Survey Report for 441545

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	441545	A. BUILDING __________ B. WING ______________	09/29/2021
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
AVALON HOSPICE	2525 PERIMETER PLACE DRIVE, SUITE 105, NASHVILLE, TN, 37214
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)
L0530
L0530	18225 Based on medical record review and interview, the agency failed to update the medication profile with new medications for 1 patient (#1) of 3 patients reviewed. The findings include: Medical record review revealed Patient #1 was admitted to the agency on 7/12/2021 with Chronic Obstructive Pulmonary Disease and was discharged on 7/20/2021. Medical record review of the patient's plan of care dated 7/12/2021 revealed a physician's order for Alprazolam (anti-anxiety medication) 1 milligram (mg) tablet four times a day. No other medications were listed. Medical record review of the patient's medication profile dated 7/12/2021 to 7/20/2021 revealed the only medication listed was the Alprazolam. Medical record review of a nurse's note dated 7/12/2021 revealed the patient called to inquire about his medications. The admitting nurse stated she was at the office and had a signed order from the doctor and would fax it to the pharmacy. The patient was notified and informed he could pick up his medications at the pharmacy "in 30 minutes". He was also informed the pharmacy closed at 8:00 PM. Medical record review of a nurse's note dated 7/16/2021 revealed the patient was able to provide prescription bottles for all of his medications. Medication refills noted and ordered at a local pharmacy. He had previously refused to show the nurse his prescription bottles. Medical record review of a physician's order dated 7/16/2021 revealed the physician ordered Lasix (anti-diuretic) 40 mg daily, Amlodipine (improves blood flow) 10 mg daily, Metolazone (used to reduce fluid retention) 5 mg daily, Potassium (supplement) 10 meq (milliequivalent) daily, Colace (stool softener) 100 mg daily, Omeprazole (decreases amount of acid in stomach) 20 mg daily and Risperdal (used to treat mental disorders) 4 mg at bedtime. All of the medications ordered were authorized by hospice for payment. Medical record review of a physician's order dated 7/20/2021 revealed an order for Methadone (used for pain relief and drug addiction) 5 mg three times a day. Medical record review of the Client Medication Report dated 7/13/2021 to 7/20/2021 revealed the medication profile was not updated with the new medications ordered on 7/16/2021 and 7/20/2021. Interview with the Administrator on 9/29/2021 confirmed the medication profile was not updated with the medication changes on 7/16/2021 and 7/20/2021.