Survey Report for 671731

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	671731	A. BUILDING __________ B. WING ______________	12/09/2019
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
LEGEND HOSPICE INC	1001 W EULESS BLVD SUITE 107, EULESS, TX, 76040
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)
L0678
L0678	36748 Based on record review and interview, the hospice failed to ensure each patient's record included signed physician's orders to initiate hospice care. This failure placed Patient #2 and Patient #3 at risk of receiving substandard care. Findings: Review of the agency's policy titled "ORDERS FOR CARE PC.5 Revised 100115" read, in part, "...POLICY Agency will obtain orders and provide care in accordance with physician's orders which are established prior to initiating patient care..." Review of Patient #2's medical record revealed no evidence of orders to initiate hospice care. Further review of the medical record revealed a document titled "Interdisciplinary team evaluation and progress notes." This document was signed and dated 4/3/19 and completed by an agency Registered Nurse (Employee L). Review of Patient #3's medical record revealed no evidence of orders to initiate hospice care. Further review of the medical record reavealed a document titled "PSYCHOSOCIAL ASSESSMENT FORM." This document was completed and signed and dated 8/15/19 by an agency Social Worker (Employee M). An interview was conducted with the Alternate Director of Nursing (Employee C) on 12/9/19 at approximately 1:00 PM. The surveyor asked Employee C why there were no orders to initiate hospice care for Patient #2 and Patient #3. Employee C looked through the medical records and stated, "I guess they aren't there." No additional evidence was received to explain or correct the findings.