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
341503 A. BUILDING __________
B. WING ______________ 		07/22/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
AUTHORACARE COLLECTIVE 2500 SUMMIT AVE, GREENSBORO, NC, 27405
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)
L0558      
28783 Based on clinical record review, policy review, call logs, caregiver interview, hospital staff interview and agency staff interview the agency failed to notify the referral source prior to the patient's discharge from the hospital that due to COVID 19 aide services were not being provided by the Hospice agency for 1 of 1 patient [#4], resulting in undue hardship and stress for patient and family. The findings include: Review of "Admission Criteria" policy received from the Vice President of Operations [#8] on 7/20/20 at 11:29 a.m. revealed, "PURPOSE ... will admit patients to care upon referral ... provided the agency is able to meet the patient's medical needs ... To ensure services are available and utilized uniformly and in a timely manner and that all eligible persons receive hospice services as needed ..." The "Plan of Care" policy received from the Vice President of Operations [#8] on 7/20/20 at 11:29 a.m. was presented as the coordination policy. The policy did not address coordination with referral sources. Review of the clinical record for Patient #4 revealed the patient was referred via fax by the Hospital Case Manager [#14] for Home Hospice Services. The faxed information sent by the Hospital Case Manager [#14] to the Hospice agency revealed, "May 1, 2020 [Friday] 1:23PM ... Plans to D/C this weekend if this can be set up c [with] equipment delivery & same day - admission ... New Home Hospice Referral ... Urgent ... Additional information ... Reason for Referral: End stage heart failure, and end stage renal disease stopping dialysis ..." The "Patient Information" documentation which was included as part of the requested referral documentation for Patient #4 revealed entries by the Referral Intake Manager [#15] as follows, "Patient Notes ... 5/1/20 Notified ... ______ [Name of Hospital Case Manager/#14] ... that DME [durable medical equipment] can be delivered Saturday and we can assess patient Saturday ..." There was no indication that the Referral Intake Manager [#15] informed the Hospital Case Manager [#14] that the Hospice agency was not providing aide services due to COVID 19. Patient #4 had a start of care date of 5/2/20. The "CONSENT FOR HOSPICE SERVICES" revealed, "I wish to have services provided by ______ [Name of Hospice agency] ... The following services have been explained to me ... C. Personal care from state certified nursing assistants ..." The Plan of Care [POC] for the Certification Period 5/2/20 to 7/30/20 indicated the patient was incontinent of bowel and bladder, short of breath on minimal exertion, lethargic, and was on compete bedrest. The patient was also a DNR [do not resuscitate]. Diagnoses on the POC included Hypertensive heart and Chronic Kidney Disease with Heart Failure and with Stage 5 Chronic Kidney Disease, or End Stage Renal Disease. SN [skilled nursing] was ordered 1 time per day for 1 day [5/2/20], 1-3 times per day x 1 day [5/3/20], Weekly Virtual/Telephonic visit frequency 1 to 2 times per week; and MSS [medical social services] Weekly Virtual/Telephonic visit frequency: 1 time per week unless otherwise requested. The Charts/Clinical Notes revealed the day of admission [5/2/20] a registered nurse [#16] conducted a telephone interview with the son of Patient #4, to obtain health history prior to the admission visit. The RN [#16] documented, "Nurse called son ... at 6:18pm to gather health history prior to admission ... Nurse educated on hospice services ... _____ [Name of son] expressed frustration that aide services ... not provided at this time ... Per _____ [Name of son] he was told by _____ [Name of Hospital] staff that an aide would come to the home every day to give a bath and get patient dressed ... Nurse explained that is a service that this agency offers, however due to COVID-19 that has been restricted in order to reduce exposure ... _____ [Name of son] states that he understands but is upset that _____ [Name of Hospital] did not tell him that. Family was thinking they would be able to care for all of patient's needs in the home with services being provided by hospice. _____[Name of son] states that the other option was Hospice Home placement ... now that's not a choice ... Nurse explained that patient could still potentially be transferred to the Hospice home if needed and that admission nurse would assess ... Admission nurse updated ..." There was no evidence that the RN [#16] notified the referral source that the Hospice agency was unable to provide needed aide services. Review of After Hours Call Log revealed, "... Message for: ON CALL ... Taken 2-MAY- 20 at 6:53PM ... Delivered 2-MAY 20 at 6:59PM ... [Caller] ______ [Name of Case Manager from Hospital/#19] ... [Patient] _________ [Name of Patient #4] ... HOSPICE NURSE IS SUPPOSED TO MEET AT 7 AND PT'S SON IS UPSET BECAUSE WAS TOLD ... AIDE WOULD NOT BE PART OF THE SERVICE ... ________ [Name of Hospice agency nurse/#18] ..." The Charts/Clinical Notes revealed entries by a RN [#18] on 5/2/20 as follows, "... 