Survey Report for 451682

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	451682	A. BUILDING __________ B. WING ______________	06/10/2021
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
KINDRED HOSPICE	4440 S PIEDRAS DRIVE SUITE 125, SAN ANTONIO, TX, 78228
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)
L0543
L0543	26899 Based on interview and record review, the hospice failed to provide care and services as written in the individualized plan of care to one of one discharged patient (Patient #1) whose clinical record was reviewed, in that the nurse did not provide nursing visits as ordered on one occasion. This failure could place the hospice patients at risk of harm from not receiving the necessary care and services. The findings included: A. Closed record review of Patient #1's plan of care for certification period 12/19/20 to 03/18/21 revealed a primary diagnosis of Non-Hodgkin Lymphoma and a nurse visit frequency of two times a week for one week followed by once a week. Review of the nurse's notes revealed no nursing visit the week of 12/27/20 through 01/02/21. Review of the Client Calendar Report print date 06/10/21 revealed no nursing visit the week of 12/21/20 through 01/02/21. During an interview and record review on 06/10/21 at 11:04 a.m., the findings above were discussed with the Administrator. The Administrator stated she was not sure a nursing visit was not completed for the week of 12/27/20 through 01/02/21 and stated she would continue look for documentation of why it was missed. B. Review of the agency's policy titled "Interdisciplinary Group Plan of Care" dated November 2020 revealed in part, "...7. Care will be provided by an interdisciplinary group..."