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
261574 A. BUILDING __________
B. WING ______________ 		12/09/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
PROMEDICA HOSPICE 12101 WOODCREST EXECUTIVE DRIVE, SUITE 102, SAINT LOUIS, MO, 63141
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)
L0508      
38507 Based on policy review, admission packet review, clinical record review, complaint investigation note, and interviews, the agency failed to ensure all alleged violations involving verbal abuse by anyone furnishing services on behalf of the hospice were reported immediately by hospice employees to the hospice administrator in one (Record/Patient #1) of one record reviewed. This deficient practice has the potential to adversely affect the safety of all patients served by the agency with violations reported. Findings included: Review of the agency's policy titled, "Abuse or Neglect (Alleged or Suspected) Reporting Reasonable Suspicion of a Crime," dated 06/16, showed, in part, the following: - Staff members report suspected abuse or neglect of patients to supervisor; and - All suspected and alleged violations by anyone furnishing services on behalf of the agency are reported immediately by agency employees and contracted staff to the agency administrator. Review of the agency's admission handbook, page 5, "Your Rights and Responsibilities," showed if an allegation of mistreatment, neglect or verbal, mental, sexual, or physical abuse including injuries of unknown source and misappropriation of patient property is made, (the agency) will take the following steps: - Notify the agency administrator; - Immediately investigate the allegation; and - Immediately take action to prevent future violations. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice on 07/31/2020 with terminal diagnoses of other sequelae of cerebral infarction (residual effects or conditions produced after the acute phase of an illness), dementia with behavioral disturbance, anxiety, severe protein-calorie malnutrition, and repeated falls. The patient lived at a long term care facility (LTCF). He/she required total care and was unable to complete any activities of daily living independently. Review of the client coordination note report dated 08/25/2020 completed by registered nurse (RN) B showed the patient was combative during the shower with kicking, hitting and pulling the worker's hair. The patient's hands were held as the hospice aide and facility aide got the patient dressed after the shower. The patient was given Ativan (an anti-anxiety medication) prior to the shower. Review of the client coordination note report dated 08/25/2020 completed by hospice aide (HA) A, showed the aide was giving the patient a shower with a facility aide when the patient became combative and was fighting, scratching, kicking, biting, and pulling hair along with cursing. The patient bit the staff's glove and ripped it off with his/her teeth. HA-A requested the hospice case manager, RN-B, be present and assist. Medications were administered prior to the shower. Review of the complaint investigation report dated 09/02/2020 showed, the following: - RN-B notified RN-C, patient care manager, of an incident regarding Patient #1 and HA-A at the LTCF. RN-B reported that he/she witnessed HA-A being verbally inappropriate in front of the patient during a hospice aide visit on Tuesday, 08/25/2020, showing extreme frustration and anger during the visit; - On Friday, 08/28/2020, the LTCF nurse called the agency with another complaint regarding HA-A about a confrontation with LTCF aides that HA-A had reported inappropriately to a LTCF supervisor; - RN-B then discussed with RN-C again about how HA-A was so upset on Tuesday, she was cursing in front of Patient #1 and saying he/she can't do this anymore and was very angry and loud; - RN-C then reported both incidents to the director of patient services (RN-D). Since it was closing time on Friday and the hospice aide (HA-A) did not work the weekend, they decided to wait until Monday 08/31/2020 to report to the administrator; - The administrator was informed on 08/31/2020 regarding the verbal abuse and an investigation was started; - Interviews were conducted with HA-A and RN-B; - The administrator self-reported to State of Missouri-DHSS hotline on 09/01/2020; - Appropriate staff was notified; and - On 09/02/2020, HA-A's employment was terminated. During a telephone interview on 12/09/2020 at 9:30 AM, RN-B stated that he/she: - Had worked for the agency almost 14 years; - Was Patient #1's case manager; - Had worked with HA-A since he/she started 14 years ago; - Had never seen HA-A behave the way she did on 08/25/2020; - Was walking down the LTCF hall on 08/25/2020 when HA-A came out the shower room and asked for her help; - The patient was combative and the whole time they were trying to get the patient's clothes on, HA-A was cursing and saying he/she just couldn't do this anymore; and - Reported the behavior to RN-C; and - HA-A was removed from Patient #1's care and reassigned to another patient. During a telephone interview on 12/09/2020 at 10:00 AM, RN-C stated that he/she: - Had worked for the agency for about one and half years; - Currently worked in the office as a patient care manager; - Was called by RN-B on 08/25/2020 to report verbal abuse to Patient #1 by HA-A; - Did not talk to HA-A that day except to tell her she would be removed from Patient #1's care; - Did not remember any specific comment from HA-A except acknowledgement of the change in assignment; - Received a call on 08/28/2020 from a nurse at the LTCF regarding HA-A regarding a customer concern; - Spoke with RN-B again and realized that more was going on with HA-A than first realized; - Then contacted the director of patient management, RN-D; - Told RN-D about incident at the LTCF on 08/25/2020 and the customer concern on 08/28/2020; - It was closing time on Friday, so they decided to let the administrator know on Monday 08/31/2020; and - At first did not think the verbal abuse rose to a level that it needed reported until the incident on 08/28/2020 and then speaking to RN-B again began to show a pattern. The incident of verbal abuse occurred on 08/25/2020. The administrator was not notified of the incident until 08/31/2020, six days later.
