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
261581 A. BUILDING __________
B. WING ______________ 		07/26/2021
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
CROSSROADS HOSPICE OF KANSAS CITY, L C 14310 EAST 42ND STREET SOUTH, UNIT 600, INDEPENDENCE, MO, 64055
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)
L0536      
29559 Based on policy review, record review, and interview, the agency: - Failed to ensure the interdisciplinary group provided a patient's primary care-giver(s) appropriate education (L544); - Failed to ensure the interdisciplinary group revised the individualized plan when a patient's condition significantly changed (L552); - Failed to ensure a plan of care included information from the patient's updated assessment (L553): and - Failed to ensure the interdisciplinary group updated the plan of care assignment for the hospice aide when a patient's condition significantly changed (L554). These deficient practices have the potential to affect all patients served by the agency.
L0544      
29559 Based on policy review, record review, and interview, Crossroads Hospice of Kansas City failed to ensure the interdisciplinary group provided a patient's primary care-giver(s) appropriate education in one of three records reviewed. (Record/Patient #3). Findings included: Review of an agency policy titled "IDG Hospice plan of Care, Coordination, and Continuity of Care" showed "Documentation of teaching and the patient's or representative's level of understanding involvement and agreements with the plan of care should appear in the clinical record". RECORD/PATIENT #3: Review of the patient's medication list, plan of care, and all interim orders showed that the patient was prescribed on 07/02/2021 the pain medication Hydrocodone-Acetaminophen 5 mg/325 mg (milligrams) every six hours as needed for pain. Review of the 07/03/2021 hospice nurse visit note showed the nurse documented that the patient's caregivers (family) reported that they were providing the patient (Hydrocodone-Acetaminophen) every four hours. The nurse failed to educate the caregivers on the appropriate prescribed Hydrocodone-Acetaminophen orders. During a review of findings with the clinical manager on 07/21/2021, he/she stated that the nurses should educate the family to the prescribed frequency of medications.
L0552      
29559 Based on policy review, record review, and interviews, Crossroads Hospice of Kansas City failed to ensure the interdisciplinary group revised the individualized plan when a patient's condition significantly changed, in one of three records reviewed. (Record/Patient #3). Findings included: Review of an agency policy titled "IDG Hospice plan of Care, Coordination, and Continuity of Care" showed in part the following: - The plan of care must include interventions for problems identified through the assessment process; - "The plan of care is one of the most important documents in hospice care"; and - The comprehensive hospice plan of care is an ongoing, ever-changing, fluid process which is documented, to ensure that the patient's condition and needs are assessed, identified, with appropriate interventions implemented to intervene and control problems. Review of an agency policy titled "Comprehensive assessment" showed in part the following: - Assessment to include physical needs; and - An update to the comprehensive assessment occurs as frequently as the patient's condition warrants. RECORD/PATIENT #3: The patient was admitted to hospice on 05/28/2021 with lung cancer. Review of the last comprehensive skin assessment from 06/15/2021 showed that the patient was a high risk for skin breakdown and had a stage III pressure ulcer to his/her right gluteal fold, a stage II pressure ulcer to the right heel, an unstagable, necrotic pressure ulcer to the left heel. A 06/29/2021 nurse's note showed the patient had a scalp laceration with steri-strips. (It should be noted there was no intervention on the plan of care for the new 06/29/2021 scalp laceration). Review of photographs taken by the hospice on 06/30/2021 of the patient's left lower leg showed multiple (4) areas covered with Telfa (non-adhering dressing), Two of the Telfa bandages have fluid visibly soaked through the dressing. Review of hospital records, dated 07/02/2020 showed that the patient presented to the emergency department at 11:29 AM with left lower leg pain. The patient was diagnosed with a distal fibula and tibia fracture. The hospital nurse documented that he/she provided Hospice Nurse-A with instructions that the patient was on new pain medications, (hydrocodone/acetaminophen), and a splint had been applied to the patient's left lower leg. The patient was discharged home from the hospital on 07/02/2021 (a Friday). The hospital emergency room records showed no instructions on care for the splint. Review of the discharge instructions from the hospital, provided to the patient's family caregivers, showed "please call and make an appointment to follow-up with orthopedics early next week." Review of the hospice nurse assessment notes from 07/03/2021, 07/04/2021, 07/05/2021, and 07/06/2021 show no assessment of the patient's skin under the splint, or re-wrapping of the splint, no documentation that the physician was called to clarify leaving the ace wrapped splint in place considering the patient's high risk for breakdown skin condition. The 07/03/2021 note did not mention the patient's new splint. The 07/04/2021 note stated "splint with ace wrap" with no further assessment. The 07/05/2021 assessment was a "phone assessment report" that showed no mention of the patient's splint. The 07/06/2021 stated "soft cast present to LLE" with no further assessment. The patient was taking hydrocodone/acetaminophen every six hours while awake for pain. Review of the orthopedic physician progress note, dated 07/07/2021 at 11:30 AM, showed that the physician documented in part "There is an extremely foul smell of the left lower extremity. The splint is disheveled and soiled. There is drainage in the splint. The splint was