Survey Report for 671656

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	671656	A. BUILDING __________ B. WING ______________	10/10/2019
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
HOSPICE CARE TEAM, INC.	2688 CALDER STREET, BEAUMONT, TX, 77702
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	19857 Based on interview and record review the agency failed to ensure skilled nursing services followed the individualized written plan of care established by the hospice interdisciplinary group (IDG) for 1 of 4 patients reviewed for ensuring the physician is notified of changes in the treatment plan. (Patient #4) The agency did not provide treatment to Patient #4 as ordered by the physician. LVN #54 did not wrap Patient #4's lower legs to prevent edema (swelling). This failure could place patients at risk for not receiving care and treatment to meet their needs. Findings included: The Plan of Care, recertification period dated 06/26/19 to 09/23/19, indicated Patient #4 had diagnoses that included Atherosclerotic heart disease of native coronary artery without angina pectoris and end stage cardiovascular disease. The plan of care indicated the patient had a goal of assess skin integrity, prevent infection and promote wound healing. An intervention was to demonstrate good preventive skin care. An order dated on 06/28/19 for Patient #4 indicated to wrap legs on Monday and Friday with a pressure dressing to prevent edema. A skilled nurse visit note dated 08/23/19 for Patient #4 indicated licensed vocational nurse (LVN) #54 did not note weeping (fluid leaking from) or swelling to the lower legs. The note did not document LVN #54 wrapped the patient's lower legs as ordered. A complaint dated 08/26/19, from the caregiver indicated LVN #54 did not wrap Patient #4's lower legs with compression dressing. The complaint indicated LVN #54 told the caregiver the patient's legs did not need to be wrapped. During an interview on 10/10/19 at 2:00 p.m., the director of nursing (DON) said LVN #54 did not notify the physician the patient's lower legs were not wrapped during the skilled nursing visit as ordered on 8/23/19. The policy Care Planning Process revised 10/01/15 indicated " ...Agency will obtain orders and provide care in accordance with physician's orders which are established prior to initiating patient care and reviewed/revised by the physician as needed or at least at the end of each benefit period ..." During an interview on 10/10/19 at 4:45 p.m., the agency was asked for additional information regarding Patient #4's treatment orders at exit, no additional information was provided.