Failure to Provide Bed-Hold Notice at Transfer: The facility did not document that written bed-hold information, including the duration of the bed hold and reserve bed payment details, was provided to residents or their representatives when residents were transferred to the hospital. Four residents had hospital transfers, but EMRs lacked evidence of signed bed-hold forms or follow-up documentation; one resident stated he was never offered a bed-hold form, and another record noted a POA signature without showing what information was provided.
The facility failed to notify the ombudsman of a resident’s planned discharge back to the community. The resident completed therapy and discharged home with home health services, but the RN-A and SSD stated the ombudsman was only notified for emergency hospital discharges or AMA departures. The DON confirmed the facility policy required notification of all discharges.
The facility failed to document or provide written BH information for residents transferred to the hospital. Records for multiple residents showed hospitalizations without evidence that a signed bedhold form was offered, completed, or sent with the resident, and family or resident interviews confirmed they were not informed in some cases. Staff and DON interviews verified that the expected BH process was not being followed and that the EMR lacked the required documentation.
A facility failed to meet bed hold notification requirements for a resident transferred to the hospital. The resident had significant medical conditions including COPD, respiratory failure, lung cancer, pulmonary HTN, oxygen dependence, and HF. The EMR lacked evidence that the resident or spouse was offered a bed hold at the time of transfer, and staff interviews showed the usual process was to notify the resident or family and document it, but that did not occur before the transfer.
Failure to Provide Written Bed Hold Notice: A resident with cognitive impairment, schizophrenia, bipolar disorder, and seizure disorder was transferred to the hospital after active seizure activity and unresponsiveness. The record lacked evidence that the resident or representative received the required written bed hold and return-rights notice at transfer, despite staff stating the process was usually completed and documented.
The facility failed to give two residents written transfer notices and written bed-hold notices when they were sent to the hospital. Records showed one resident had moderate cognitive impairment and the other had intact cognition, but neither record showed a written notice with ombudsman info, appeal rights, or the required bed-hold details such as state policy duration, reserve bed payment policy, or facility bed-hold policy. Staff interviews indicated uncertainty about whether the notices were provided, and the nurse manager stated the facility did not have a process for written transfer notices.
Failure to Document Required Involuntary Discharge Notice: The facility transferred a resident to a sister facility without documented written notice of the involuntary discharge, appeal rights, resident or resident rep notification, attempted contact with the resident’s daughter, or Ombudsman notification. The SW and Administrator acknowledged missing discharge documentation, and the Ombudsman confirmed the required discharge process had not been followed.
Missing Transfer and Bed-Hold Notices: The facility failed to provide written transfer notices that included appeal rights and Ombudsman contact information, and failed to provide written bed-hold information for two residents transferred to the hospital/ED. Staff said they typically sent the face sheet, orders, and MAR, but did not give the required transfer or bed-hold forms, and the records did not show that these notices were provided.
A resident with ESRD on dialysis, PVD, and right elbow effusion was transferred to the ER and then admitted to the hospital for further testing and MRI. Although the facility’s admission packet and bed hold policy stated that a bed hold notice should be provided before transfer and acknowledged by signature, the EMR and hard chart had no written bed hold for the transfer. The resident could not recall being offered one, and the LSW, DON, and ADM could not locate documentation that a written bed hold was offered.
A resident with schizophrenia, diabetes, and epilepsy was transferred to the hospital for seizure activity, and the facility notified the provider and family. However, the medical record lacked evidence that the State LTC Ombudsman was notified of the transfer, and the ADON stated there was no way to verify whether nurses had sent the bed hold notification.
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