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)
L0552      
29559 Based on policy review, record review and interview, the agency failed to ensure the interdisciplinary group (IDG) updated the plan of care (POC) with changes as frequently as the patient's condition required but no less frequently than every fifteen days in one (Record/Patient #3) of five records reviewed. This deficient practice has the potential to affect all patients served by the agency. Findings included: Review of the agency policy titled, "Comprehensive Assessment," revised 11/19/2020, showed in part: - An update of the comprehensive assessment is conducted by the designated hospice team members in collaboration with the patient's attending physician (if any) and the hospice medical director as frequently as the patient's condition warrants but no less frequently than every 15 days and includes identification of changes that have occurred since the initial assessment, information on the patient's progress toward desired outcomes and goals, and reassessment of the patient's response to care; - The IDG team reviews and updates the POC at least every 15 days; and - The clinical record/EMR (electronic medical record) and as indicated, minutes of the IDG meeting must reflect the appropriate documentation that the POC was reviewed and updated and that effective interchange, reporting and coordination of patient/family care occurs. Review of the agency policy titled, "IDG Hospice Plan of Care, Coordination and Continuity of Care," revised 12/01/2018, showed in part: - The initial POC is established at the time of admission; - The POC must reflect patient and family goals, include interventions for problems identified through the assessment process, and include all services necessary for palliation and management of the terminal illness and related conditions; and - The comprehensive assessment will be established within five calendar days after election to hospice services and will be updated, at minimum, every 15 days or when changes occur. RECORD/PATIENT #3: Review of the initial POC dated 08/05/2021 showed in part: - The initial POC was discussed with IDG members; and - Interventions included for nursing to monitor/evaluate symptoms, monitor and assist with pain management, social worker to provide emotional support, evaluate social/financial needs and the patient's interpersonal support, and the chaplain to monitor the patient/caregiver spiritual needs. Review of the nursing visits showed: - On 08/05/2021 the initial comprehensive assessment showed the patient had a diagnosis of colon cancer with metastasis to the liver. The patient's bowel sounds were hypoactive. The patient reported having a soft bowel movement that day; - On 08/10/2021 the patient stated he/she had not had a bowel movement and the nurse recommended a bisacodyl (laxative) suppository today. The last bowel movement was 08/07/2021. The patient is independent and wanted to administer this him/herself; - On 08/13/2021 a phone call assessment showed no information regarding the patient's constipation; - On 08/17/2021 the assessment failed to include a bowel assessment; - On 08/20/2021 a phone call assessment showed the assessment showed no information regarding the patient's constipation; - On 08/24/2021 the patient was unable to remember when his/her last bowel movement was and felt constipated. The nurse encouraged the patient to use a bisacodyl suppository today and change the bowel regiment from docusate (laxative) to senna plus (laxative). The hospice physician agreed. The plan was to take the bisacodyl while he/she was waiting for his/her senna to be delivered then take two senna at bedtime; and - On 08/31/2021 the patient's abdomen was soft with hypoactive bowel sounds. Last bowel movement was 08/29/2021. Review of the POC showed no update regarding the patient's constipation until 08/24/2021. Review of the IDG note dated 08/26/2021 (21 days after the start of care) showed the patient did not like to take pain or constipation medications. The patient also had a fentanyl patch (narcotic pain medication) in place. During an interview on 09/08/2021 at approximately 4:00 PM, the assistant clinical director stated it looked like they had an IDG meeting on 08/12/2021. He/she provided the medication profile which the hospice physician signed and dated 08/12/2021. He/she was unable to find the IDG note at this time. During an interview on 09/10/2021 beginning at 9:36 AM the administrator stated that they could not find the IDG note for 08/12/2021. There was a software problem and no entry was made into the EMR (electronic medical record).