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
741730 A. BUILDING __________
B. WING ______________ 		07/16/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
A HEALING TOUCH HOSPICE 2900 N TEXAS SUITE 104, WESLACO, TX, 78596
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)
L0538      
21741 Based on record review and interview, the hospice failed to ensure the plans of care (POC) included all services necessary to meet the specific patient needs for 3 of 3 active patients (#1, #2 and #3) whose records were reviewed. Patients #1, #2, and #3's electronic clinical records included plans of care that did not contain orders for the skilled nurses to perform mid-arm circumference measurements. The POCs also did not include the specific reasons or conditions for PRN (as necessary) 02 Sats (Oxygen Saturation Rates of the Blood). This failure could place the hospice's active patients at risk of harm of not receiving the care and services to meet their specific needs. The findings included: 1. Review of active Patient #1's clinical record included a form titled "Physician's Telephone Verbal Order" completed by Registered Nurse (RN) C and signed by the Hospice Medical Director on 03/27/20. The form revealed the terminal diagnosis as Alzheimer's Disease and comorbities listed as Dementia, Depression, Urinary Incontinence, Ureterocele, Hypothyroidism and Hyperlipidemia. Patient #1's clinical record included two Hospice form titled "Hospice Initial Plan of Care/Physician's Orders" for the certification periods 03/16/20 to 06/13/20 and 06/14/20 to 09/11/20. The POCs included orders for 02 (Oxygen) Sats (Saturation Rate of the Blood) PRN (as necessary) and a skilled nurse (SN) visit frequency of two times a week and a Hospice Aide visit frequency as two times a week. Patient #1's record included another form titled "Hospice Recertification For Second Benefit Period" completed by RN C and signed by the Medical Director on 06/05/20. The form revealed the certification period dates from 06/14/20 to 07/11/20. The form revealed related conditions listed as Dementia, Depression, Urinary Incontinence, Ureterocele, Hypothyroidism and Hyperlipidemia Patient #1's electronic clinical record included one SN visit form titled "General Clinical Chart Details"completed by RN C dated 06/15/20 and six SN visit forms completed by Licensed Vocational Nurse (LVN) F dated 06/18/20, 06/23/20, 06/25/20, 06/30/20, 07/07/20 and 07/09/20. The SN visit forms revealed RN C and LVN F performed pulse oximetry to assess the oxygen saturation rates of the blood and mid arm circumference measurements. Further review of the POCs failed to reveal the specific reasons or conditions for the SNs to perform 02 Sats PRN or orders for the SNs to perform mid-arm circumference measurements. During an interview on 07/16/20 at 9:36 a.m. with the Alternate Administrator (Alt Adm)/Director of Nurses (DON) and RN C, the surveyor presented the above findings and asked if the POC included the specific reasons or conditions for PRN 02 Sats and orders to perform mid-arm circumference measurements. After review of the POC, the Alt Adm/DON stated "no." 2. Review of active Patient #2's clinical record included a Physician's Telephone Verbal Order form completed by RN C and signed by the Hospice Medical Director on 07/01/20. The form revealed the terminal diagnosis as Hemiplegia following CVA (Cardio Vascular Accident). The form listed comorbidities as Dysphagia, UTI, Severe Protein-Calorie Malnutrition, Malaise, Dementia, BPH (Benign Prostatic Hypertrophy, A-Fib (Atrial Fibrillation), Hypertension, Diabetes Mellitus, Chronic Kidney Disease and GERD (Gastro-Esophageal Reflux). Patient #2's clinical record included a Hospice Initial Plan of Care/Physician's Orders form for the certification periods 06/18/20 to 09/15/20. The form completed by the RN C revealed a terminal diagnosis as CVA. The POC included orders for 02 Sats PRN, a SN visit frequency of two times a week and a Hospice Aide visit frequency as two times a week. Patient #2's electronic clinical record included one General Clinical Chart Details SN visit form completed by RN C dated 06/18/20 and five General