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
151591 A. BUILDING __________
B. WING ______________ 		07/10/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
ELARA CARING 2130 W SYCAMORE, SUITE 240 A, KOKOMO, IN, 46901
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)
L0509      
42754 Based on record review and interview the hospice failed to follow their policy to ensure that all complaints received were investigated and documented in the agency complaint log for 1 of 1 complaint received via email to the corporate office (#1). Findings include: The hospice policy titled "Complaint Resolution", stated but not limited to " .... A documented investigation is conducted within five (5) working day by appropriate personnel ... All complaints will have a full resolution or attempt to resolve including effective action taken to include the outcome reported back to the complainant within 15 working days ...." In review of the complaint log, it failed to evidence a complaint by patient #1. During an interview with the family of patient #1 on 7/9/20 at 9:10 AM the family stated an email was sent to the hospice agency in regards to the complaint, but no contact was ever made by the agency to the family or patient. During an interview at 3:15 PM on 7/10/2020 with employee A, she was asked if she had received an email on 2/26/2019 at 5:30 PM from patient #1 niece. After review of emails employee A indicated that the email was received from patient #1 and that it was missed and not forwarded to the Administrator of the hospice, thus never investigated. During an interview at 3:55 PM on 7/10/2020 with employee A, stated " ...we let them down in the first few days with the bed and making sure she was comfortable. "
L0579      
42754 Based on observation, record review, and interview, the hospice agency failed to adequately screen patients and visitors for COVID-19 per professional standards for 1 of 1 visitor observed into the office, and 1 of 2 home visits observed. Findings included: The Centers of Disease Control (CDC) article titled "Infection Control Guidance," updated July 9, 2020 stated but not limited to "....screen and triage everyone entering a healthcare facility for signs and symptoms of COVID-19" Upon arrival and entrance to the agency, the staff failed to screen surveyor for temperature, respiratory issues, travel, and exposure. During home visit at 12:25 PM on 7/9/2020, with patient #2, employee D failed to screen family or patient of signs and symptoms of COVID-19 at arrival or departure. The clinical record of patient #2 failed to evidence documentation that the patient and family had been screened for COVID-19. During an interview with spouse of patient #2 at 1:10 PM on 7/9/2020, they indicated the agency had not called or had the Registered Nurse (RN) screened for symptoms of COVID-19 for approximately 3 to 4 weeks. During an interview at 4:30 PM on 7/9/2020 the administrator indicated that patients were to be screened at each visit with vital signs, respiratory signs and symptoms, and exposure questions. Furthermore she stated the office called each patient weekly to screen for signs and symptoms of COVID-19.