Survey Report for 741591

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	741591	A. BUILDING __________ B. WING ______________	12/09/2019
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
TRINITY HOSPICE	11122 WURZBACH STE 302, SAN ANTONIO, TX, 78230
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)
L0547
L0547	22360 Based on record reviews and interviews, the agency failed to provide care and services in accordance with the plan of care (POC) for one of three active patients (Patient #1) whose clinical records were reviewed, in that, Patient #1 was receiving weekly pill box refills by the agency nurses and it was not included in the updated POC. This deficient practice placed Patient #1 at risk of not having his individual needs met and could affect the agency's other 167 active patients. The findings included: A. Review of the policy titled "Plan of Care Process" revised date 05/01/19 read in part, "All hospice care and services furnished to patients and their families will follow an individualized written POC established by the hospice interdisciplinary group (IDG)...The POC must reflect patient and family goals and interventions based on problems identified in the initial, comprehensive, and updated comprehensive assessments..." B. During an interview with Staff D on 12/09/19 at 10:16 a.m., she stated that she was Patient #1's RN (Registered Nurse) Case Manager and conducted nursing visits once a week. Staff D further stated that she refilled Patient #1's medication planner (pill box) once a week and that his wife administered the medications. C. Review of Patient #1's clinical record revealed a start of care (SOC) date of 03/20/18 and a terminal diagnosis of End Stage Cardiovascular Disease. Review of Patient #1's clinical record revealed a nursing note dated 11/13/19 and signed by Staff D revealed that Staff D "filled medications planner [pill box]..." D. During an interview with the Administrator/Supervising Nurse and the Alternate Supervising Nurse on 12/09/19 from 3:15 p.m. to 3:45 p.m., the above findings were reviewed and discussed. The Administrator/Supervising Nurse stated that only recently within the last two months have the nursing staff intervened by refilling the pill box for Client #1. The Administrator further stated that it was not documented in the updated POC. During the exit conference on 12/09/19 at 4:06 p.m., the Administrator/Supervising Nurse and Alternate Supervising Nurse were informed that the agency had two additional business days to provide additional documentation for review. No additional documentation was provided at the time of exit or within two business days of the exit. The Alternate Administrator provided a census of 167 hospice clients from the Active Client List on 12/06/19.