Survey Report for 331519

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	331519	A. BUILDING __________ B. WING ______________	02/17/2022
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
VNSNY HOSPICE AND PALLIATIVE CARE	220 E 42ND STREET, 7TH FLOOR, NEW YORK, NY, 10017
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)
L0500
L0500	33127 Based on record review and interview, the hospice failed to protect and promote the rights of all patients. The Hospice failed to: Ensure a timely response to all patient and family calls for assistance. Failure to respond timely to calls for assistance has the potential for negative patient outcomes. (L 512) The hospice's failure to ensure all patients' rights are respected presents the likelihood for serious injury, serious harm, serious imparement or premature death to the patients under the hospice's care.
L0512
L0512	33127 Based on records reviews and staff interviews, the Hospice failed to ensure the protection of rights of all patients that requires timely response to calls identifying patient distress. This was evident in four (4) of twenty-three (23) clinical records reviewed. (Patient #1, #2, #11, and #16). Failure to ensure that all patients receive timely response to evaluate and manage pain and symptoms, including receiving ordered medications, has the potential and likelihood for negative patient outcomes. The Finding Are: On 02/16/2022, at 03:00 PM, surveyor requested policy and procedure addressing timeframe for response to patient and family calls. On 02/16/2022, at 04:00 PM, the Director of Quality Hospice and Supervisor Quality Provider Services were interviewed and stated: "Response time depends on multiple factors. Each patient's situation is unique. We do not have policy with time frame for response." 1. Patient #11 has Start of Care date of 10/02/2021 with diagnosis "Chronic Systolic (Congestive) Heart Failure" as documented on the Hospice Certification and Plan of Care (POC), dated 10/06/2021 to 01/03/2022. The Client Episode Coordination Notes Report dated 11/22/2021 documents: "Hospice - Incoming Call (CSR - Customer Service Representative) Message Left; Note: Message Left For: Queens West Team Topic: RN visit Time Call 12:41PM. Call Note: Niece(name) is requesting a nurse visit for today. She stated that HHA (Home Health Aide) Called her and told her that the PT (patient) is complaining about chest pain and her heart hurts. Niece (name) would like a nurse to check and evaluate the patient. Please follow up at (niece phone number) to confirm that a nurse will visit." The Client Episode Coordination Notes Report dated 11/23/2021 documents: "Hospice - Incoming Call (CSR) Connected. Time of Call 2:24 PM. Call note: Niece (name) calling to inform that patient has passed away today at 11/23 at The Mount Sinai Hospital. Caller stated she had call yesterday 11/22 regarding urgent patient matter about patient not doing well with request to have clinical visit. 911 was contacted patient was brought to hospital. Caller not sure if hospice was informed of patient passing. Family is in the process of funeral arrangements. Call connected to (R. name of the hospice team member)." The Client Episode Coordination Notes Report dated 11/23/2021 2:26 PM documents: "Hospice - Death Notification Death reported to VNSNY by: Niece DOD (day of death) 11/23/21; TOD (time of death) 10:30 AM not sure if that was exact time; Location: GIP Mount Sinai Hospital." The clinical record has no documented evidence of the patient's niece being contacted or visit being scheduled. On 02/16/2022, at 02:00 PM, the Clinical Supervisor was interviewed and stated: "The proper escalation process wasn't handled, and Customer Service Representative did not notify clinical supervisor about this call." 19902 2. Patient #1 has a hospice admission date of 1/14/2022, discharge date of 1/21/2022, and a re-admission date of 1/30/2022, with a terminal diagnosis of Malignant Neoplasm of Endometrium, and comorbid related diagnoses Emphysema Unspecified and Unspecified Asthma Uncomplicated documented on the Hospice Plan of Care (POC) dated 1/14/2022 to 4/13/2022. The Hospice Plan of Care dated 1/14/2022 to 4/13/2022 documents: Medications - "Acetaminophen 300mg-Codeine 30 mg tablet every 6 hours/PRN (as needed). reason: pain; Methadone 5mg (milligram)/5ml (milliliter) Oral Solution 5mg every 4 hours (start 02/14/2022), reason: pain;" "Ipratropium-Albuterol 3mg (2.5 based)/ 3ml Nebulization Soln (Solution) (Start 01/14/2022), reason: SOB (shortness of breath) & wheezing);" "Hospice Nurse to instruct in performing inhalation therapy and care for equipment." There is no documented evidence that the Hospice nurse determined that the patient had the necessary instruction for performing inhalation therapy at the start of care. The Hospice Coordination Notes - Urgent Call connected Note dated 1/17/2022 2:16 PM (time of call) document: "Caregiver (a non-hospice aide) (for) patient (name) called about nebulizer not received only the medication received." The Hospice Coordination Notes - Hospice After Hours Supervisor (AHS) Inbound Triage Call Note dated 1/17/2022 2:16 PM (time of call) document: "Situation: Has not received nebulizer machine; background: received Duo Neb vials (nebulizer medication) from pharmacy last night; Assessment: Order placed via (vendor name) for stat urgent delivery for today." The Hospice RN Visit Note dated 1/19/2022 4:06 PM documents: "Duo Neb regimen via nebulized (nebulizer) instructed to caregiver. Pt requires Methadone prefilled to be administered by caregiver: VN (visiting nurse) collaborated with Dr. (name) to order syringes for tomorrow Methadone prefill. VN left 1 syringe prefilled to be administer by caregiver." The Hospice Coordination Notes -AHS Inbound Triage Call dated 1/19/2022 6:42 PM (time of call) documents: "911 activation;" aide (non-hospice aide) "activated 911 due to the pt having SOB (shortness of breath) and foaming in the mouth. Pt is unresponsive." The Hospice Physician GIP (General Inpatient) Collaboration Note dated 1/20/2022 documents: "There are uncontrolled symptoms requiring intensive physician/nursing intervention. Patient is a 70 YO female with Hospice diagnosis of Endometrial CA, related Asthma and Emphysema with uncontrolled dyspnea despite home intervention;" "GIP LOC (level of care) medically necessary for symptom management of dyspnea." There is no evidence that the hospice ensured that the patient was able to start nebulizer treatment and take pain medication as ordered. On 2/10/2022 at 4:10 PM, the Hospice Director of Quality was interviewed, and there was no additional information provided for the survey findings. 3. Patient #2 has a hospice admission date of 12/14/2021 with terminal diagnosis of Malignant Neoplasm of Pyloric Antrum as documented on the hospice plan of Care (POC) dated 12/14/2021 to 3/13/2022. The Hospice Coordination Notes - Incoming Call Note dated 1/3/2022 9:48 AM (time of call) document: "Spouse claims pt (patient) may have pneumonia/wheezing. Call connected." The Hospice Coordination Notes RN (Registered Nurse) Narrative dated 1/3/2022 (no time) document: "Received a call form pt spouse (name). As per (spouse), Pt SPO2 74%. (spouse) expressed she is a nurse and believes pt may have aspiration pneumonia. Pt heard in back with loud audible gurgling. As per spouse no fever just low SPO2 and change in respirations. Spouse verbalized she removed Fentanyl patch as she feels the medication is causing too much sedation. This (nurse) instructed caregiver to administer 1 dose of Morphine 0.25ml (milliliter) to help with current symptoms pt is experiencing. This CS (Clinical Supervisor) reached out to team to assign RN; (Name of RN) for visit." The Hospice Coordination Notes - Incoming call Message Left dated 1/3/2022 12:14 PM (time of call) document: "Call note Patient spouse (name) - I spoke with supervisor (name) earlier. I am taking him (patient) to the hospital. I am calling to cancel hospice. That's it I just want to tell her that." The Hospice Coordination Notes -Healthix Alert Note dated 1/3/2022 documents: "Alert received from (hospital); admit date 01/03/2022 12:06 PM; Event Type: ED (emergency department) Admit; Diagnosis: Severe Diff (Difficulty) Breathing." The Hospice Coordination Notes -Healthix Alert Note dated 1/3/2022 document: "Admit Date 01/03/2022 12:41PM; Event Type: ED Admit; Diagnosis R06.02 Shortness of