7:04p.m Answering service called. 7:06pm ______[Name of Hospital Case Manager/#19] ... called and was upset that we were not offering aide service since this family cannot take care of the patient home. Instructed her that due to COVID 19 and the stay at home order, the aides have not been making visits ... She stated this was unacceptable and she should have know [as written] this prior to discharge ..." The initial SN visit was conducted in person by a registered nurse [#17] on 5/2/20. Review of the SN visit notes revealed "... Care Coordination ... Caregiver Confidence ... What can we do or what questions can we answer to help you feel more confident and better able to care for your loved one?: Help find someone to come give bath and wash hair ..." #17 did assess that the patient and family needed Hospice Aide services which was not a part of Hospice Services that were being provided at the time due to COVID 19. A telephone interview was conducted with the son of Patient #4 on 7/17/20 at 2:05 p.m. to 2:15 p.m. Interview revealed, "... If they can't provide the service, they should not accept the patients ... The case manager at ______ [Name of Hospital] was under the impression that they were going to provide the services, starting on the day of discharge. It was a completely different story when my mother was coming home that afternoon. The nurse called us on the phone and said that she would be coming out and that would be the only time she would be coming out. The big blow was that there was not an aide available to help us ... The Case Manager [Hospital Case Manager] called us on Monday, and we told her that the nurse only came and stayed about 30 minutes. We really thought that _____ [Name of hospital] had messed us up, but after we told the Case Manager [Hospital case Manager] what happened; she was upset. She hung up and called us back. She made arrangements with another Hospice agency. I don't remember the name of the agency we switched her too, but they were wonderful ... She came home on Saturday [5/2/20] and passed on Thursday [5/7/20]. Yes, she was at home under Hospice care when she passed." Telephone interview with the Hospital Case Manager [#14] conducted on 7/20/20 at 2:46 p.m. revealed, "She [Patient #4] went out [discharged from hospital] with Hospice and the Hospice agency didn't share with us that they were not sending aides out. The family told me that the nurses [hospice nurses] were going to be seeing the patient virtually. This was a patient that had 2 sons and they obviously needed aide services for bathing. I called them [patient's sons] and they told me [told the details of nurse seeing patients virtually and no aide services] ... That was very upsetting, I think she [hospice nurse] went out over the weekend [5/2/20] and I didn't find out until Monday [5/4/20]. I called them [hospice agency] and they told me that they should have told me that [that the hospice agency was not providing aide services] and I agreed ... I ended up calling ______ [Name of different Hospice Agency] and they went out the same day [5/4/20] and were able to provide the services needed ... the patient died soon after she was admitted." Telephone interview with the Referral Intake Manager [#15] conducted 7/20/20 between 4:04 p.m. to 4:19 p.m. revealed, "They did not tell me the services [specifics of services the patient needed] ... I actually just got a fax ... They said that the patient needed Hospice Services. This was on Friday that I received the fax. I did call and speak with _______ [Name of Hospital Case Manager/#14] and told her that the DME could be sent out on Saturday. I told _______ [Name of Hospital Case Manager/#14] that we had a nurse that could go out to assess on Saturday. I did not mention that to her at that time [did not mention that the agency was not providing aide services due to COVID 19] ... Under the Hospice benefit we cover Nurse, Chaplain and Medical Social work. The nurse does assess the need for aide services at that time [at the time of the initial assessment once patient is in the home] ... Certainly, if I'm asked what Hospices services entail, I go in depth if I'm questioned at time of referral ... In hind sight I understand where you are coming from [coming from regarding informing the referral source that the Hospice agency was not providing aide services due to COVID 19] ..." The Vice President of Operations [#8] was on the line during this interview and indicated that intake "usually" did not discuss the services. Record review and interviews confirmed the Hospice agency failed to notify the referral source prior to the patient's discharge from the hospital, that aide services were not being provided by the Hospice agency due to COVID 19. Complaint Intake # NC00165916