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
151615 A. BUILDING __________
B. WING ______________ 		01/21/2022
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
PHYSIOCARE HOSPICE LLC 1440 INNOVATION PLACE, WEST LAFAYETTE, IN, 47906
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)
L0671      
43294 Based on record review and interview, the agency failed to ensure all clinical records contained complete and correct clinical visit notes for 6 of 10 active patient records reviewed (patients #2, 3, 4, 5, 6, and 8.) Findings Include: 1. A review of an agency policy titled "Clinical/Service Data Collection, Policy No, 6-022," last revised December 2018, indicated "Documentation in the clinical/service record will be timely, detailed, accurate, and reflect the care or services provided." Further review evidenced "1. A clinical/service record will be initiated and maintained for each patient receiving care or services ... and will include at a minimum: ... E. Dates, times, and types of interventions, assessments, and coordination of care/services .... 6. Entries into the clinical/service record will be made on the day care/service is provided to the patient. All documentation will be turned into the office at the end of the workday ... 10. All entries will reflect the date care was provided, including the month, day, and year." 2. A review of an agency policy titled "Care/Service Coordination, Policy No. 1-006," last revised October 2019, indicated " ... #4. Care coordination will include, but not be limited to E. Timely documentation of coordination of care activities .... Further review indicated ... 6. ... Documentation of all communications will be included in the clinical record ... on a ... clinical note ... 8. Written evidence of care coordination may be found in the plan of care/service, case conference summary forms, clinical notes in the patient's clinical record ...." 3. During an entrance interview on 1/18/21 at 1:06 PM , the administrator was queried as to the agency policy for completing visit notes. The administrator stated clinicians were expected to complete their visit notes within 24 hours. 4. On 1/20/21 at 3:30 PM, the administrator was interviewed concerning the agency policy and process for completion and submission of clinical notes. The administrator stated that visits were labeled in the EMR (Electronic Medical Record) and included visits identified as "planned," which indicated a pending visit but no clinical documentation; visits identified as "in progress," which indicated the visit was occurring/just occurred, and the clinical note was started but not finished; and visits identified as "completed," which meant the visit was finished, and the clinical note was completed, signed, and ready for quality review in advance of billing. The administrator was queried concerning policy No. 6-022, which stated documentation should be timely. The administrator stated the agency expectation for completing clinical notes was no more than 24 hours after the visit. The findings related to incomplete visit notes for patients #2, 3, 4, 5, 6, 7, 8, 9, 10, and 11 were reviewed with the administrator. When queried as to whether the agency had a pattern of clinical notes not completed within 24 hours, the administrator stated being aware of an ongoing problem with employees B, G, and K, all of whom received disciplinary counseling with pending termination if unable to meet standards of documentation that included completion of visit notes within 24 hours after the visit. 5. The clinical record for patient #2 was reviewed on 1/20/22 at 11:53 AM, for the patient's current benefit period of 11/2/21 - 1/30/22. The record evidenced a skilled nurse visit was scheduled for 1/18/22. Review of the schedule for patient #2 evidenced the skilled nurse visit was in "planned" status. The record failed to evidence the skilled nurse clinical note for 1/18/22 was completed timely/within 24 hours of the visit. 6. The clinical record for patient #3 was reviewed on 1/20/22 at 12:15 PM, for the patient's current benefit period of 1/3/22 - 3/3/22. The record evidenced a certified nursing assistant (CNA) visit was scheduled for 1/11/22. Review of the schedule for patient #3 indicated the CNA visit was "in progress." Further review evidenced a chaplain visit on 1/17/21. Review of the schedule indicated the chaplain visit was "in progress." The record failed to evidence the CNA and chaplain clinical notes had been completed timely/within 24 hours of their respective visits. 7. The clinical record for patient #4 was reviewed on 1/20/22 at 12:45 PM, for the patient's current benefit period of 11/26/21 - 2/23/22. The record evidenced a CNA visit was scheduled for 11/22/21. Review of the schedule for patient #4 indicated the CNA visit was "in progress." The record failed to evidence the CNA clinical note was completed timely/within 24 hours of the visit. 8. The clinical record for patient #5 was reviewed on 1/20/22 at 1 PM, for the patient's current benefit period of 11/21/21 - 1/19/22. The record evidenced a medical social work visit was scheduled for 1/6/22, and indicated the visit was "in progress." The clinical record also evidenced CNA visits scheduled on 1/12/22 and 1/17/22, and indicated both visits were "in progress." The record failed to evidence the clinical notes were completed timely/within 24 hours of the visits. 9. The clinical record for patient #6 was reviewed on 1/20/22 at 1:20 PM, for the patient's current benefit period of 12/3/21 - 1/31/22. The record evidenced a CNA visit was scheduled for 1/17/22 and a skilled nurse visit was scheduled for 1/18/22. Review of the patient's schedule indicated both visits were "in progress ." The record failed to evidence all clinical notes were completed timely/within 24 hours of the visits. 10. The clinical record for patient #8 was reviewed on 1/20/22 at 1:50 PM, for the patient's current benefit period of 11/22/21 - 1/20/22. The record evidenced a medical social work visit was scheduled for 1/7/22. Review of the patient's schedule indicated the visit was in "planned" status. The record failed to evidence the clinical note was completed timely/within 24 hours of the visit.