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
341575 A. BUILDING __________
B. WING ______________ 		10/23/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
NOVANT HEALTH HOSPICE AND PALLIATIVE CARE A DEVELO 324 N MCDOWELL STREET, CHARLOTTE, NC, 28204
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)
L0587      
37615 Findings include: Based on agency document review, clinical record review, and staff interview, the RN failed to respond to a patient's death for over 4 hours after the first documented phone call from the family stating the patient had died for 1 of 3 patients reviewed (#1). Cross refer to 418.64 (b)(1) Tag L591
L0591      
37615 Based on agency document review, clinical record review, and staff interview, the agency failed to provided nursing services within an expected time frame for 1 of 3 patients (#1). Findings include: A Competency Validation Tool-Death Visit by the Hospice Nurse was received on 10/22/20 at 2:40 p.m. from Accreditation personnel. The tool stated, once the notification of patient death is received, immediately contact family by phone "within 15 minutes." Also, the staff should provide the family with an estimated time of arrival; "every attempt is made to visit within 1 hour." Patient #1 was admitted on 4/8/20 with diagnoses of colon cancer with metastasis to the liver. The Plan of Care for 8/27/20-9/8/20 included Skilled Nurse visit every 7 days. On 9/8/20, RN #1 conducted a home visit from 12:20-1:10 p.m. The patient was unresponsive. Blood pressure 72/0, pulse 116, and temperature 93 degrees. The visit note's caregiver psychosocial assessment revealed: "Needs expressed: emotional need, physical need ...Stress factors: exhaustion, ack of caregivers, lack of knowledge, loss of control, (Comment: reports normal, generalized anxiety r/t [related to] pandemic.). RN #1 implemented an Imminent Death care plan and educated the caregivers. The note stated, "Family has been at bedside and have started to say their "good-byes". On 9/8/20 at 4:45 p.m. the RN Supervisor called the patient's daughter. "This writer t/c [telephone call] to [patient name] daughter ...regarding delayed response to her 1 pm t/c to Hospice. [Daughter] expressed disappointment and anger at ______Hospice for their lack of response to her need for a SNV [skilled nurse visit]. She called 911 and medic came out to pronounce her Father's death. [Daughter] stated she called __________ Funeral Home and they will need to await the call from _____ Hospice RN before going out to patients [sic] home. [Daughter] stated her Father was seen earlier today by ____Hospice Nurse ____[nurse name] and she [daughter] was made aware they [sic] her Father was dying and it would not be long before he expired. [Daughter] stated once this happened she tried to reach _____ Hospice. This writer v/u [verbalized understanding] her statement of feeling disappointed, angry, surprised that she did not get a good response from ___ Hospice when she expected things to have been handled much better. [Daughter] stated her Mother was a former patient with ____ Hospice and it went well. This writer empathized with [daughter] and let her know that there was difinitely [sic] a drop in the communication/emails that were sent out and they [sic] this writer learned of the need for a SNV, and is now f/u [following up] with her call ..." On 9/8/20 at 5:30 p.m. RN #2 conducted a "Hospice Death" home visit. The RN documentation stated the time of death was 1:31 p.m. and the "presumptive signs of death: absence of pulse ...Conclusive sign of death: rigor mortis." On 9/9/20, the chaplain called to offer condolences to the family. The "Daughter explained frustration with hospice and difficulty in connecting with hospice to get help at pt [patient's] end of life. A review of emails from 9/8/20 revealed the following: · An email from receptionist to supervisor at 1:27 p.m. stated, "[Son in law] said patient had passed away. Right after [son in law] ended the call, [daughter] called too saying patient had passed, they called 911, said they could not get through. I told her I was speaking to [son in law] right before her call. I actually heard the siren during the first call." · An email from receptionist to supervisor at 3:16 p.m. stated, "Caller is [son in law] ...re patient _______. [Son-in-law] said the police is still there, and waiting around until a nurse can come to pronounce patient. They want to have estimated time on how much longer to expect the nurse's arrival. He is a little irate that it's taking this long." · An email from receptionist to supervisor and the weekday afterhours team (that starts at 5:00 pm.) at 3:48 p.m. stated, "Caller is [daughter in law] asking when someone can come to the home. First call