On the allegations: Facility failed to issue a refund and facility failed to comply with resident's admission agreement

This is an amended report. On the allegations: Facility failed to issue a refund and facility failed to comply with resident's admission agreement.

Reporting Party (RP) alleges that on 07/02/2023, R1 was hospitalized for 8 days. RP alleges that they advised S1 on 07/06/2023 that R1 will not return to facility, due to their medical condition. R1 was discharged from the hospital and moved into a skilled nursing facility. RP alleges that S1 advised, if R1’s personal items are removed, R1 will be entitled to a refund. On 07/06/2023, RP removed R1 personal belongings from facility. Dylan Hull, Licensee, subsequently refused to issue a refund, citing that RP was required to provide the facility a 30-day prior notice before vacating. R1 was admitted to facility on May 6, 2023, and was taken to hospital on July 2, 2023. A pre-admission refund was provided as required by Title 22 Regulations.

LPA Miller reviewed the Admission Agreement dated May 1, 2023, which states in part, “All charges will be refunded on a prorated basis upon notice that the Resident’s medical condition will not allow a return to the facility when all the resident’s personal belongings are removed from the facility and the personal property form (LIC621) is completed. If the resident leaves the facility other than a medical condition, a thirty (30) day notice to the facility is required.”

The admission agreement does not contain explicit language stating which “medical conditions” meet the degree to which a 30-day notice is no longer required and does not state that the medical condition must be a restricted or prohibited condition. The contract language is vague and ambiguous.

R1 suffered a medical emergency on 07/02/2023 and was transported the hospital after a 9-1-1 call was placed. R1 was diagnosed with pneumonia and was subsequently discharged to a skilled nursing facility on 07/10/2023. Licensee acknowledged in a prior interview that the facility cannot provide the same level of care as a skilled nursing facility (SNF). The resident’s belongings were removed on 07/06/2023. R1 remained at the SNF until 08/15/2023.

This is an amended report. LPA obtained documentation consisting of a copy of the 07/10/2023 hospital discharge that reflects, “Discharge Disposition: Skilled Nursing Fac” and the discharge summary from Post Acute care that confirms R1 stayed in a SNF from 07/10/2023 through 08/15/2023. LPA also reviewed 09/05/2023 correspondence from their physician that states, “patient is unable to return to board and care facility due to [their] medical condition” and R1 requires 24/7 supervision due to their dementia. The document does not specify any medical condition other than dementia.

Licensee stated they were verbally notified around 07/06/2023 that R1 would not be returning after being sent to the hospital. However, a written 30-day notice was not submitted. Although the documentation from 09/05/2023 states R1 was unable to return to the board and care facility due to their “medical condition,” it only states R1 needed 24/7 supervision due to their dementia, which would be within the scope of this facility. Additionally, this documentation is from approximately 2 months after R1 entered the SNF, at which time R1’s condition could have changed. Licensee stated they were willing to take R1 back from the hospital with pneumonia and would have implemented additional care as needed to meet their needs. Licensee also stated R1 did not have a prohibited health condition.

The admission agreement states a 30-day notice was required unless the resident’s medical condition did not allow them to return to the facility. The investigation revealed no medical documentation indicating R1 could not return to the facility from on or around 07/06/2023, when RP removed R1’s personal belongings from the facility and provided verbal notice that R1 would not be returning to the facility. The Licensee maintains they could have met R1’s needs. The investigation determined the admission agreement was followed and R1 was not owed a refund.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report was provided.