Failure to Readmit Hospitalized Resident to First Available Bed per Bed-Hold Policy
Penalty
Summary
The deficiency involves the facility’s failure to permit a resident to return to the first available semi-private bed following hospitalization, in accordance with its own "Bed-Holds and Returns" policy. The resident had been admitted with multiple diagnoses, including an immune disorder, type 2 DM with complications, abnormal gait and mobility, and chronic total occlusion of extremity arteries. The resident’s H&P documented that the resident could express needs but could not make medical decisions, and the MDS showed moderately impaired cognitive skills with a need for partial/moderate assistance in several ADLs. Progress notes indicated the resident was transferred to a GACH for evaluation and treatment related to failure to thrive, with a seven-day bed hold in place, and later transferred to an LTACH where physician notes documented that the resident had improved and stabilized. When the LTACH sent an inquiry fax requesting the resident’s readmission, the facility refused to readmit the resident, citing the lack of an available Candida auris isolation bed. However, review of the facility census and interviews with the Marketing staff and ADON showed that several semi-private rooms each had one female bed available on the relevant dates, and that the facility could have arranged four rooms to make one room available during that period. The Marketing staff and ADON both acknowledged that the facility could have made a specific room available to readmit the resident, as they later did for another resident who was readmitted to that same room. Further review with the administrator confirmed that the facility received the LTACH inquiry and declined readmission for the resident, while subsequently making the same room available to admit another resident. The Infection Preventionist stated that the facility had no current C. auris isolation residents and that an empty room could have been designated as a C. auris isolation room to allow the resident’s return. An interview with another resident indicated that this resident had never been asked to change rooms but would have agreed if asked, and there were no progress notes documenting any refusal to change rooms. The facility’s "Bed-Holds and Returns" policy stated that residents seeking to return after the state bed-hold period must be allowed to return to their previous room if available or immediately to the first available bed, provided they still require facility services and are eligible for Medicare or Medicaid services, conditions that were met for this resident.
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