on the patient's passing came in a little after 1:00 p.m. They are getting a little upset. Both daughter and son-in-law have called multiple time. Can someone call the family please?" · An email from receptionist to supervisor, the weekday afterhours team (that starts at 5:00 pm.), and 2 other staff members at 4:33 p.m. stated, "These are the email threads on [patient] death. They have been calling since 1:18 p.m. I do not blame them for being upset. No one has acknowledge [sic] these emails from me. Like I said earlier, I even tried to call [supervisor] but cannot reach her. So sorry folks, but someone dropped this ...." · At 4:48 RN #2 responded that she is on her way to the patient's home. · An email from receptionist to supervisor, the weekday afterhours team (that starts at 5:00 pm.), and several other was sent at 5:03 p.m. The email stated the funeral home had called and said, "The funeral home cannot pick up the body until hospice pronouncement is done." This was confirmed in an interview with the Business Operations Manager on 10/22/20 at approximately 1:00 p.m. She also stated the receptionist did not notify her that no one was responding. An interview with the receptionist on 10/22/20 at 1:25 p.m. confirmed the above emails. The receptionist stated the usual method of notifying the nurse of a death was to send an email to the supervisor and to the RN case manager. No email went to the RN case manager on this death due to the RN case manager was off work that day. Interview also revealed a telephone call was made to the supervisor at 3:08 p.m. but no answer. Receptionist confirmed she did not call anyone else in the hospice office. The receptionist also reviewed the Telephone Call log from 9/8/20. The first incoming call regarding the patient's death was at 1:18 from the son-in-law. Before the first email could be sent, the daughter called in at 1:23 p.m. The son-in-law called again at 3:08 p.m. The daughter called once more at 3:41 p.m. An interview was conducted with the RN Supervisor on 10/22/20 at approximately 1:45 p.m. The interview revealed that it had been an "extremely busy day." She also confirmed she had been in a class that day. EMS record was reviewed. The EMS record stated, "Dispatched for cardiac arrest. It is report that Pt [patient] has a DNR [do not resuscitate] and death was expected. Upon arrival, crew is greeted by a family member who reports Pt was in Hospice care for end stages of colon cancer. Family says Hospice RN left appx. 1 hour ago and she stated that she didn't expect Pt to make it through the afternoon. Family says about 30 minutes after she left Pt stopped breathing (1300). Family attempted to call the RN several times, as well as Hospice but couldn't get anyone to answer. Family went ahead and called 911. Pt is found on his bed lying on his (R) side pulseless and apneic. Pt's skin is still warm to touch. No heart tones can be heard. ECG is applied and Pt is in asystole. Pt pronounced 10-67 @ 13:31:32 by _____. ECG removed, and Pt is covered again as family had him covered. Family says that Hospice will be to the house for arrangements, but it's unclear when they will arrive ...Crew will need to stay at house until [police department] arrives. A call to the police department on 10/27/20 at 9:40 a.m. revealed a police report was not completed as they police went as back up for EMS. The responding officers were not available for interview. An interview was conducted with responding police officer on 11/2/20 at 1:00 p.m. The officer stated the original 911 call came in on 9/8/20 at 1:16 p.m., but police dispatch was cancelled due to EMS notifying the police department patient was a hospice patient with a Do Not Resuscitate order. The police received another call at approximately 1:48 p.m. from EMS stating they had pronounced the death and needed to leave the home. EMS requested the police to come to the home since the hospice had not arrived yet. The officer spoke with his superior and was dispatched to the home at 2:08 p.m. The office arrived at 2:30 p.m. The officer stayed until 4:20 p.m. There was not interaction with the family as the officer stayed outside. As of 4:20 p.m., when the officer left, the hospice staff had not arrived. In an interview with the patient's daughter on 10/22/20 at 10:55 a.m. it was reported the patient stopped breathing at approximately 1:00 p.m. and the hospice did not come to the home until almost 6:00 p.m. The daughter voiced the distress and the anger of the family due to the length of response time from the hospice. She stated, "it is unacceptable to leave a dead body in a house for almost 6 hours." She stated she "called the funeral home to come get him [patient] but they wouldn't without hospice calling them.