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
141527 A. BUILDING __________
B. WING ______________ 		02/14/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
JOURNEYCARE - GLENVIEW 2050 CLAIRE COURT, GLENVIEW, IL, 60025
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)
L0556      
21768 A. Based on the clinical record review, observation of the Inpatient Unit and staff interview it was determined that the Hospice staff failed to ensure care based on patient and family needs. This was found in 1 of 1 (Pt. #2) records reviewed with the Inpatient stay. Findings include: 1. Pt #2 SOC 11/18/19 Diagnosis: Chronic Obstructive Pulmonary Disease. The clinical record was reviewed on 02/14/20 at 10:30 AM. The POC dated 11/18/19 required the SN 1 time a week for 1 week and 2 PRN visits to monitor and evaluate lung sounds and "meet the need of the patient". The record included several phone calls from the patient's daughter: On 12/04/19 at 1336 PM, there's a documented voice message from the daughter stating that "haven't received a phone call until 5 hours later ...visit should have been between 9:30 AM-10:30 AM as that was what she was told". There's a documented phone call on 12/05/19 at 1:12 PM from the daughter requesting a call back, visit ASAP." She also stated the patient was short of breath, anxious and the "medication is not working". No documentation of a call back. There's another documented call on 12/05/19 at 1353 PM stating "her MOM is very SOB and has been .... Notified the Regional Director ... and she will call the daughter now." No documentation of call back. There's a call from the daughter on 12/05/19 at 3:44 PM stating the patient is uncomfortable. No call back documentation. On 02/14/20 at 3:00 PM, during the interview with the Vice- President, it was stated that the SN should have provided a respiratory assessment. It was also stated that the Hospice practice for responding to a phone call is immediately by the on-call Manager (RN) and the visit should be made within 1- 4 hours and not greater than 24 hours. The record included calls on 12/07/19 at 11:43 AM, stating the daughter is dissatisfied with the care and the patient is "gasping for air". There's another call on12/07/19 at 4:15 PM stating the patient is still having symptoms of respiratory distress. The record lacked documentation of the return calls to the family. The SN assessment was dated 12/07/19 7:47 PM. On 12/07/19 the SN documented an on-call visit "breathing labored ..." and the patient was transferred via ambulance to the inpatient unit with a respiration rate of 36. The multiple calls on 12/05/19 and 12/07/19 are evidence that the Hospice delayed assessment for the patient in respiratory distress and evidence of the long wait time on call back to speak to a nurse about the patient. 2. The above findings were confirmed with the Director of Compliance and the Vice-President of Hospice (Acting Administrator) on 02/14/20 between 1:15 PM and 1:45 PM.
L0736      
21768 A. Based on the observation of the Inpatient Unit and staff interview it was determined that the Hospice staff failed to ensure potential threat to the health and safety of patients. This was found in 1 of 1 Inpatient units observed (Glenview unit). Findings include: 1. Pt #2 SOC 11/18/19 Diagnosis: Chronic Obstructive Pulmonary Disease. The clinical record was reviewed on 02/14/20 at 10:30 AM. The POC dated 11/18/19 required the SN 1 time a week for 1 weeks and 2 PRN visits to monitor and evaluate lung sounds and "meet the need of the patient". The record included calls on 12/07/19 at 11:43 AM, stating the daughter is dissatisfied with the care and the patient is "gasping for air" and the patient was transferred via ambulance to the inpatient unit with a respiration rate of 36. 2. On 02/14/20 at 1:00 PM, a tour of the Inpatient unit was conducted. It was observed that the Inpatient unit refrigerator included 9 containers of Orange juice that expired on January 27, 2020 creating a potential threat to the health and safety of patients 3. On 02/14/20 between 1:00 PM and 1:30 PM, during the interview with the Unit staff Employee # 6 (Aide) and Employee # 7 (RN) they were unaware of the expiration dates. The RN and Aide stated that they had not provided any juices to the three (3) Inpatients. It was further observed that the Director of Compliance (Employee #8) proceeded to discard the 9 expired juices. 4. The above findings were confirmed with the Director of Compliance and the Vice-President of Hospice (Acting Administrator) on 02/14/20 at 1:45 PM.