Survey Report for 261574

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	261574	A. BUILDING __________ B. WING ______________	02/20/2020
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)
L0543
L0543	29559 Based on policy review, record review and interviews, the hospice provider failed to ensure hospice aide services furnished followed an individualized written plan of care established by the hospice interdisciplinary group (IDG~IDT) in collaboration with the primary caregiver and family in one of three sampled cases (Record/Patient #3). The patient was assigned a bath twice weekly, it could not be verified that a bath was provided for a 14 day period. The deficient practice has the potential to affect all patients on service with the hospice. Findings included: Review of the agency policy "INTERDISCIPLINARY GROUP & CROUP MEETING POLICY" showed in part the following: - The Interdisciplinary Group (IDG) is responsible for providing and supervising the care of hospice patients. The IDG meets regularly to oversee patient and caregiver palliative and support management. When there is more than one IDG group, one is designated in advance to establish policies and procedures governing the day-to-day provision of hospice care and services. - Core hospice services include, at a minimum, a doctor of medicine or osteopathy, a registered nurse, a social worker and a spiritual care, bereavement and dietary counselor. To ensure quality services and care are provided to meet the individual needs of the patient and caregivers. - The IDG meets regularly at least every 14 days (or per state regulations) after the initiation of services or at more frequent intervals specified in the plan, and more frequently in response to a significant change in the individual's condition. (Exception: can be held on the 15th day due to a holiday or other extenuating circumstance). - The IDG develops, in collaboration with the patient's attending physician, reviews and modifies patient/caregiver care plan as appropriate, taking into consideration changes in patient's clinical status and patient/caregiver's social, cultural and physical environment, that may present obstacles to effective interventions. - If the IDG determines that the written goals and interventions are not effective in meeting the needs of the patient or the patient's caregiver, or both, or that needs have changed, the plan of care is revised to provide for updated goals and intervention strategies to meet those needs. - Changes and revision to the patient/caregiver plan of care are documented on the care plan, and the plan of care is updated as necessary. - Members of the hospice group participate in the plan of care review. The hospice physician provides oversight of the patient/caregiver care plan. - Documentation of patient/caregiver issues and needs discussed during the IDG are recorded on the Interdisciplinary group plan of care and review of the comprehensive assessment form. - The IDG is responsible for establishing policies and procedures governing the day-to-day provision of hospice. Review of the agency policy "AIDE SUPERVISION POLICY" showed that aide Supervision is provided to promote professional development and improve performance. To ensure compliance with aide assignment, determine effectiveness of service, implement changes in goals, instructions or care. - Supervision at least every two weeks, a supervisory home visit is made by registered nurse or qualified therapist to patients receiving home health aide or hospice aide services to evaluate effectiveness of service. - An on-site supervisory visit must be made with aide present annually or as required by state specific regulations. - Personal care service non-skilled patients are contacted at least monthly by supervisor, registered nurse, or therapist, and visited at least every 60 days with home health aide present. - Environmental support and chore service (homemaker) patients in a certified agency are contacted at least every 60 days by supervisor, registered nurse or therapist, and are visited at least every 6 months with homemaker present. In a non-certified agency the homemaker, environmental support and chore service patients are contacted at least monthly and visited every 6 months with homemaker present. - If an area of concern is noted by the supervising nurse during the on-site supervisory visit, the supervising nurse is to make a follow-up on-site supervisory visit with the aide present to observe the delivery of care. - If the supervising nurse verifies the area of concern during the follow-up on-site visit with the aide present, the aide will complete a skills review prior to providing further care. RECORD/PATIENT #3: Review of the plan of care showed that the patient was assigned a hospice aide twice a week by the IDG. The written aide assignment by the registered nurse was to visit the patient every Tuesday and Thursday to bathe the patient, provide nail care, apply skin lotion, shampoo the patient's hair, and provide mouth care. Review of all hospice aide visit notes showed no hospice aide visit between 12/24/2019 and 01/06/2020. Review of the nurse visit note dated 12/27/2019 showed the nurse documented the following: - The nurse assessed that the patient still required assistance from others with toileting, dressing, grooming, bathing and eating; - The interventions provided by the nurse was for pain assessment. the nurse did not provide a bath, shower, or any hygiene care; and - No care coordination with other disciplines occurred. Review of the nurse visit note dated 12/30/2019 showed the nurse documented the following: - The nurse assessed that the patient still required assistance from others with toileting, dressing, bathing and eating; - The interventions provided by the nurse did not include a bath, shower, or any hygiene care; and - No care coordination with other disciplines occurred. Review of the nurse visit note dated 01/03/2020 showed the nurse documented the following: - The nurse assessed that the patient still required assistance from others with toileting, dressing, bathing and feeding; - The interventions provided by the nurse did not include a bath, shower, or any hygiene care; and - No care coordination with other disciplines occurred. The hospice electronic medical record was reviewed for IDT updates and frequency changes regarding aide services with the hospice office manager on 02/19/2020 at 11:30 AM, No frequency changes for the aide or discussion of the issue of no aide visits were addressed at IDT update. During a home visit observation (in a long-term care facility) on 02/18/20, the patient was interviewed. The patient stated that the aide was to come twice a week on Tuesdays and Thursdays. When asked if there was any issues with the aides coming, he/she stated that there were some related to the hospice aide being ill. The director of nursing at the long-term care facility where the patient lived was interviewed on 02/18/2020 at 3:05 PM. He/she stated that when the hospice aide cannot come for the bath, that the hospice should call the facility charge nurse so that a facility aide can provide the bath. The days of the week the hospice aide is coming is listed on the coordinated task sheet. When the long-term care aides performed a bath in the facility, a bath sheet was completed. Review of the "coordinated task sheet" (also known as coordinated task plan of care), maintained by the hospice as a written tool to coordinate care with the long-term care nurses showed the aide assigned was incorrectly named and the days of the week the hospice aide was coming was incorrect. During a home visit observation (in a long-term care facility) on 02/18/20, the bath sheets for the period of 12/18/2019 through 02/18/2020 was requested from the facility DON. Review of the provided "bath sheets" showed no bath or shower was provided to the patient 12/24/2019 through 01/06/2020 by the long-term care facility staff. During an interview with the patient's hospice case manager on 02/20/2020 at 9:19 AM showed that he/she stated the following: - When asked if the patient had been bathed by the hospice aide from 12/24/2019 through 01/06/2020, he she responded that the assigned aide had quit. - The nurse said that he/she may have bathed the patient once during that time, but probably did not document it; - When asked what was the system at the agency when aide visits cannot be met for a aide quitting, he/she calls the direct supervisor (patient care manager-A), and he/she did in this case. During an interview with patient care manager-A (PCM-A) on 02/19/2020 at 10:05 AM, when asked about if there were any issues with missed aide visits with Patient #3, he/she stated the only instances that he/she was aware of is when an aide was sick mid-day and the visit was missed, and a reschedule due to hazardous weather. During an interview with the patient's family representative on 02/19/2020 at 12:18 PM showed that he/she stated the following: - He/she is the family contact for the hospice; - He/she had concerns with the patient getting baths. When the hospice aide is out, the hospice (PCM-A) told him/her that the facility should provide the bath; - When he/she spoke with the facility (long-term care facility) nurse (unknown), the facility nurse told him/her that the hospice was to be giving all the baths; and - The hospice thought the facility was picking up the slack when the hospice had no aide, and the facility was not. The end result was the patient did not get a bath for almost two weeks.