Survey Report for 261623

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	261623	A. BUILDING __________ B. WING ______________	04/14/2022
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
HOSPICE COMPASSUS-NORTH CENTRAL MISSOURI	303 NORTH KEENE STREET, SUITE 306, COLUMBIA, MO, 65201
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)
L0507
L0507	42078 Based on clinical record review and interview, the agency failed to ensure the person acting as the representative for the patient was the legal representative designated by the patient, in accordance with state law, to exercise the patient's rights to the extent allowed by state law, in one (Record/Patient #1) of three records reviewed. This deficient practice has the potential to affect the exercise of patient rights for all of the agency's patients. Findings included: RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice services on 03/12/2022, with a terminal diagnosis of aplastic oilgodendroglioma of the frontal lobe (cancer of the brain). The patient resided in his/her own home with his/her spouse. The patient died on 04/06/2022. Review of the document titled, "Hospice RN (registered nurse) Start of Care," dated 03/12/2022 showed that: - The nurse failed to obtain a copy of the patient's advance directive (AD) because, "A copy was not available at the time of admission;" - Failed to obtain verbal identification of the legal representative designated by the AD; - The patient was oriented to person, and the reason the patient's cognitive function was not assessed was, "Not appropriate at time of evaluation;" - Failed to contain documentation that the patient had been declared mentally incompetent; and - The patient's spouse had signed all of the consent forms during the admission visit. Review of subsequent hospice clinical visits performed showed that: - On 03/15/2022, the nurse and chaplain visit documentation failed to contain the efforts of staff to obtain copies of the patient's advance directive, or verbal clarification of the content of the advance directive; - The medical social services visit documentation on 03/15/2022, showed that the patient had an advance directive, and failed to describe the type of advance directive the patient had executed, or the efforts taken to obtain a copy of the patient's advance directive; and - The nursing visits dated 03/18/2022, 03/22/2022, 03/25/2022, and 03/29/2022, failed to contain documentation of efforts to obtain a copy of the patient's advance directive. During an interview on 04/12/2022 at 4:00 PM, the complainant stated that he/she took a copy of the power of attorney (POA) documentation to the agency and that he/she was unsure of the exact date. Review of the document titled, "Advance Directive," dated 07/14/2017, showed that the complainant was assigned as the agent to make health care decision for the patient when he/she became unable to do so or to communicate his/her wishes. During an interview on 04/13/2022 at 12:30 PM, the administrator stated that: - The patient's parent had dropped off a copy of the patient's AD to the hospice office on 04/04/2022; - The Director of Clinical Services (DCS) called the patient's spouse, after the patient's parent had left the agency, and was notified by the spouse that the document assigning POA to the parent had been revoked, and he/she did not have a copy of the revocation, but a copy was at the physician's office; - The administrator called the physician's office and was notified by office staff that the patient had revoked the POA for his/her parent on 12/26/2017; - The administrator had faxed a medical records request to the physician's office on 04/07/2022, requesting a copy of the documentation revoking the POA for the parent; and - The physician's office had not sent the revocation documentation at the time of the interview. Review of the document titled, "General Message," (Page 13), and received via fax at the Department of Health and Senior Services on 04/13/2022, showed that the POA from 07/2017 was no longer valid for the patient's parent effective 12/26/2017. During an interview on 04/14/2022 at 10:50 AM, the administrator stated they expected staff to document their efforts to obtain copies of AD and POA documentation.
L0518
L0518	42078 Based on review of clinical documentation and interview, the agency failed to assure the patient received information about the services covered under the hospice benefit in one (Record/Patient #1) of one record reviewed. This deficient practice as the potential to affect the services provided to all of the agency's patients. Findings included: RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice services on 03/12/2022, with a terminal diagnosis of aplastic oilgodendroglioma of the frontal lobe (cancer of the brain). The patient resided in his/her own home with his/her spouse. The patient died on 04/06/2022. Review of the start of care nursing visit dated 03/12/2022 showed that: - A self-care deficit and required assistance with eating, bathing, dressing/grooming, toileting, transferring, continence, meal preparation, shopping, and housework; and - The visit note failed to contain documentation that an aide (for bathing and personal care) and/or homemaker services were offered to the patient. During an interview on 04/12/2022 at 4:00 PM, the complainant stated that: - That the patient was bedfast and "basically a vegetable"; - The patient couldn't eat; and - The he/she had requested assistance with bathing and personal care at the end of March. Review of nursing visit dated 04/01/2022 showed that: - The patient continued to have a self-care deficit and required assistance with eating, bathing, dressing/grooming, toileting, transferring, incontinence, male preparation, shopping and housework; - The patient used four to six incontinent briefs each day; and - The visit note failed to contain documentation that an aide (for bathing and personal care) and/or homemaker services were offered to the patient. During an interview on 04/13/2022 at 12:50 AM, registered nurse (RN) 1 stated that: - He/she asked the patient and spouse if assistance was needed with bathing, personal care, or homemakers and they must have declined the service because the services were not listed on the plan of care; and - He/she did not document a specific refusal of the bathing, personal care, or homemaker services in the clinical record. During an interview on 04/13/2022 at 09:30 AM, the RN2 stated that: - He/she performed a follow-up visit on 04/01/2022, as a follow up to a concern made by the patient's parent; - The assessment showed: * The patient was completely bedbound; * The patient would lay on the hospital bed without a top sheet; and * Was incontinent of stool, and the agency provided adult briefs; - Visit frequencies were discussed and the spouse agreed with the current plan of care and visit frequency; and - The visit note failed to contain documentation that an aide (for bathing and personal care) and/or homemaker services were offered to the patient.