| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 012505 | (X3) Date Survey Completed 07/26/2018 |
| Name of Provider or Supplier Physicians Choice Dialysis-Montgomery | Street Address, City, State 1001 Forest Avenue, Montgomery, AL | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| V0559 | POC-OUTCOME NOT ACHIEVED-ADJUST POC CFR(s): 494.90(b)(3) If the expected outcome is not achieved, the interdisciplinary team must adjust the patient's plan of care to achieve the specified goals. When a patient is unable to achieve the desired outcomes, the team must- (i) Adjust the plan of care to reflect the patient's current condition; (ii) Document in the record the reasons why the patient was unable to achieve the goals; and (iii) Implement plan of care changes to address the issues identified in paragraph (b)(3)(ii) of this section. This STANDARD is not met as evidenced by: Based on review of facility policy, facility ESRD (end stage renal disease) Core Data Worksheet documentation, medical record and interview, it was determined the staff failed to develop an unstable Plan of Care that included interventions and goals to meet the needs of Patient Identifier (PI) # 4 determined to be unstable -psychosocial needs. This affected 1 of 1 in-center unstable in-center hemodialysis records reviewed and had the potential to affect all unstable patients treated at the facility. Findings include: Policy: 1-14-01 Title: Interdisciplinary teams (IDT) Patient Assessment and Plan of Care Revision Date: April 2017 ...Plan of Care: 8. The facility's interdisciplinary team will develop and implement a written, individualized, comprehensive plan of care that specifies the services necessary to address the patient's needed....and changes in the patient's condition, and will include measurable and expected outcomes and estimated timetables to achieve these outcomes..." Review of the facility ESRD Core Survey Data Worksheet on 7/24/18 revealed the facility designated PI # 4 unstable on 6/21/18 and on 7/5/18, primary reason documented, Psychosocial. Medical record review revealed the IDT Patient POC Meeting Report dated 7/2/18. The category title, Psychosocial, revealed all goals were met which included stable support system, stable living situation, stable mood and open communication between patient and clinical team. There was no documentation in the 7/2/18 IDT POC regarding PI # 4's unstable behavior, no interventions documented on the unstable POC to address any unstable psychosocial issues, no follow up time frames, no recent trigger date or source, no comments from the MSW or other IDT members and no planned interventions identified to meet the patients' needs. In an interview conducted on 7/26/18 at 11:18 AM, EI # 1, Facility Administrator submitted Registered Nurse documentation dated 6/21/18 regarding aggressive behavior by PI # 4 toward staff, Medical Social Worker (MSW) documentation dated 6/22/18 that revealed RISK (management) was notified regarding the incident and patient will be notified via written letter regarding clinic rules. On 6/25/18, documentation by the MSW concerning the IDT meeting with the patient, provided a copy of Patient Rights and Responsibility, Network 8 information and written warning. MSW will continue to assess and provide referrals, case management and emotional support. There was no documentation in the 7/2/18 POC of the IDT's plan to address the aggressive behavior which deemed the patient unstable for psychosocial reasons. There was no monitoring and interventions, counseling services or referrals to assist PI # 4 in achieving and sustaining an appropriate psychosocial status. During an interview on 7/26/18 at 3:30 PM, the aforementioned findings were confirmed by EI # 1. |