Breath." There is no documented evidence of timely follow-up to report of respiratory distress efforts to determine the status of the patient's symptoms after the initial call and recommendation for treatment. There is no documented evidence that patient's spouse was informed of the nurse's estimated time of arrival to address the patient's pain and symptoms. The hospice failed to provide a timely response to manage the patient's symptoms of pain and distress. The hospice failed to provide timely RN visit, failed to provide RN ETA (estimated time of arrival) to the patient and spouse, and failed to follow-up on the request for urgent assistance to address Patient #2 symptoms of respiratory distress. On 2/10/2022 at 4:10PM, the Hospice Director of Quality was interviewed, and there was no additional information was provided for the survey findings. 4. Patient #16 has a hospice admission date of 12/26/2021 with diagnosis of Alzheimer's Disease, Unspecified as documented on the hospice plan of Care (POC) dated 12/26/2021 to 3/25/2022. The Hospice Coordination Notes dated 1/12/2022 documents the following: 11:02PM (Time of Initial Call) - Hospice AHS Inbound Triage Call Note: "Pt son stated patient fell. Pt was found on the bathroom fall (floor). Pt son stated he does not know if patient hit her head. No head injuries reported. Pt reported bruising and a lump on the right leg. Pt son is concerned the patient leg might be broken." "Assessment: Advise to take Tylenol for the pain. Requesting nursing visit for post fall and to assess. Pain scale: Patient's Pain (Scale 1 least 10 greatest) rating: 8. Recommendation: Plan is to request a nursing visit for post fall and to assess." 11:26PM Hospice Urgent Visit Request for After Hours: "Urgent Request Reason: Post fall and patient has lump on the right thigh." Assigned to SN (Skilled Nurse) (name). The Hospice Coordination Note - AHS (After Hours Supervisor) Visit Follow-up Note dated 1/13/2022 documents: "I talked to (patient's son) at 12:35AM, ETA (estimated time of arrival) 1:30AM." The Hospice SN Visit Note dated 1/13/2022 1:34AM (In-home began time) documents: "Patient is observed in hospital bed. Vital signs stable. Right leg seems to be fractured. The right thigh is very swollen and painful on touch and movement and right leg is shorter then (than) the other leg. Patient is able to move the left leg, but not right one. MD (Medical Doctor) (name) was called. She said she already say patient has to go the ER (Emergency Room)." "I talked with (After Hours Supervisor) whom asked patient son to call 911. EMS (Emergency Medical Services) came shortly." The Hospice AHS Coordination Notes dated 1/13/2022 1:56AM document: "Collaborated with Dr. (name) regarding patient s/p (status post) fall. Stated from conversation with LPN (Licensed Practical Nurse) (name) right leg fracture suspected. Recommendation have patient go to ER for X-Ray or order to call 911 or activate Paramedicine." The Hospice AHS Post Triage Follow-up Call Coordination Note dated 1/13/2022 1:48AM (time of initial call) documents: "Informed son that Dr. (name) recommendation that patient be taken to ER for X-ray for suspected right hip fracture. Son agree to take patient to ER." The Hospice AHS Post Triage Follow-up Call Coordinator Note dated 1/13/2022 3:45AM (time of call) documents: "Coordinated with son (name):" Patient "admitted to (name) Hospital, broken right femur. Son stated that the hospital plan is to place (patient) into fraction (traction) and perform surgery. He is in agreement of hospital plan." The clinical record documents that the hospice took approximately two and half hours (from 1/12/2022 11:02PM (initial call) to 1/13/2022 1:34AM (SN home visit)) to respond to a patient with a fall, possible fractured leg and pain level of 8 out of 10 post fall. The Hospice failed to provide a timely and appropriate response to a report of a patient fall and possible leg fracture, with pain and bruising. The Hospice failed to assess patient for pain. On 2/16/2022 at 3:00PM, the Hospice Director of Quality Management Services was interviewed, and stated the hospice "Should have called Paramedicine/EMS (Emergency Medical Services)" to immediately respond.