Survey Report for 141582

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
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION	141582	A. BUILDING __________ B. WING ______________	03/19/2020
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
ACCENTCARE HOSPICE & PALLIATIVE CARE OF ILLINOIS	606 POTTER RD, FL 6, DES PLAINES, IL, 60016
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
L0579	37373 . Based on observations, review of Agency policy and staff interview, it was determined that the Hospice failed to ensure staff followed infection control measures. Findings include: 1. Upon arrival to Hospice Residence on 03/19/2020 at 1:15 PM Surveyor #1 was not fully screened for COVID-19 before entering facility. Surveyor #2 arrived at 1:45 PM and was not screened at all for COVID -19 before entering facility. 2. During the entrance interview on 03/19/2020 at 1:20 PM the Inpatient Service Director stated that all families,caregivers,vendors and visitors are screened before entering the facility following Center for Disease Control recommendations. 3. The Agency policy titled "Covid-19 Risk & Response Emergency Plan" was reviewed on 03/19/2020 at 2:30 PM. The policy required "...1. All families, caregivers, vendors & visitors will be screened at each contact following Centers for Disease Control recommendations"....2. "Visitors who answer yes to any of the screening questions will not be allowed entrance". 4. During an interview with the Inpatient Service Director and Director of Clinical Operations on 03/19/2020 at 3:30 PM findings of Agency staff failing to screen surveyors upon entry to facility were confirmed.