Survey Report for 921671

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	921671	A. BUILDING __________ B. WING ______________	11/12/2020
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
ELITE HEALTH CARE SYSTEMS	7484 UNIVERSITY AVENUE SUITE 250, LA MESA, CA, 91942
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)
L0671
L0671	39448 Based on interview and record review, the agency failed to ensure communication was documented for one of two sampled patients (1). As a result, there was no record of what happened to Patient 1 after they were transported to the mortuary, or if Patient 1's family was aware of his location. Findings: Per the facilities Patient Face Sheet, dated 11/10/20, Patient 1 was admitted on 9/28/20. On 10/22/20 at 10:50 A.M., a concurrent interview and review was conducted with HR (Human Resources) of Patient 1's record. There were no notes to indicate the hospice was able to contact the of Patient 1's family of his location. On 11/10/20 at 2:55 P.M., a telephone interview was conducted with the DPCS (Director of Patient Care Services). The DPCS stated, she did not document her followup notification calls related the patient's status in Patient 1's chart because she was not able to document in the chart after it was closed. The facilities policy, titled Medical Record, effective 8/1/16, did not direct staff to document communication with patient's families, or indicate if staff were able to document in a patient's chart after discharge.