Failure to Provide Written Transfer/Discharge Notice and Ombudsman Copy After Refusal to Readmit Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide a written notice of transfer/discharge to a resident’s legal representative and to send a copy of that notice to the Ombudsman when the facility refused to readmit the resident after a hospital transfer. The resident was admitted in mid-February and transferred to the hospital in early March, after which the facility did not allow the resident to return. The clinical record identified the resident’s wife as the responsible party, emergency contact, and power of attorney for care and financial decisions. The admission MDS documented severe cognitive impairment, multiple dementia-related diagnoses, behavioral symptoms directed and not directed toward others that interfered with care and activities, wandering behavior that placed the resident and others at risk, and frequent bowel and bladder incontinence. Progress notes showed that EMS attempted to return the resident to the facility, but nursing staff informed EMS that the facility could not provide care due to the resident’s behavior and that there were orders for a “do not return” because the facility was unable to meet the resident’s needs related to aggressive and combative behavior. The nurse documented that the hospital called to inquire why the resident was refused and was told the resident had again attacked a staff member and that there was a “do not return” order. Transfer documentation included an “Emergent Transfer Requirement” checklist, which showed that regulatory items requiring completion with the resident or responsible party at the time of transfer—specifically the prepared transfer notice form with signed or witnessed acknowledgment and the bed-hold policy, as well as the FIT-100 form with appeal information—were not checked off. The associated Admission, Transfer, Discharge Rights form was signed by only one nurse, with the witnessing nurse section left blank, and it listed an outdated local Ombudsman contact. Interviews with the DON and nursing staff confirmed that the facility decided not to accept the resident back after the hospital transfer because they believed the resident’s behavioral needs could not be met and that the resident had assaulted staff. The DON reported that the hospital called to ask if the resident could return and was told no, and that the DON had a phone conversation with the Ombudsman about not accepting the resident back, but there was no written notification. The DON and a nurse stated that the transfer packet, including bed-hold information and notice of transfer, was sent with the resident via EMS, and the nurse reported verbally informing the resident’s wife that the resident would not be accepted back. However, the family was not present at the time of transfer, and there was no evidence that the legal representative received a written notice of transfer/discharge or that a written copy was sent to the Ombudsman. The facility’s policies on bed hold and notice of transfer/discharge were provided, but the bed-hold policy contained outdated regulatory references, and the process described in the notice policy (including FIT-100 and ITD-100 forms and written notices with appeal information) was not documented as having been followed for this resident.
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