L0509      
38507 Based on policy review, admission packet review, clinical record review, complaint investigation note, and interviews, the agency failed to ensure all alleged violations involving anyone furnishing services on behalf of the hospice were immediately investigated to prevent further potential violation while the alleged violation is being verified when the verbal abuse incident occurred on 08/25/2020 and the investigation did not start until 08/31/2020, in one (Record/Patient #1) of one record reviewed. This deficient practice has the potential to adversely affect the safety of all patients served by the agency with violations reported. Findings included: Review of the agency's policy titled, "Abuse or Neglect (Alleged or Suspected) Reporting Reasonable Suspicion of a Crime," dated 06/16, showed, in part, the following: - Staff members report suspected abuse or neglect of patients to supervisor; - Immediate action to prevent further violations while the alleged violation is being verified is initiated, if warranted; and - All suspected and alleged violations by anyone furnishing services on behalf of the agency are reported immediately by agency employees and contracted staff to the agency administrator. Review of the agency's admission handbook, page 5, "Your Rights and Responsibilities," showed if an allegation of mistreatment, neglect or verbal, mental, sexual, or physical abuse including injuries of unknown source and misappropriation of patient property is made, (the agency) will take the following steps: - Notify the agency administrator; - Immediately investigate the allegation; and - Immediately take action to prevent future violations. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice on 07/31/2020 with a terminal diagnoses of other sequelae of cerebral infarction (residual effects or conditions produced after the acute phase of an illness), dementia with behavioral disturbance, anxiety, severe protein-calorie malnutrition, and repeated falls. The patient lived at a long term care facility (LTCF). He/she required total care and was unable to complete any activities of daily living independently. Review of the client coordination note report dated 08/25/2020 completed by registered nurse (RN) B showed the patient was combative during the shower with kicking, hitting and pulling the worker's hair. The patient's hands were held as the hospice aide and facility aide got the patient dressed after the shower. The patient was given Ativan (an anti-anxiety medication) prior to the shower. Review of the client coordination note report dated 08/25/2020 completed by hospice aide (HA) A, showed the aide was giving the patient a shower with a facility aide when the patient became combative and was fighting, scratching, kicking, biting, and pulling hair along with cursing. The patient bit the staff's glove and ripped it off with his/her teeth. HA-A requested the hospice case manager, RN-B, be present and assist. Medications were administered prior to the shower. Review of the complaint investigation report dated 09/02/2020 showed, the following: - RN-B notified RN-C, patient care manager, of an incident regarding Patient #1 and HA-A at the LTCF. RN-B reported that he/she witnessed HA-A being verbally inappropriate in front of the patient during a hospice aide visit on Tuesday, 08/25/2020, showing extreme frustration and anger during the visit; - Then on Friday, 08/28/2020, the LTCF nurse called the agency with another complaint regarding HA-A and a confrontation with the LTCF aides that HA-A reported inappropriately to a LTCF supervisor; - RN-B then discussed with RN-C again about how HA-A was so upset on Tuesday, she was cussing in front of Patient #1 and saying he/she can't do this anymore and was very angry and loud; - RN-C then reported both incidents to the director of patient management (RN-D). Since it was closing time on Friday and the hospice aide (HA-A) did not work the weekend, they decided to wait until Monday 08/31/2020 to report to the administrator; - The administrator was informed on 08/31/2020 regarding the verbal abuse and an investigation was started; - Interviews were conducted with HA-A and RN-B; - The administrator self-reported to State of Missouri-DHSS hotline on 09/01/2020; - Appropriate staff was notified; and - On 09/02/2020, HA-A's employment was terminated. During a telephone interview on 12/09/2020 at 9:30 AM, RN-B stated that he/she: - Had worked for the agency almost 14 years; - Was Patient #1's case manager; - Had worked with HA-A since he/she started 14 years ago; - Had never seen HA-A behave the way she did on 08/25/2020; - Was walking down the LTCF hall on 08/25/2020 when HA-A came out the shower room and asked for her help; - The patient was combative and the whole time they were trying to get the patient's clothes on, HA-A was cursing and saying he/she just couldn't do this anymore; and - Reported the behavior to RN-C; and - HA-A was removed from Patient #1's care and reassigned to another patient. During a telephone interview on 12/09/2020 at 10:00 AM, RN-C stated that he/she: - Had worked for the agency for about one and half years; - Currently worked in the office as a patient care manager; - Was called by RN-B on 08/25/2020 to report verbal abuse to Patient #1 by HA-A; - Did not talk to HA-A that day except to tell her she would be removed from Patient #1's care; - Did not remember any specific comment from HA-A except acknowledgement of the change in assignment; - Received a call on 08/28/2020 from a nurse at the LTCF regarding HA-A regarding a customer concern; - Spoke with RN-B again and realized that more was going on with HA-A than first realized; - Then contacted the director of patient management, RN-D; - Told RN-D about incident at the LTCF on 08/25/2020 and the customer concern on 08/28/2020; - It was closing time on Friday, so they decided to let the administrator know on Monday 08/31/2020; and - At first did not think the verbal abuse rose to a level that it needed reported until the incident on 08/28/2020 and then speaking to RN-B again began to show a pattern. The verbal abuse incident occurred on 08/25/2020 and the investigation did not start until 08/31/2020, six days later.