Survey Report for 671561

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	671561	A. BUILDING __________ B. WING ______________	11/08/2019
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
INTERIM HOSPICE OF WEST TEXAS	3305 101 STREET STE 100, LUBBOCK, TX, 79423
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)
L0781
L0781	30188 Based on interview and record review the agency failed to ensure the skilled nursing facility was provided with the required information for 1 of 8 patients sampled for coordination of care. (Patient #2) The agency did not provide the skilled nursing facility with an updated plan of care and medication profile for Patient #2. This failure could place the patients at risk for a delay in receiving timely and effective care/treatment. Findings included: An Admission Consent and Election of Hospice Services dated 10/17/19 indicated Patient #2 was admitted to hospice on 10/17/19 with terminal diagnoses including chronic obstructive pulmonary disease, heart disease, and high blood pressure. During an interview on 11/05/19 at 1:25 p.m., a skilled nurse facility licensed vocational nurse, said the hospice binders are located at the nurse station and are used to retrieve any hospice coordination information. The hospice binder on 11/05/19 at 1:30 p.m., for Patient #2 did not contain a plan of care, or a hospice medication profile. During an interview on 11/05/19 at 2:35 p.m., the Community liaison for hospice arrived at the skilled nurse facility with clinical records dated from June 2019-October 2019 for Patient #2. The clinical records included plans of care, interdisciplinary group meetings, visit notes, and medication profiles for Patient #2. The Community liaison said he could not answer why the information was not in the hospice binder, but it should have been. During an interview on 11/7/19 at 1:05 p.m., the administrator said skilled nurse facility hospice charts should have had the information in them, she has had a change in staff, it is not an excuse, but she is working on it. The administrator said she recognized the skilled nurse facility charts needed updated, had implemented it in staff education, but did not incorporate it in their QAPI (quality assurance performance improvement) program. The administrator was asked for additional information, no additional information was provided. A Provision of Hospice Services to Residents of a SNF/NF (skilled nurse facility/nurse facility) policy dated 02/15/13 indicated: " ...8. The facility in which the patient resides has the following information regarding the hospice patient: a. The current IDG plan of care, including any attending physician or hospice physician orders ...b. (v) current hospice medications ...."