removed. There was skin breakdown in multiple areas of the skin wounds. The skin had a very foul smell. There was a large blister over the fracture site. The skin around the fracture site was completely necrotic and the bone was visible. The wound was severely infected. The patient has an open comminuted distal fibula and tibia fracture. (the patient) has osteomyelitis and the wound is severely infected. She will need an amputation of the lower extremity. The amputation could cause death. This is an open fracture and the wound is severely infected". Review of the hospice plan of care, and all interim orders showed no intervention regarding the patient's new left lower leg fracture and splint. Review of the Interdisciplinary care group (IDG) meeting notes, dated 07/07/2021 showed discussion notes in part "ongoing pain and decline since injury went to ortho appointment dr recommended amputation of leg and family is going forward with this plan, will revoke service for the surgery". The patient's family signed revocation of hospice benefit documents on 07/07/2021, and the patient was discharged from Crossroads Hospice. The patient died on 07/13/2021. Interview with hospice nurse-A (the patient's primary hospice nurse) on 07/21/2021 at 1:05 PM showed he/she stated the following: - When asked the date the patient's wounds were last measured by the hospice, he/she looked in the hospice EMR (electronic medical record) and stated that measurements were last done as time stamped on 06/15/2021; - He/she received report from the hospital emergency room nurse on 07/02/2021. The hospital nurse told her the patient's leg was broke, new pain meds were started and a splint was applied. The hospital nurse provided no instruction on the splint care; - When asked if he/she assessed the skin under the patient's left lower leg splint after the patient returned home, he/she responded no, that in his/her experience (splints) stay in place until the follow-up ortho (orthopedics) visit; - When asked to describe the patient's left lower leg splint, he/she stated that the splint was wrapped in ace bandage from toe to knee. The dressing was dry and intact, no odor, no drainage on his/her 07/06/2021 nurse visit; - When asked if the plan of care was updated regarding the patient's splint or broken left leg, he/she stated "no, but I should have"; - When asked if he/she had clarified with the physician to rewrap the splint, or leave the splint on considering the patient's actual and high risk for skin breakdown, and with skin tears under the splint, he/she responded "no". - He/she did not assess the patient after his/her return from the hospital (on 07/02/2021) until 07/06/2021, other nurses filled in.
L0553      
29559 Based on policy review, record review, and interviews, Crossroads Hospice of Kansas City failed to ensure a plan of care included information from the patient's updated assessment in one of three records reviewed (Record/Patient #3). Findings included: Review of an agency policy titled "IDG Hospice plan of Care-Content, plan Goals, interventions and outcomes" showed in part the following: - The plan of care must include interventions for problems identified through the initial, comprehensive, and updated assessments; and - "The hospice professional will use clinical expertise and resources to determine as indicated, the most appropriate intervention to be utilized and will monitor as assess said interventions to ensure that goals and outcomes are met. RECORD/PATIENT #3: Review of a comprehensive skin assessment dated 06/28/2021, completed by a hospice nurse, showed that the patient had a new scalp laceration with steri-strips. Review of the plan of care, all interim physician orders, and interdisciplinary group meeting notes from 07/07/2021 showed no update to the plan of care or intervention for the patient's new scalp laceration. During a review of findings with the clinical manager and alternate administrator on 07/21/2021 at 1:45 PM, they stated that the nurse should have updated the plan of care interventions on the patient's changes.
L0554      
29559 Based on policy review, record review, and interviews, Crossroads Hospice of Kansas City failed to ensure the interdisciplinary group updated the plan of care assignment for the hospice aide when a patient's condition significantly changed in one of three records reviewed. (Record/Patient #3). Findings included: Review of an agency policy titled "IDG Hospice plan of Care, Coordination, and Continuity of Care" showed in part the following: - "The plan of care is one of the most important documents in hospice care"; and - The comprehensive hospice plan of care is an ongoing, ever-changing, fluid process which is documented, to ensure that the patient's condition and needs are assessed, identified, with appropriate interventions implemented to intervene and control problems. RECORD/PATIENT #3: Review of the nurse's comprehensive skin assessment from 06/15/2021 showed that the patient had a stage III pressure ulcer to his/her right gluteal fold, a stage II pressure ulcer to the right heel, an unstagable, necrotic pressure ulcer to the left heel. A 06/28/2021 nurses note showed the patient had a scalp laceration with steri-strips. Review of hospital records, dated 07/02/2020 showed that the patient presented to the emergency department at 11:29 AM with left lower leg pain. The patient was diagnosed with a distal fibula and tibia fracture. The hospital nurse documented that a splint had been applied to the patient's left lower leg. The patient was discharged home from the hospital on 07/02/2021. Review of the hospice aide assignment, last updated on 05/28/2021, showed no instructions for the aide regarding the new left lower leg splint or the new scalp laceration during the provision of care and the assigned complete bed bath. During a review of findings with the clinical manager and alternate administrator on 07/21/2021 at 1:45 PM, they stated that the nurse should have updated the aide plan of care to provide instructions on the patient's changes.