Survey Report for 921669

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	921669	A. BUILDING __________ B. WING ______________	03/29/2022
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
PACIFIC POINT HOSPICE & PALLIATIVE CARE	5946 PRIESTLY DRIVE, SUITE 102A, CARLSBAD, CA, 92008
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)
L0555
L0555	39448 Based on interview and record review, the agency failed to complete home visits per the plan of care for 1 of 2 sampled patients (1). As a result, Patient 1 did not receive the care ordered by the physician in order to address patient care needs. Findings: Per the agency's Patient Profile, Patient 1 was admitted to the agency on 6/25/21, with diagnoses to include Alzheimer's disease (a mental and physical decline). Per the agency's Plan of Care Order for certification period from 6/26/21 through 8/23/21, Patient 1 had an order for CHHA (Certified Home Health Aide) visits two times per week. Per the agency's Missed Visit Form, dated 8/19/21, " ...Patient family wants to reschedule for 8/20/21 ..." Per the agency's untitled, undated document, which listed Patient 1's CHHA visits, there was not a CHHA visit listed on 8/20/21. Per the agency's MSW (Medical Social Worker) Phone Call, dated 8/20/21, " ...MSW received upset text from daughter regarding her mother not receiving a bath today ... no other aid available to go today ..." On 12/30/21 at 3:20 P.M., a telephone interview was conducted with CHHA 1. CHHA 1 stated, on 8/19/21 she notified the scheduler and the DPCS (Director of Patient Care Services) that Patient 1 requested a visit for the following day, and they confirmed with CHHA 1 that they would schedule someone to complete the visit. CHHA 1 further stated, she did not know why the scheduler and the DPCS did not schedule anyone to complete the visit, but she assumed it was a miscommunication. On 1/4/22 at 11:15 A.M., a telephone interview was conducted with the DPCS. The DPCS stated, the scheduler should have confirmed which CHHA was going to complete the visit on 8/20/21 instead of assuming that CHHA 1 was going to do it. Per the facility's policy, titled, Missed Visits, revised April 2020, " ...2. If a visit is missed and not rescheduled the clinician will ... Document in the patient's clinical record the following information ... date and type of visit that was missed ... Reason for the missed visit ... Other person(s) that were notified of the missed visit ..."