toileting, dressing, and personal hygiene. The resident was discharged to the GACH with return anticipated, and a prior H&P indicated the resident had capacity to understand and make decisions.

When the GACH determined the resident was medically cleared for discharge back to the facility, the GACH case manager reported that the facility refused readmission before receiving any clinical documents. The case manager stated that clinical documents were not sent because the facility declined the readmission and that the facility cited aggressive behaviors as the reason, despite the resident being calm and exhibiting appropriate behavior at that time. Facility staff, including RN 1 and the Marketing Director (MD), described the usual readmission process as beginning with a phone call from the GACH followed by transmission of clinical documents for review by the DON or designee to determine whether the resident’s needs could be met, including any special treatments or isolation requirements. RN 1 stated there were few valid reasons to decline readmission, such as lack of available beds or required services not provided by the facility, and that aggressive behavior was never an acceptable reason.

In this case, the receptionist reported receiving a call from the GACH about the resident’s potential readmission and transferring it to the MD, who was temporarily handling admissions. The MD acknowledged informing the GACH case manager that the facility would not accept the resident back due to behavior, referencing prior screaming at staff and a possible incident of hitting a staff member, and stated that the DON made the decision to deny readmission based on this past behavior. RN 1 confirmed that the facility had no clinical documents to review for this readmission and that the denial was made without such review. A census review for the date of the attempted return showed 11 empty beds, including six available for a male resident, indicating the facility could have accommodated the resident. Facility policies on bed-holds and admission criteria required that residents be permitted to return to an available bed and that appropriate medical records be received prior to or upon admission, which were not followed, resulting in the resident’s denial of return and an unnecessary nine-day stay at the GACH.