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
341501 A. BUILDING __________
B. WING ______________ 		06/07/2021
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
CAREPARTNERS HOSPICE & PALLIATIVE CARE SERVICES 21 BELVEDERE ROAD, ASHEVILLE, NC, 28803
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)
L0555      
37615 Based on clinical record review and staff interview, the agency failed to conduct a home visit as ordered by the physician for 1 of 3 patients (#2); and to assess a blood pressure for 1 of 1 patient's that required blood pressure medication adjustments (#2). Findings include: 1A. Patient #2 was admitted on t 4/14/21 with diagnoses of cardiomyopathy with heart failure. The Plan of Care for 4/21/21-7/19/21 included orders for skilled nursing 3 times per week for 2 weeks, weekly for 11 weeks, and 3 times per week for 1 week. The skilled nurse visit on 5/28/21. At the time of the visit the blood pressure was 98/62. The physician was notified, and medication changes were made and the nurse was to visit on 5/31/21 to recheck blood pressure. A visit was conducted by the RN on 5/31/21. The blood pressure was 90/58. The documentation revealed, "Pt [patient] seen ambulating in hall at time of arrival just after a fall, pt hit her head on the tpilet [sic] and lost conciousness [sic] for a few seconds ...BP 90/5 [sic] ...Dr. _______ notified of fall and VS [vital signs]." New medication orders received related to blood pressure medications. Nurse to recheck BP the next day. "This nurse is off on Tuesday and scheduler notified of the need.." the add the visit to the schedule . No visit made until 6/2/21. An interview with the agency director on 6/7/21 at 3:00 p.m. revealed the RN requested visit, but the scheduler did not schedule it. 1B. Patient #2 was placed in respite care on 6/4/21. The RN home visit note for 6/4/21 stated, "Follow up over weekend for BP recheck." The RN conducted a visit on 6/5/21 and failed to assess blood pressure. An interview on 6/7/21 at 4:00 p.m. with the Clinical Manager confirmed there was no blood pressure assessed at the 6/5/21 visit.
L0557      
37615 Based on policy review, complaint log review, clinical record review, and staff interviews, the agency failed to provide the most recent medication list for 1 of 1 patient entering respite care (#2). Findings include: A policy, "The Hospice Interdisciplinary Team, Care, Planning, and Coordination of Services, 95PC.HOS.0154", was provided by the agency director on 6/7/21 at 5:00 p.m. The policy stated, "The interdisciplinary team is responsible for ...Coordination and communication with other organizations and individuals that may be providing services to the patient ...The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions including ...Drugs and treatment necessary to meet the needs of the patient ...The hospice must develop and maintain a system of communication and integration, in accordance with the hospice's own policies and procedures to ...Provide for and ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement." A review of the complaint log was provided by the agency director on 6/7/21 at approximately 11:30 a.m. The log identified a family concern from patient #2's family. The log stated, "SW [social worker] called daughter to follow up weekend events [sic]. Family request emergency respite because patient was having blood pressure issues resulting in two falls in one week. [Name of hospice home] was full for respite so arrangements made at [Name of Skilled Nursing Facility (SNF)] to take patient on Friday (same day as request). Patient had recently had medication changes that were not reflected in system or medication list sent to the [SNF]. Family quite upset that time of medication and medications given were wrong and could not be corrected easily. Patient ended up being brought home on Saturday evening out of concern that patient would not do well without corrected med list. Weekend staff got a corrected blister pack but [SNF] would not accept/use it for some reason. This has caused family much upset and make them less likely to use respite again but they would like or [sic] system to reflect immediately medication changes made by the MD/RN CM [case manager]." Patient #2 was admitted on 4/14/21 with diagnoses of cardiomyopathy with heart failure. The Plan of Care for 4/21/21-7/19/21 included orders for skilled nursing 3 times per week for 2 weeks, weekly for 11 weeks, and 3 times per week for 1 week. RN #1 conducted a visit on 5/28/21. At the time of the visit the blood pressure was 98/62. The physician was notified, medication changes were made, and the nurse was to visit on 5/31/21 to recheck blood pressure. A visit was conducted by the RN #1 on 5/31/21. The blood pressure was 90/58. The documentation revealed, "Pt [patient] seen ambulating in hall at time of arrival just after a fall, pt hit her head on the tpilet [sic] and lost conciousness [sic] for a few seconds ...BP 90/5 [sic] ...Dr. _______ notified of fall and VS [vital signs]." New medication orders received related to blood pressure medications. Nurse to recheck BP the next day. "This nurse is off on Tuesday and scheduler notified of the need.." On 6/2/21, RN #1 conducted a home visit. The blood pressure was 112/64. The note stated, "Recheck BP on Friday for follow-up ..." On 6/4/21, RN #1 visited. The blood pressure was 100/58 ..."Pt had a syncopal episode with fall, no I jury [sic] called to Dr. ____ with BP changes, orders for medication changes entered and fall reported." A telephone note from the MSW #1 on 6/4/21 confirmed the agreement of the family with respite care. The MSW emailed information and called the SNF "and gave an update." On 6/4/21 at 8:52 p.m. the LPN visited the patient in the SNF. The visit note stated, "Family not able to call patient and were worried ...Patient has not had any medications since arriving here at noon spoke with ____ she says meds weren't available until just now." A review of the information faxed to the SNF on 6/4/21, the medication profile revealed the following blood pressure medication discrepancies: · Aldactone 25 mg daily-most recent order was for 12.5 mg daily · Carvedilol 25 mg 37.5 mg daily-most recent order was for 12.5 mg twice daily · Dilt-XR 180 mg daily-discontinued on 6/4/21 A Care Coordination Note from 6/5/21 stated, " ...[Daughter] voices frustration re [regarding] medication reconciliation between hospice med list and what medications are currently being given in facility. [Daughter] states facility assures her medications are according to the current/active med list provided by hospice at time of respite admission, though she feels changes have been made that are not reflected now in facility medications..." An interview with the LPN on 6/7/21 at approximately 3:00 p.m. revelated that medications had not arrived at the SNF for the patient until around the time of her visit on 6/4/21 (8:52 p.m.). The patient had arrived at the SNF for respite at approximately 12:00 p.m. An interview with MSW on 6/7 at 3:20 revealed she had asked for the hospice medical records department to email the medication list. The interview revealed respite patient's usually take their medications to the facility. The MSW stated, "I did tell the family to take the meds with them and the COVID vaccine card." An interview with MSW #2 on 6/7/21 at 3:25 p.m. revealed the patient had experience blood pressure which resulted in 2 recent falls. Respite was desired by the caregiver to have blood pressure medications given regularly. The patient went to SNF for respite. The medication list sent to the SNF was not accurate. There had been recent medication changes, but this was not reflected in the list sent. The facility meds were incorrect due to the old medication list being sent. Weekend staff got medications corrected. It was revealed the medication profile was printed prior to the nurse syncing her computer to ensure the electronic medical record was current.