Survey Report for 261585

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	261585	A. BUILDING __________ B. WING ______________	09/23/2021
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
AVALON HOSPICE	2024 MAIDEN LANE, SUITE 202, JOPLIN, MO, 64804
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)
L0514
L0514	29559 Based on policy review, record review, and interviews, the hospice failed to ensure a patient's / primary caregiver's right to refuse chaplain service was respected in one of four sampled cases (Record/Patient #1). The deficient practice has the potential to affect all patients on service with the hospice. Findings included: Review of the agency policy titled "Patient Bill of rights Policy No. 2-002" showed in part that the purpose of rights is to assist patients in making decisions and support active participation in care planning. The patient has the right to participate in care planning, has the right to refuse care or treatment. RECORD/PATIENT #1: Review of the initial registered nurse (RN) assessment, completed on 07/23/2021 showed the nurse documented/assessed the following: - There was no lack of faith. (the family interview contradicts this assessment); and - The family agreed on the initial care plan "to meet spiritual or religious needs if that is what you value through chaplain services" (the family interview contradicts this assessment). Review of an interdisciplinary care group (IDG) coordination note from the admission nurse, dated 07/23/2021 showed no mention of patient being agnostic, or refusing chaplain services. During an interview on 09/22/2021 at 9:30 AM the clinical manager stated that: - The patient/family can refuse the social worker and chaplain visits; - He/she always mentioned that the social worker and chaplain would be coming; - The nurse can do the spiritual assessments if the patient/spouse refuses; - He/she could not recall what specific questions he/she asked the caregiver about spiritual beliefs. The spouse seemed overwhelmed and just ready for him/her to go; - He/she could not remember what the spouse said when asked about spiritual concerns; - He/she did not remember him/her saying they were agnostic or atheist; - He/she talked about the social worker and chaplain coming out within five days and the spouse said okay; - I tell them they are here to listen and not be preachy and the spouse was like "okay"; and - He/she had not had patients or staff complain that the social worker or chaplain were pushy when trying to get into the homes. Review of the agency complaint log showed that the patient's caregiver/spouse called in complaint on 07/26/2021 that the family requested no chaplain visits. "(He/she) states that during the phone call from the chaplain to set up the appointment the chaplain was "arrogant and only interested in his own time. The (social worker) called patient today to setup (his/her) appointment and John stated that (he/she) would like to speak with the supervisor and that (he/she) does not want chaplain services." Review of a "chaplain hospice eval-phone" assessment by the hospice chaplain (chaplain-A)on 07/27/2021 at 8:38 PM showed the following: - "No active religious/spiritual participation"; - The patient/caregiver have a "spiritual stress indicator" of "isolation from faith affiliation"; - The remaining spiritual assessment "to be assessed at a later date"; and - The "other plans/follow-up" showed "caregiver refused visits" (it should be noted that this entry showed that the caregiver directly informed the chaplain that chaplain services was not desired by the family on 07/27/2021. The hospice received a complaint from the family on 07/26/2021 regarding no chaplain visits). Review of a narrative note, dated 07/27/2021 by the hospice chaplain showed "received a call from the social worker that caregiver spouse had called our office triage and complained that chaplain was not acting appropriately and being pushy and arrogant. Chaplain was not aware of anything abnormal during conversation with caregiver during our conversation at the car. Caregiver declined any visits from chaplain and social worker. Chaplain immediately called the caregiver and apologized for any behavior or misunderstanding. Caregivers phone always goes to voicemail, so left a message. (This showed that after the caregiver had informed the chaplain by phone assessment once. the social worker also informed the chaplain a second time, the chaplain still tried to reach out to the patient/caregiver). During an interview on 09/23/2021 at 10:18 AM the patient's primary caregiver/spouse stated that: -The nurse that admitted the patient asked if he/she wanted to have a chaplain. He/she told the nurse he/she did not want a chaplain; -He/she thought the chaplain called twice. The social worker also asked about the chaplain coming and said something about how they usually worked together. I said no to having the chaplain and that we were not religious and did not want a chaplain; -Right after he/she told the social worker that, the chaplain called a second time; -The first time the chaplain just showed up and told him/her that they only had five days to do the paperwork, and I said if I don't want