Clinical Chart Details SN visit forms completed by LVN F dated 06/23/20, 06/25/20, 06/30/20, 07/06/20 and 07/09/20. The SN visit forms revealed RN C and LVN F performed pulse oximetry to assess the oxygen saturation rates of the blood and mid arm circumference measurements. Further review of the POCs failed to reveal the specific reasons or conditions for the SNs to perform 02 Sats PRN or orders for the SNs to perform mid-arm circumference measurements. During an interview on 07/16/20 at 10:12 a.m. with the Alt Adm/(ADON) and RN C, the surveyor presented the above findings and asked if the POC included the specific reasons or conditions for PRN 02 Sats and orders to perform mid-arm circumference measurements. After review of the POC, the Alt Adm/DON stated "no." 3. Review of active Patient #3's clinical record included a Physician's Telephone Verbal Order form completed by RN D and signed by the Hospice Medical Director on 06/17/20. The form revealed the terminal diagnosis as Parkinson's Disease. The form listed comorbidities as Dysphagia, Muscle Wasting, Lack of Coordination, Muscle Weakness, Spinal Stenosis Lumbar Regions, Low Back Pain, Osteoporosis, Cognitive Communication Defect, Dysarthria, Diabetes Mellitus and PVD Peripheral Vascular Disease. Patient #3's clinical record included a Hospice Initial Plan of Care/Physician's Orders form for the certification period 06/09/20 to 09/06/20. The form completed by the RN D revealed a terminal diagnosis as Parkinson's Disease. The POC included orders for 02 Sats PRN, a SN visit frequency of two times a week and a Hospice Aide visit frequency as two times a week. Patient #3's electronic clinical record included one General Clinical Chart Details SN visit form completed by RN D dated 06/09/20 and eight General Clinical Chart Details SN visit forms completed by LVN F dated 06/10/20, 06/11/20, 06/18/20, 6/22/20, 06/25/20, 06/30/20, 07/06/20 and 07/08/20. The SN visit forms revealed RN C and LVN F performed pulse oximetry to assess the oxygen saturation rates of the blood and mid arm circumference measurements. Further review of the POCs failed to reveal the specific reasons or conditions for the SNs to perform 02 Sats PRN or orders for the SNs to perform mid-arm circumference measurements. During an interview on 07/16/20 at 10:30 a.m. with the Alt Adm/(ADON) and RN C, the surveyor presented the above findings and asked if the POC included the specific reasons or conditions for PRN 02 Sats and orders to perform mid-arm circumference measurements. After review of the POC, the Alt Adm/DON stated "no." The Hospice did not provide additional information by the time of exit on 07/16/20 at 11:31 a.m.
L0545      
21741 Based on record review and interview, the hospice failed to ensure the plans of care (POC) included all services necessary to meet the specific patient needs for 3 of 3 active patients (#1, #2 and #3) whose records were reviewed. Patients #1, #2, #3 and #4's electronic clinical records included plans of care that did not contain orders for the palliation and management of the terminal illness and related conditions. This failure could place the hospice's active patients at risk of harm of not receiving the care and services to meet their specific needs. The findings included: 1. Review of active Patient #1's clinical record included a form titled "Physician's Telephone Verbal Order" completed by Registered Nurse (RN) C and signed by the Hospice Medical Director on 03/27/20. The form revealed the terminal diagnosis as Alzheimer's Disease and comorbities listed as Dementia, Depression, Urinary Incontinence, Ureterocele, Hypothyroidism and Hyperlipidemia. Patient #1's clinical record included two Hospice form titled "Hospice Initial Plan of Care (POC)/Physician's Orders" for the certification periods 03/16/20 to 06/13/20 and 06/14/20 to 09/11/20. The forms completed by the RN C revealed a terminal diagnosis as Alzheimer's Disease. The forms also revealed related conditions list as Dementia, Depression, Urinary Incontinence, Ureterocele, Hypothyroidism and Hyperlipidemia. The POC included a skilled nurse (SN) visit frequency of two times a week and a Hospice Aide visit