F0628

D

Failure to Provide Required Written Transfer Notice and Appeal Rights

Topeka, Kansas Survey Completed on 03-31-2026

Penalty

No penalty information released

Summary

The facility failed to provide a resident and their representative with the required written notification of transfer when the resident was sent to the hospital. The electronic medical record documented that the resident had an unplanned discharge to an acute hospital with return anticipated, and a Discharge MDS was completed. The facility’s Nursing Home to Hospital Transfer Form for this resident did not include the transfer location, did not document that the resident or legal representative was notified of the transfer, and did not state the reason for the transfer. The form also lacked any written information about the resident’s appeal rights, including the name, address, and telephone number of the entity that receives appeal requests, how to obtain and complete an appeal form, and how to submit an appeal hearing request.

Surveyor interviews further showed that staff practice did not ensure written notification of transfer and appeal rights. A licensed nurse reported that she would document in the EMR who was notified of the transfer, where the resident was transferred, and what information was sent regarding the resident’s medical condition, but this documentation did not appear on the written transfer form. An administrative nurse stated that the facility would not provide written notification if the resident was their own legal representative or had a BIMS score of 12 or greater, indicating intact cognition. The facility’s written Transfer or Discharge Notice policy stated that a 30‑day written notice would be provided for impending transfers or discharges and that, in a medical emergency, the resident would be transferred to an acute care setting and a determination made regarding the need for a formal notice of discharge, but the required written notice elements were not provided for this resident’s hospital transfer.