it then there is no need to do any paperwork; -When asked if he/she agreed to have the chaplain come the next day at 11:00 AM, the reporter stated, "No, I wouldn't have any reason for him/her to come back"; and -After the social worker told the chaplain what he/she had said, the chaplain called a few minutes later and left a voicemail with a bible verse even after I told him/her we were agnostic (neither believes or disbelieves in a god or religious doctrine) and did not have religious beliefs. During an interview on 09/23/2021 at 9:06 AM, the social worker at the parent agency stated that: - The chaplain is present during their stand up calls in the mornings; - It was extremely rare that a patient/family does not want a social worker or chaplain, and he/she typically called to affirm that; - When he/she called the patient's spouse, the spouse complained that the chaplain was something like overbearing and was very adamant he/she did not want the chaplain; - He/she thought the chaplain had called the spouse and thought the chaplain couldn't get hold of the spouse and the chaplain went to the home to set a time; - He/she told the chaplain about the spouse's disposition and his/her preference; - The chaplain did not meet the social worker for the visit; - He/she could not remember if he/she found out the spouse was an atheist (lacks belief in the existence of god) before or after he/she made the first visit; - He/she was not sure if it was before or after he/she talked with the spouse about the chaplain, that the administrator talked with the spouse; and - He/she was sure he/she had relayed the information to the administrator and the IDG. During an interview on 09/22/2021 at 10:08 AM the chaplain, (chaplain-A) stated that: - The nurse does the initial assessment then it is put on my tablet by day three or four for me to do the chaplain assessment; - He/she tried to contact the spouse two or three times that morning (07/27/2021) to schedule a visit for that day or the next then went by the home; - He/she set up an appointment for 11:00 AM the following day; - He/she and the social worker were going to do the visit together; - When he/she pulled up to the home the spouse came out to the car; -He/she could not remember exactly what was said but asked if he/she could come tomorrow at 11:00 AM. He/she agreed for me to come the next day and that was all the conversation that day; - The nurse did not inform him/her that the spouse did not want chaplain visits or that he/she was agnostic or atheist; - The social worker called him/her that the spouse had declined a visit and had a complaint that he/she called the office about; - He/she had no idea why or what the reason was; - When asked if he/she made any follow up phone calls after that, he/she stated, "Not that I remember, no" (this answer contradicts what the chaplain documented on 07/27/2021); -When asked if he/she would ever leave a scripture or prayer on a voicemail, he/she stated, "Heavens no" but maybe would if it was an existing patient but not someone he/she did not know; - He/she had never had a patient say they did not want a chaplain; and - He/she did not have any contact with the patient or spouse after that. During an interview on 09/23/2021 at 9:35 AM, with a second hospice chaplain, (chaplain-B) at the multiple location site stated that: - When the nurse gives reports about an admission he/she tells them whether the patient is open to a spiritual assessment; - When I see the patient, I explain why I am there and let them know, "they call the shots"; - He/she asks if they are open to subsequent visits; - If he/she was notified a patient/family did not want chaplain services, he/she would honor that and call to verify that was what they wanted. (it should be noted this practice contradicts the expectation by the hospice administrator); and - If I am there and they decline services, I thank them and let them know if they change their mind to let them know. During an interview on 09/23/2021 at 9:50 AM the administrator stated that: - He/she wrote the situation up with (Patient #1) as a quality improvement event; - The patient's spouse felt like the chaplain was arrogant; - The chaplain had went to the home,and the spouse came out and spoke to the chaplain at the car; - He/she had a lengthy conversation with the spouse and told him/her he/she did not have to have those services; - When asked about the note that the chaplain immediately called the spouse after speaking with the social worker, the administrator stated that his/her thoughts were that the chaplain called because he/she wanted to apologize; and - If the chaplains were told a patient/family did not want chaplain services, it would not be their standard of practice to call the patient/family to confirm that information. Review of the 08/03/2021 IDG meeting summary showed chaplain-A wrote "Caregiver spouse refused chaplain visit at the door because of (his/her) religious beliefs as an atheist. (His/Her) perception was that the hospice chaplain was visiting to convert (him/her) to a specific religion." (It should be noted that the patient and the patient's primary caregiver/spouse identify as agnostic and not as atheists).