frequency as two times a week. Patient #1's record included another form titled "Hospice Recertification For Second Benefit Period" completed by RN C and signed by the Medical Director on 06/05/20. The form revealed the certification period dates from 06/14/20 to 07/11/20. The form revealed related conditions listed as Dementia, Depression, Urinary Incontinence, Ureterocele, Hypothyroidism and Hyperlipidemia. Further review of the Hospice Initial Plan of Care/Physician's Orders forms for the certification periods 03/16/20 to 06/13/20 and 06/14/20 to 09/11/20 failed to contain documentation the Plans of Care included orders to address the comorbidities (related conditions). During an interview on 07/16/20 at 9:36 a.m. with the Alternate Administrator (Alt Adm)/Alternate Director of Nurses (ADON) and RN C, the surveyor presented the above findings and asked if the assessment addressed the co-morbidities. After review of the POC, the Alt Adm/ADON stated "no." 2. Review of active Patient #2's clinical record included a Physician's Telephone Verbal Order form completed by RN C and signed by the Hospice Medical Director on 07/01/20. The form revealed the terminal diagnosis as Hemiplegia following CVA (Cardio Vascular Accident). The form listed comorbidities as Dysphagia, UTI, Severe Protein-Calorie Malnutrition, Malaise, Dementia, BPH (Benign Prostatic Hypertrophy, A-Fib (Atrial Fibrillation), Hypertension, Diabetes Mellitus, Chronic Kidney Disease and GERD (Gastro-Esophageal Reflux). Patient #2's clinical record included a Hospice Initial Plan of Care/Physician's Orders form for the certification periods 06/18/20 to 09/15/20. The form completed by the RN C revealed a terminal diagnosis as CVA. The forms also revealed related conditions list as Dysphagia, UTI, Severe Protein-Calorie Malnutrition, Malaise, Dementia, BPH, A-Fib, Hypertension, Diabetes Mellitus, Chronic Kidney Disease and GERD. The POC included a SN visit frequency of two times a week and a Hospice Aide visit frequency as two times a week. Further review of the Hospice Initial Plan of Care//Physician's Orders form for the certification period 06/18/20 to 09/15/20 failed to contain documentation the POC included orders to address the comorbidities (related conditions). During an interview on 07/16/20 at 10:12 a.m. with the Alt Adm/(ADON) and RN C, the surveyor presented the above findings and asked if the POC included orders to address the comorbidities. After review of the POC, the Alt Adm/DON stated "no." 3. Review of active Patient #3's clinical record included a Physician's Telephone Verbal Order form completed by RN D and signed by the Hospice Medical Director on 06/17/20. The form revealed the terminal diagnosis as Parkinson's Disease. The form listed comorbidities as Dysphagia, Muscle Wasting, Lack of Coordination, Muscle Weakness, Spinal Stenosis Lumbar Regions, Low Back Pain, Osteoporosis, Cognitive Communication Defect, Dysarthria, Diabetes Mellitus and PVD Peripheral Vascular Disease. Patient #3's clinical record included a Hospice Initial Plan of Care/Physician's Orders form for the certification period 06/09/20 to 09/06/20. The form completed by the RN D revealed a terminal diagnosis as Parkinson's Disease. The forms also revealed related conditions list as Dysphagia, Muscle Wasting, Lack of Coordination, Muscle Weakness, Spinal Stenosis Lumbar Regions, Low Back Pain, Osteoporosis, Cognitive Communication Defect, Dysarthria, Diabetes Mellitus and PVD Peripheral Vascular Disease. The POC included a SN visit frequency of two times a week and a Hospice Aide visit frequency as two times a week. Further review of the Hospice Initial Plan of Care//Physician's Orders form for the certification period 06/09/20 to 09/06/20 failed to contain documentation the POC included orders to address the comorbidities (related conditions). During an interview on 07/16/20 at 10:30 a.m. with the Alt Adm/(ADON) and RN C, the surveyor presented the above findings and asked if the POC included orders to address the comorbidities. After review of the POC, the Alt Adm/DON stated "no." The Hospice did not provide additional information by the time of exit on 07/16/20 at 11:31 a.m.