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
671626 A. BUILDING __________
B. WING ______________ 		01/09/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
HOSPICE PLUS HOUSTON 1022 S JOHN REDDITT DR, LUFKIN, TX, 75904
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)
L0649      
30188 Based on interview and record review, the hospice failed to organize, manage, and administer its resources to provide the hospice care and services to patients, caregivers and families necessary for the palliation and management of the terminal illness and related conditions in 1 of 5 patients reviewed for the management of services. (Patient #1) The hospice did not organize, manage, and administer its resources to provide the hospice care and services to Patient #1, or caregivers and family necessary for the palliation and management of the terminal illness and related conditions in that: The hospice did not make sure hospice oriented contracted nurses who provided their continuous care services. The hospice nurse did not make a visit to assess Patient #1 when the family called to report patient #1 was uncomfortable. The hospice nurse did not make a visit after notification of Patient #1's death to ensure family care needs were met. This failure placed patients at risk of dying without dignity and unmet care needs for the patient and family. The findings included: The Plan of Care for Patient #1's certification period dated 11/05/19 to 02/02/2020 indicated: Patient #1's start of care was on 11/05/19 with diagnoses including heart failure, chronic respiratory failure with hypoxia (deficiency in the amount of oxygen reaching the tissues), atrial fibrillation (irregular and often faster heartbeat), and convulsions (a sudden, violent, irregular movement of a limb or of the body, caused by involuntary contraction of muscles). Patient #1 was admitted to hospice at a contracted hospital inpatient facility. During an interview on 01/07/20 at 10:00 a.m., Patient #1's daughter said: During the night of 11/05/19 thru the morning of 11/06/19 hospice should have been at the bedside when her father was actively dying and for the family during and after his passing. The family admitted him to hospice, so he could die with dignity, pain free, surrounded by love, and everyone could receive emotional support to go through his transition. Patient #1's daughter said her father was in constant seizure activity, uncomfortable, and he "literally suffered to death and it was a brutal experience." Patient #1's daughter said the hospital nurse called the on-call hospice nurse during the night and informed them medication was given for seizures. The hospital nurse told Patient #1's daughter there were no new orders and hospice would be there in the morning to assess her father. The hospital nurse said had never dealt with this type of situation and did not know what to do. Patient #1's daughter said she called the hospice on-call nurse and told him she was watching her father "suffer to death." The on-call nurse replied, until the nurse went to assess him nothing could be done. The hospice nurse did not call back until almost an hour after her father had passed. No one from hospice came to be with the family during or after his death, and no support had been provided to Patient #1 or the family. Client Coordination notes for Patient #1 dated 11/06/19 at 2:01 a.m., indicated: The Hospital nurse called on-call RN #55 and stated Patient #1 had a seizure, was given intravenous Ativan (used to treat anxiety and produce a calming effect), and she would monitor and call back with any other concerns. Client Coordination notes for Patient #1 dated 11/06/19 at 4:04 a.m., indicated: Patient #1's daughter called on-call RN #55 and stated her dad was having discomfort and the hospital nurse was in the room. Client Coordination notes for Patient #1 dated 11/06/19 at 4:58 a.m., indicated: The Hospital nurse called on-call RN #55 and reported Patient #1 had expired and was pronounced by the house doctor at the hospital at 4:05 a.m. The family was grieving appropriately, and bereavement was to follow up. Client Coordination notes for Patient #1 dated 11/05/09-1106/19 did not contain documentation the contracted staff who provided continuous care services to Patient #1 contacted the hospice during the active dying process or immediately after death. Hospital nurse notes for Patient #1 dated 11/05/09-1106/19 did not contain documentation of communication or coordination with hospice. During an interview on 01/08/20 at 3:41 p.m., ID #54 said she received a call from Patient #1's daughter on 11/06/19 at 2:30 p.m. Patient #1's daughter was not pleased with services provided, her dad was having constant seizures, the staff at the hospital was not helpful, and hospice did not ensure management of his symptoms. Patient #1's daughter felt like her father's nor the family's needs were met. She felt like hospice should have been there with them. ID #54 said communication between the entities "could have been better". During an interview on 01/08/20 at 4:15 p.m., the administrator said: Communication with the family was not "black or white." The nursing staff at the hospital gave the hospice nurse an impression everything was under control. The on-call nurse should have gone to be with the family after notification of death and he was counseled for not doing so. Notification of death should have been reported immediately to the hospice agency, and contracted staff is not trained on an individual basis, but in-services are provided at least annually. During an interview on 01/09/20 at 10:00 a.m., the on-call RN #55 said: He received a call from the hospital nurse on 11/06/19 around 2 am, and Patient #1 was given Ativan for seizure activity. RN #55 said he offered to go to the hospital, but the nurse said everything was under control. Patient #1's daughter called around 4:00 a.m., and said her dad was having discomfort, and she did not provide specific information when asked of his symptoms. Patient #1's daughter said the hospital nurse was in the room and ended the phone call. RN #55 said he called back to the hospital to talk to the nurse and she was indeed in Patient #1's room, so he waited for a return call. The return call did not occur until almost an hour later, and the hospital nurse told him Patient #1 had expired, was pronounced by the house doctor, the coroner had been contacted, and the family was grieving appropriately. RN#55 said he "reached out" to the family, but there was no answer. RN #55 said at no time did the hospital nurse indicate Patient #1 was at the end stages of dying or he would have gone to the hospital. A Coordination of Care with contracts/agreements policy dated May 2019 indicated: " ...Hospice will maintain professional responsibility for all services provided ...4. Hospice inpatient care will be designated, hospice-oriented, and trained registered nurses and other personnel ...5. All care provided will be in accordance with the hospice plan of care and documented in the clinical record ..." A Bereavement Services policy dated April 2019 indicated: "Purpose-To ensure that appropriate and coordinated bereavement services are provided to families/caregivers ...The program will provide bereavement services to the families/caregivers of hospice patients both before and after the patient's death ..." A Hospice Nursing care policy dated April 2019 indicated: "Purpose-To specify the role of the nurse in hospice care ...Duties will include the responsibility for coordination of care ...determine the scope and frequency of services needed based on acuity ad patient and family/caregiver needs ...3. The hospice nurse will: A. Manage discomfort and provide symptom relief ...B. Incorporate specialized nursing skills related to palliative and end-of-life care into all clinical care provided ...D. Provide emotional support to the patient and family ...J. Provide specialized hospice training to other staff family/caregivers to insure adequate care ...K. Provide an ongoing evaluation of the patient and family/caregiver response to care ...5. A hospice nurse will be available on a 24-hour basis to meet the physical, psychosocial, spiritual, and practical needs of patients and families/caregivers admitted to the hospice program ..."