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
391544 A. BUILDING __________
B. WING ______________ 		12/29/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
AMEDISYS HOSPICE OF PA 1368 MALL RUN ROAD, SUITE 624, UNIONTOWN, PA, 15401
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)
L0512      
42178 Based on review of agency policy, clinical records (CR), and staff (EMP) interviews, the agency failed to ensure the patient's right to receive effective symptom control from the hospice for one (1) of four (4) Clinical records reviewed (CR1). Findings included: Review of agency policy completed on December 29, 2020 at approximately 1:45pm revealed the following: " Policy AA-005 ...Hospice Plan of Care ...Changes in the patient's condition will be reflected in the patients ongoing POC and shall be made in writing by the Clinical Manager or registered nurse overseeing the patient 's care ... " Review of CRs on December 29, 2020 between approximately 11:15 am and 3:00 pm revealed: CR1 start of care (SOC) 7/7/20, CR revealed head lesion identified on 7/15/2020 by nurse at visit. No documentation available as evidence that doctor was notified about wound or orders were obtained for wound care or treatment. Nursing visits on 7/21/20 and 7/27/20 mention head wound, with no evidence of notification to doctor made and no orders obtained. 7/21/20- "...was going to call Dr about patients head wound but Pt refused, he said he was fine and wasn't going to take an antibiotic anyway." 7/27/20 " ...stated above, patient was irritable today and did not want the wound care done ... intermittent head pain. He refuses to have the wound on his head assessed which is a surgical flap that is draining brown drainage and he covers it with a paper towel or napkins and a hat ... " 7/29/20 (on call note)-Neighbor called 911 due to blood on head and 911 called Hospice reporting, "wound on head with maggots/small bugs in it, causing pain." Nursing documentation from the 7/28/20 Interdisciplinary group meeting (IDG) addressed wound and drainage with no evidence of doctor addressing wound at that meeting and no orders for treatment of wound at this time. Documentation reflects patient was sent to the hospital 7/29/2020 (admitted 7/30/20200 through 8/4/2020 for infected scalp wound with maggot infestation. It was at the time of discharge that the Hospice received orders from hospital for scalp wound. 8/4/2020 order for wound care read; "Orders...for head wound: Pack wound base with wet to dry NSS, cover with occlusive dressing. Change 3x a week and PRN [as needed] for dislodgement and saturation. CG [caregiver] may do when SN [skilled nurse] not present..." Per visit documentation, wound care was refused at many visits including dates of: 8/10/20, 8/12/20, 8/13/20, 8/18/20, 8/19/20, 8/28/20, 9/2/20, 9/5/20, 9/8/20, 9/19/20, 9/30/20, 10/10/20, 10/13/20, 10/16/20, 10/19/20, 10/26/20, and 10/29/20. Missed visit notes in CR reflect that the patient refused visits on dates: 9/9/20, 9/25/20, 10/2/20, 11/4/20, and 11/6/20. Interview with EMP3 on December 29, 2020 at approximately 12:00 pm revealed that the wound is believed to be chronic from skin cancer 10 years prior and was not identified on admission. EMP3 confirmed that agency documentation stating "caregiver may do when nurse not present" indicates non-skilled caregivers from homecare agency. Documentation reflects nonskilled services provided by Twin Oaks 12 hours 3 days a week. Interview with EMP1, EMP2, and EMP3 on December 29, 2020 at approximately 12:15 pm confirms employees unaware that non-skilled agency caregivers in the home were unable to perform wound care. Findings confirmed in exit interview on December 29, 2020 at approximately 4:30 pm at which EMP1, 2, and 3 were present, in addition to Clinical Vice President, Area Vice President, and Regional Director of Clinical Operations.
