Survey Report for 361612

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	361612	A. BUILDING __________ B. WING ______________	01/16/2020
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
ZUSMAN COMMUNITY HOSPICE	1151 COLLEGE AVENUE, COLUMBUS, OH, 43209
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)
L0518
L0518	35036 Based on review of the hospice marketing brochure, medical record review and staff interview the hospice was publically advertising patients may receive care at Zusman House our in-patient unit. This affected Patient #1 and had the potential to affect all patients receiving services from the Hospice. The census was 36 patients. Findings include: Review of the marketing brochure posted online was reviewed on 01/16/20. "The marketing brochure revealed patients may receive care at Zusman House our in-patient unit." The brochure stated "our facility features comfortable private rooms with ample space for family and friends." On 01/16/20 at 9:12 AM an interview with the Executive Director (ED) revealed the hospice had an inpatient unit with five beds, however, they did not have current full-time staff for the unit. The ED stated the agency has a contract with Wexner Heritage House, a Skilled Nursing Facility (SNF) on the same campus, if a patient were to need General Inpatient Care (GIP). The ED stated they tell patients the inpatient unit is not always available. She stated they also let patients know if needed the hospice would transfer them to another inpatient hospice. The ED stated they have only had one patient this past year in the inpatient unit for vent withdrawal and they base in-patient admission on a case by case basis. On 01/16/20 at 10:20 AM the ED revealed all the hospitals in the area were aware they were not currently accepting inpatient hospice referrals. The ED agreed the marketing material might be misleading as they could not staff the inpatient unit for patients at this time and had not been able to for quite some time, however, they did explain this to patients and their family upon admission. Review of Patient #1's record revealed the patient was admitted to the hospice on 04/04/19 while still living at home. On 04/09/19 a progress note revealed a call was received that the patient was not doing well and had a major change in ability to walk. An as needed visit was completed. The Clinical director, and medical director were both notified. Patient #1 was transported to Wexner Heritage house skilled nursing facility at 7pm by ambulance for general inpatient care (GIP) to manage symptoms. The patient was not admitted to the Zusman House in-patient unit as it was closed. Further review of the medical record revealed the patient was on GIP status from 04/09/19 to 04/18/19 and was on respite care on 04/19/19 until transferred to another SNF on 04/23/19. The patient transferred to another hospice on 04/25/19.