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
671514 A. BUILDING __________
B. WING ______________ 		10/30/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
LESTER DIERKSEN MEMORIAL HOSPICE 6500 N SUMMERHILL ROAD SUITE 2B, TEXARKANA, TX, 75503
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)
L0579      
25013 Based on interview and record review, the agency failed to ensure acceptable standards of practice were followed to prevent the transmission of COVID-19 (a sometimes-fatal upper respiratory infection The agency did not place CNA B in quarantine or have her tested for COVID 19 after she reported headache, elevated blood pressure, and a 101-degree temperature. This failure placed patients at risk of exposure to COVID 19. Findings included: During an interview on 10/30/20 at 9:11 a.m., the administrator said CNA B worked at a nursing facility as well as for the hospice agency. She said CNA B saw patients in the nursing facility and she did patient home visits. The administrator said employees were to take their temperatures every morning prior to making visits and report any COVID signs and symptoms to the supervising nurse. The administrator said staff was not allowed to make visits if exhibiting signs/symptoms. During an interview on 10/30/20 at 11:30 a.m., the supervising nurse said CNA B called the alternate supervising nurse on 10/12/20 and said she was not going to work for the hospice agency that day because she was instructed by the DON of the nursing facility she had to go home because she had a temperature, headache, and her blood pressure was elevated. The supervising nurse said CNA B contacted the supervising nurse on 10/14/20 and said she had no temperature and felt fine and was ready to return to work. The supervising nurse said she allowed CNA B to return to work on 10/14/20. The supervising nurse said CNA B was tested for COVID during routine checks at the nursing facility on 10/16/20. She said the results were received on 10/20/20 at 7:20 p.m. and were positive. The supervising nurse said CNA B had seen patients on 10/14, 10/15, 10/16, and 10/19. During an interview on 10/30/20 at 12:24 p.m., the alternate supervising nurse said when an employee exhibited COVID signs and symptoms, they could not make home visits and had to have a COVID test. The alternate supervising nurse said CNA B contacted her on 10/12/20 and said she was sent home from the nursing facility because she had a headache and her blood pressure was up. She did not remember if she told her she had a temperature. She said CNA B made a quick recovery and requested to return to work on 10/14/20. The monthly schedule indicated CNA B did not work on 10/12/20 and 10/13/20. The monthly schedule showed she provided care for clients on 10/14, 10/15, 10/16, and 10/19. During an interview on 10/30/20 at 12:00 p.m., CNA B said she worked at a nursing facility and when she completed her shift for them she provided care to the hospice patients in the nursing facility and then she did 1 to 2 home visits for the agency. She said while working at the nursing facility on 10/12/20 she started to feel bad, she had a 101 temperature, a severe headache, and her blood pressure was up. CNA B said the nursing facility DON sent her home. CNA B said she contacted the alternate supervising nurse for the hospice agency and told her she could not work on 10/12/20 because she had a 101 temperature, severe headache, and her blood pressure was elevated. CNA B said she started feeling better on 10/13/20 and asked if she could return to work on 10/14/20. CNA B said she saw patients on 10/14, 10/15, 10/16, and 10/19. CNA B said the nursing facility performed weekly COVID testing. She said she had a test on 10/02/20 and it was negative, but she missed getting COVID tested the next week because she arrived late. She said the next test was on 10/16/20 and she was made aware it was positive on 10/20/20 late that evening. CNA B said she wore a facemask and gloves while providing care to the patients. She said the agency placed her in quarantine after she received the positive result. During an interview on 10/30/20 at 12:20 p.m., the nursing facility DON said on 10/12/20 CNA B spiked a temperature of 101, had a headache and fast onset of malaise, and was sent home. The administrator said they did not have a current COVID policy they followed the CDC guidelines. The administrator provided a CDC update dated 07/20/2020 with the following highlighted " ...symptom-based criteria were modified to at least 24 hours have passed since last fever without the use of fever reducing medications ..." The CDC Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance) last updated 8/10/20 accessed 11/09/20 at https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html indicated "...Who this is for: Occupational health programs and public health officials making decisions about return to work for healthcare personnel (HCP) with confirmed SARS-CoV-2 infection, or who have suspected SARS-CoV-2 infection (e.g., developed symptoms of COVID-19) but were never tested for SARS-CoV-2 ... For HCP who were suspected of having COVID-19 and had it ruled out, either with at least one negative test or a clinical decision that COVID-19 is not suspected and testing is not indicated, then return to work decisions should be based on their other suspected or confirmed diagnoses ... Symptom-based strategy for determining when HCP can return to work. HCP with mild to moderate illness who are not severely immunocompromised: At least 10 days have passed since symptoms first appeared and At least 24 hours have passed since last fever without the use of fever-reducing medications and Symptoms (e.g., cough, shortness of breath) have improved ... In some instances, a test-based strategy could be considered to allow HCP to return to work earlier than if the symptom-based strategy were used ..."