**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview conducted during a recertification survey, the facility did not ensure for 1 of 1 resident reviewed for hospitalization that the resident or her representatives were given timely written notification of a transfer and the reasons for the move in a language and manner they could understand. This was evident for 1 of 2 residents reviewed for closed record. The finding is: Resident #9 was an [AGE] year old female admitted on [DATE] with diagnoses including, but not limited to, pneumonia and congestive heart failure. The 5-day Scheduled Minimum Data Set (a resident assessment and screening tool) of 2/2/18 indicated the resident was cognitively alert. The progress notes of 2/4/18 at 7:45 AM documented that the resident complained of shortness of breath. The oxygen saturation (a measure of the blood oxygen level) was checked and the results were 60 to 65% (normal range is 90-100%). The resident received respiratory treatment and was placed on a venturi mask (medical device to deliver a set concentration of oxygen). The oxygen saturation level then increased to 90%. The resident stated she felt better but the shortness of breath persisted. The resident received a medication to improve her breathing status. Arterial blood gases were performed and the oxygen level was 70%. The resident was sent to the hospital for further evaluation and left the facility in guarded condition. Review of the medical record revealed no documented evidence that the resident or her representative received written notification of the transfer on 2/4/18. The Registered Nurse/Administrator was interviewed on 2/7/18 at 2:00 PM and she stated she had not provided the resident or her representative with a transfer notice. 415.3(h)(1)(iii)(a-e)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview conducted during a recertification survey, the facility did not ensure for 1 of 1 resident reviewed for hospitalization that the resident or her representatives were given timely written notification of the bed hold policy before transfer in a language and manner they could understand. This was evident for 1 of 2 residents reviewed for hospitalization. ( Resident #9). The finding is: Resident #9 was an [AGE] year old female admitted on [DATE] with diagnoses including, but not limited to; pneumonia and congestive heart failure. The 5-day Scheduled Minimum Data Set (MDS; a resident assessment and screening tool) of 2/2/18 indicated the resident is cognitively alert. The progress notes of 2/4/18 at 7:45 AM documented that the resident complained of shortness of breath. The oxygen saturation (a measure of the blood oxygen level) was checked and the results were 60 to 65% (normal range is 90-100%). The resident received a respiratory treatment and was placed on a venturi mask (medical device to deliver a set concentration of oxygen). The oxygen saturation level then increased to 90%. The resident stated she felt better but the shortness of breath persisted. The resident received medication to improve her breathing status. Arterial blood gases were performed and the oxygen level was 70%. The resident was sent to the hospital for further evaluation and left the facility in guarded condition. Review of the medical record revealed no documented evidence that the resident or her representative received written notification about the facility's bed hold policy prior to the transfer on 2/4/18. In an interview with the Registered Nurse/Administrator on 2/7/18 at 2:00 PM she stated she had not provided the resident or her representative with a notice of the bed hold policy. 415.3(h)(1)(iii)(a-e)