DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
051763 A. BUILDING __________
B. WING ______________ 		09/15/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
LIGHTBRIDGE HOSPICE 6155 CORNERSTONE COURT EAST, #220, SAN DIEGO, CA, 92121
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0505      
39448 Based on interview and record review, the agency failed to call the patient's selected mortuary at the time of death for one of two patients (1). As a result, Patient 1's family did not know the location of Patient 1's remains until the day after Patient 1's death. Findings: Per the facility's Patient Information, Patient 1 was admitted to the agency on 9/9/19, and died on 10/7/19. The Patient Information listed Mortuary 1 as Patient 1's selected funeral home. Per the agency's Charts/Clinical Notes, dated 9/12/19, Patient 1's FM (Family Member) notified the SCC (Spiritual Care Counselor) that Patient 1 had final arrangements with Mortuary 1. Per the agency's Charts/Clinical Notes, dated 10/7/19, Patient 1's FM called the agency and notified SN 1 (Skilled Nurse) they had contacted Mortuary 1, who reported they did not pick up Patient 1. SN 1 reported to a supervisor, who determined the wrong mortuary was contacted at the time of death. On 10/16/19 at 2:44 P.M., a telephone interview was conducted with SN 2. SN 2 stated, when Patient 1 died, she called the phone number for Mortuary 1 listed on Patient Information for Patient 1, but it was the wrong number. SN 2 further stated, she searched online for Mortuary 1 and found the number for Mortuary 2. SN 2 stated, when she called Mortuary 2 and asked if they were Mortuary 1, Mortuary 2 said yes, so she called them to pick up Patient 1. On 1/29/20 at 2:40 P.M., an interview was conducted with the SCC. The SCC stated, when she entered a mortuary into the Patient Information, she entered the name, and the agency's database filled in the phone number. On 2/21/20 at 3:20 P.M., an interview was conducted with the Director of Quality and Compliance. The Director of Quality and Compliance stated, when Patient 1 was sent to the wrong mortuary, the agency did not have a process for auditing mortuary phone numbers in the agency's database to ensure the database had accurate information. On 2/27/20 at 2:10 P.M., a telephone interview was conducted with the IT (Information Technologist). The IT stated, the phone number for Mortuary 1 was entered into the agency's database in 2013, and they had not updated or checked phone number since. Per the facility's undated policy, titled LightBridge Mortuary Arrangement Process, " ...Upon Admission and subsequent Hospice Care, the Lightbridge (LB) Staff will ... Ensure the contact number for the mortuary in the patient records, is the 24/7/365 telephone number ..."