F0627

D

Improper Discharge Notice and Failure to Readmit a Resident Within 30-Day Period

Zapata, Texas Survey Completed on 03-17-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure a resident was permitted to remain in the facility and not be transferred or discharged in violation of federal discharge requirements. The resident was an adult male with multiple serious chronic conditions, including type 2 diabetes with neuropathy and foot ulcers, end-stage renal disease on dialysis, heart failure, hypertension, major depressive disorder, and atherosclerotic heart disease. He had a BIMS score of 13, indicating no cognitive impairment, and was independent in self-care, using a walker and electric wheelchair. Active discharge planning toward community placement had been documented, and the resident had previously approached social services requesting assistance with a possible future discharge to live alone with services.

The record shows that the resident was first issued a 30‑day discharge notice on one date in late January, which he appealed and won due to a technicality. Despite this, he remained behind on his Medicaid applied income payments for several months, accumulating a significant balance. On a later date in early March, the DON and administrator again issued a 30‑day discharge notice, citing continued non‑payment and ongoing behavioral concerns. However, the notice given on that date listed an effective discharge date only a few days later, rather than 30 days from the notice date. The resident and the Ombudsman both reported that the second notice was dated with a discharge date six days after issuance, and the Ombudsman stated the facility documented that he was to be discharged to an apartment.

Social service notes on the same day as the second notice document extensive discussions with the resident about his planned move to an apartment, his lack of payment of applied income, and his conflicting statements about wanting to leave versus wanting to stay. The SW documented contacts with an apartment complex, home health agency, dialysis center, and other community resources, and noted that the apartment would be available around the 11th or 12th of that month. The resident was then sent to the hospital shortly after this planning. Before the 30th day from the second 30‑day notice had elapsed, the resident was ready for discharge from the hospital and expressed a desire to return to the original facility while he awaited finalization of his apartment. The Ombudsman reported that the administrator stated the owner did not want to take the resident back and did not want to honor the 30‑day notice. The facility did not readmit the resident when he was discharged from the hospital prior to the 30th day after the 30‑day notice, resulting in a failure to provide a proper 30‑day discharge date and a failure to readmit him during that 30‑day period as required.

Throughout his stay, the record reflects multiple behavioral incidents, including verbal agitation, sexually inappropriate comments toward staff, attempts to enter restricted areas such as the medication room, going into other residents’ rooms, recording staff and residents on his phone, and frequent threats to report staff to the state. Staff, including CNAs, LVNs, the ADON, DON, and facility owners, reported feeling uncomfortable or unsafe due to his comments, recording behavior, and perceived threats. The facility owners and leadership cited these behaviors, along with his refusal to pay applied income, as reasons for pursuing discharge. However, despite these concerns and the ongoing discharge planning, the facility did not provide a discharge date that was 30 days after the 30‑day notice and did not allow the resident to return from the hospital before the 30‑day period expired, which surveyors identified as a failure to ensure the resident’s right to remain in the facility and to be transferred or discharged only in accordance with regulatory requirements.