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
231664 A. BUILDING __________
B. WING ______________ 		02/18/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
OAKLAND HOSPICE 7125 ORCHARD LAKE RD, SUITE 222, WEST BLOOMFIELD, MI, 48322
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)
L0648      
38304 Based on observation, document review and interview, the hospice agency failed to organize, manage, and administer its resources to provide hospice care and services to patients, caregivers, and families after a change in hospice ownership (See L649); and the hospice failed to be primarily engaged in providing hospice services and it was determined that the hospice was not operational (See L652). The cumulative effect of these systemic problems resulted in the hospice's inability to maintain continuity of Hospice services to ensure the provision of safe and appropriate patient care during a change of ownership.
L0649      
38304 Based on observation, document review and interview, the hospice failed to organize, manage, and administer its resources to provide hospice care and services to patients, caregivers, and families. It was determined that the hospice was not operational. Findings included: During the entrance interview on 2/18/2020 at 9:25 AM, it was determined the agency had admitted 0 patients since the CHOW (Change of Ownership) effective 3/16/2019. Admin-A was queried as to why the agency had not admitted any patients yet. Admin-A replied, "We're ready to go, I have been waiting to get final approval from CMS before going forward. I have the staff checked off on being corporate compliant with paid trainings and in-services." It was observed throughout the investigation that no personnel were present relating to patient care. The only staff present were the administrator and an office assistant.
L0652      
38304 Based on document review and interview, the hospice failed to be primarily engaged in providing hospice services, resulting in the potential for unmet care needs in the community. Findings included: During the entrance interview on 2/18/2020 at 9:25 AM, it was determined the agency had admitted 0 patients since the CHOW (Change of Ownership) effective 3/16/2019. Admin-A was queried as to why the agency had not admitted any patients yet. Admin-A replied, "We're ready to go, I have been waiting to get final approval from CMS before going forward. I have the staff checked off on being corporate compliant with paid trainings and in-services." Review of the CHOW documentation noted that Genesee Community Hospice Care (GCHC), located at 1509 South State Rd., Suite B, Davison MI 48423 was to be renamed Oakland Hospice and relocated (37 miles) to 7125 Orchard Lake Rd., Suite 222, West Bloomfield MI 48322. Copies of the employee roster and Organization Chart from both GCHC and Oakland Hospice were requested and provided by Admin-A at 10:40 AM. The two staff lists were compared to determine the extent of staff retention after the CHOW became effective. Of the 11 documented GCHC staff (Administrator through Home Health Aide), none were included on the current employee roster at Oakland Hospice. Regarding the Organization Chart comparison, none of the names listed for GCHC carried over to Oakland Hospice. The Admin-A was queried at 11:05 AM whether Hospice services at the GCHC location were still maintained. Admin-A responded, "We have no services or employees over there (GCHC) since it was a complete transfer of all assets. I'm not sure how that address is being utilized right now." Admin-A was further questioned if the relocation was voluntary. Admin-A stated, "Yes, we initiated the change." A review of the dates which Hospice patients were admitted to GCHC revealed that the last patient was discharged on 7/15/18. No further documented Hospice services were provided after that date. It was determined the hospice was not operational and the hospice failed to be primarily engaged in providing hospice services to patients, caregivers, and families.