L0557      
42178 Based on review of agency policy, clinical records (CR), and staff (EMP) interviews, the agency failed to ensure the patient's right to receive effective symptom control from the hospice for one (1) of four (4) Clinical records reviewed (CR1). Findings included: Review of agency policy completed on December 29, 2020 at approximately 1:45pm revealed the following: "...Policy AA-006...Interdisciplinary Team...Operational Guidelines:1. Ensure that the IDT retains responsibility for directing, coordinating, and supervising the care and services provided. 2. Ensure that care and services are provided in accordance with the POC...4. Provide for and ensuring the ongoing sharing of information between all disciplines providing care and services in all setting, whether the care and services are provided directly or under arrangement...Discuss, review, and evaluate patients who are having specific problems with pain and/or symptom control. Review of CRs on December 29, 2020 between approximately 11:15am and 3:00pm revealed: CR1 start of care (SOC) 7/7/20, CR revealed head lesion identified on 7/15/2020 by nurse at visit. No documentation available as evidence that doctor was notified about wound or orders were obtained for wound care or treatment. Nursing visits on 7/21/20 and 7/27/20 mention head wound, with no evidence of notification to doctor made and no orders obtained. 7/21/20- " ...was going to call Dr about patients head wound but Pt refused, he said he was fine and wasn't going to take an antibiotic anyway." 7/27/20 " ...stated above, patient was irritable today and did not want the wound care done ... intermittent head pain. He refuses to have the wound on his head assessed which is a surgical flap that is draining brown drainage and he covers it with a paper towel or napkins and a hat ... " 7/29/20 (on call note)-Neighbor called 911 due to blood on head and 911 called Hospice reporting "wound on head with maggots/small bugs in it, causing pain. " Nursing documentation from the 7/28/20 Interdisciplinary group meeting (IDG) addressed wound and drainage with no evidence of doctor addressing wound at that meeting and no orders for treatment of wound at this time. Documentation reflects patient was sent to the hospital 7/29/2020 (admitted 7/30/20200 through 8/4/2020) for infected scalp wound with maggot infestation. It was at the time of discharge that the Hospice received orders from hospital for scalp wound. 8/4/2020 order for wound care read; "Orders...for head wound: Pack wound base with wet to dry NSS, cover with occlusive dressing. Change 3x a week and PRN [as needed] for dislodgement and saturation. CG [caregiver] may do when SN [skilled nurse] not present..." Per visit documentation, wound care was refused at many visits including dates of: 8/10/20, 8/12/20, 8/13/20, 8/18/20, 8/19/20, 8/28/20, 9/2/20, 9/5/20, 9/8/20, 9/19/20, 9/30/20, 10/10/20, 10/13/20, 10/16/20, 10/19/20, 10/26/20, and 10/29/20. Missed visit notes in CR reflect that the patient refused visits on dates: 9/9/20, 9/25/20, 10/2/20, 11/4/20, and 11/6/20. There is no evidence in patient record or clinical notes that collaboration of care had taken place or that the doctor was notified of ongoing refusal of assessment or treatment to the wound. Findings confirmed in exit interview on December 29, 2020 at approximately 4:30pm at which EMP1, 2, and 3 were present, in addition to Clinical Vice President, Area Vice President, and Regional Director of Clinical Operations.
L0558      
42178 Based on review of clinical records (CR), agency policy, and staff (EMP) interview it was determined the agency failed to ensure staff maintained a system of communication and integration with other non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions for one (1) of four (4) CR reviewed. (CR1) Findings Included: Interview with EMP3 on December 29, 2020 at approximately 12:00 pm revealed that the wound is believed to be chronic from skin cancer 10 years prior and was not identified on admission. EMP3 confirmed that agency documentation stating "caregiver may do when nurse not present" indicates non-skilled caregivers from homecare agency. Documentation reflects nonskilled services provided by Twin Oaks 12 hours 3 days a week. Review of CRs on December 29, 2020 between approximately 11:15am and 3:00pm revealed: CR1 start of care (SOC) 7/7/20, CR revealed head lesion identified on 7/15/2020 by nurse at visit. Nursing visits on 7/21/20 and 7/27/20, mention head wound as follows: 7/21/20- " ...was going to call Dr about patients head wound but Pt refused, he said he was fine and wasn't going to take an antibiotic anyway." 7/27/20 "... stated above, patient was irritable today and did not want the wound care done ... intermittent head pain. He refuses to have the wound on his head assessed which is a surgical flap that is draining brown drainage and he covers it with a paper towel or napkins and a hat ... " 7/29/20 (on call note)-Neighbor called 911 due to blood on head and 911 called Hospice reporting, "wound on head with maggots/small bugs in it, causing pain." Documentation reflects patient was sent to the hospital 7/29/2020 (admitted 7/30/20200 through 8/4/2020) for infected scalp wound with maggot infestation. It was at the time of discharge that the Hospice received orders from hospital for scalp wound. 8/4/2020 order for wound care read; "Orders...for head wound: Pack wound base with wet to dry NSS [normal saline solution], cover with occlusive dressing. Change 3x a week and PRN [as needed] for dislodgement and saturation. CG [caregiver] may do when SN [skilled nurse] not present..." Per visit documentation, wound care was refused at many visits including dates of: 8/10/20, 8/12/20, 8/13/20, 8/18/20, 8/19/20, 8/28/20, 9/2/20, 9/5/20, 9/8/20, 9/19/20, 9/30/20, 10/10/20, 10/13/20, 10/16/20, 10/19/20, 10/26/20, and 10/29/20. Missed visit notes in CR reflect that the patient refused visits on dates: 9/9/20, 9/25/20, 10/2/20, 11/4/20, and 11/6/20. There is no evidence in patient record or clinical notes that collaboration of care had taken place with the non-skilled agency caring for the patient in home. Unclear is patient was refusing care from non-skilled caregivers as well. Interview with EMP1, EMP2, and EMP3 on December 29, 2020 at approximately 2:00pm confirmed agency unaware of services patient accepting from non-skilled agency. At this time, no member of interview able to confirm if non-skilled caregivers aware of head wound or need to call Hospice with patient concerns. Findings confirmed in exit interview on December 29, 2020 at approximately 4:30pm at which EMP1, 2, and 3 were present, in addition to Clinical Vice President, Area Vice President, and Regional Director of Clinical Operations.