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
111640 A. BUILDING __________
B. WING ______________ 		06/19/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
ACCENT CARE HOSPICE & PALLIATIVE CARE OF GEORGIA 11675 GREAT OAKS WAY, SUITE 310, ALPHARETTA, GA, 30022
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)
L0579      
37796 An onsite complaint investigation was conducted on June 18, 2020 at Seasons Hospice and Palliative care - Atlanta. The onsite investigation was a follow up to the remote review conducted during the COVID-19 Public Health Emergency for Complaint GA# 00205442 from June 10-11, 2020. The agency was found to be in substantial compliance with Conditions of Participation at 42 CFR Part 418, Requirements for Hospice Agencies. Complaint #GA 00205442 was substantiated. The following deficiencies were cited. Based on observation, staff and family interviews, review of clinical records, complaint logs, visitors logs, and the written Policy titled and dated "Covid-19 Risk & Response Emergency Plan, 4/15/20, Infection control policy #401, 5/24/19, IPC Patient Management Strategies for Covid -19, 4/15/20, and Seasons Hospice Inpatient Center Visiting Policies, 4/15/20", it was determined that the Inpatient Unit (IPU) failed to ensure infection control practices was implemented for one of two patients (P) #1 and #2. The IPU failed to protect and prevent patient #1 visitors and staff from infections and communicable diseases. Finding include: The complaint investigation revealed that family members of patient #1 had direct contact with the patient between 5/12 and 5/14/2020 and was not screened for COVID-19 precautions prior to entering the patient's room. Review of the IPU's complaint log revealed P#1's family member contacted the facility on 5/14/2020 and spoke with the National Clinical Support Specialist to verbalized concerns that their family members were not screened prior to visiting the patient in the room. Review of the IPU's visitor's log lacked signatures of the family members visits on the above dates and there was no documentation that P#1's family members (visitors) were screened to deem that they were free of communicable and other health diseases. The IPU failed to ensure the safety of the visitors and patients by allowing family and visitors to enter the IPU without appropriate COVID -19 screening, education and Personal Protective Equipment per the agencies written policy. During an telephone interview with the Executive Director (ED) on June 11, 2020 at 2:15 p.m. it was confirmed that all available documentation regarding COVID-19 policies was provided to the surveyor for review and the ED stated that the process of COVID-19 screening was not followed prior to P#1's family visits in the room.