Every finding on record at Crossroads Hospice of Atlanta, LLC

It is required that the hospice provides nursing care under the supervision of a Registered Nurse (RN). This standard was not met as evidenced by clinical record review, document review, and interview. The agency policy states that the RN is to make a supervisory visit within 30 days of an LPN visit to patients. In 12 of 19 (63%) clinical records reviewed, the RN did no supervisory visits for the care given by Licensed Practical Nurses (LPN) within the 30-day compliance period. Clinical Record 2: The patient was admitted on 8/23/21 with a diagnosis of Senile Degeneration of the Brain. An LPN visit was made on 11/22/22; there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. Clinical Record 3: The patient was admitted on 10/11/22 with a diagnosis of Alzheimer's Disease. An LPN visit was made on 12/19/22; there was no evidence documented of a RN supervisory visit before 1/19/2023 (31 days). Clinical Record 6: The patient was admitted on 10/13/2022 with a diagnosis of Cerebrovascular Disease. An LPN visit was made on 10/16/22 and there was no documented evidence of a RN supervisory visit made before 11/16/2022 (31 days). Clinical Record 9: The patient was admitted on 4/2/22 and diagnosed with Senile Degeneration of the Brain. An LPN visit was made on 7/19/22 and there was no documented evidence of a RN supervisory visit in the 30-day compliance period. Clinical Record 10: The patient was admitted on 9/30/22 with a diagnosis of Chronic Obstructive Pulmonary Disease. An LPN visit was made on 10/1/22 and there was no documented evidence of a RN supervisory visit in the 30-day compliance period. Clinical Record 11: The patient was admitted on 10/26/22 with a diagnosis of Atherosclerotic Heart Disease. An LPN visit was made on 11/03/22 and there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. Clinical Record 12: The patient was admitted on 8/23/22 with a diagnosis of End-Stage Renal Failure. An LPN visit was made on 4/4/23 and there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. Clinical Record 14: The patient was admitted on 1/31/22 with a diagnosis of Malignant Neoplasm of Unspecified Part. An LPN visit was made on 4/4/23 and there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. Clinical Record 17: The patient was admitted on 2/15/23 with a diagnosis of Heart Disease. An LPN visit was made on 2/19/23 and there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. Clinical Record 18: The patient was admitted on 12/8/22 with a diagnosis of Parkinson's Disease. An LPN visit was made on 12/13/22 and there was no documented evidence of an RN supervisory visit in the 30-day compliance period. Clinical Record 19: The patient was admitted on 10/4/22 with a diagnosis of Chronic Obstructive Pulmonary Disease. There was an LPN visit made on 4/19/23, and there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. Clinical Record 4: The patient was admitted on 1/27/23 with a diagnosis of Parkinson's Disease. An LPN visit was made on 1/29/23, there was no documented evidence of a RN supervisory visit made in the 30-day compliance period. A joint review with the Clinical Director of all twelve clinical records revealed that no RN supervisory visits were done within the 30-day compliance period after the first visit from the LPN. In an interview with the Clinical Director, she agreed that the staff had not satisfied the policy. While the surveyor was still present, the Clinical Director developed a performance improvement plan. In a joint review with the Clinical Director of all twelve clinical records it was revealed that no RN supervisory visit was done within the 30-day compliance period after the visit from the LPN. The agency policy states that the RN is to make a supervisory visit within 30-days of an LPN visit to patients. In an interview with the Clinical Director she agreed that the policy has not been satisfied by the staff. While the surveyor was still present the clinical director developed a performance improvement plan.

Based on a review of medical records, an interview with staff, and a review of the state rules for hospice, it was determined the facility failed to comply with state rules when it did not allow the State Agency (SA) surveyor meaningful access to the facility records. --- A request to review five (5) medical was made to the facility. The requested access to the medical records were denied by the facility on 1/18/2023 by the Clinical Director (CD) An interview was conducted with the Clinical Director (CD) and the Site Educator (SE) on 1/18/2023 at 12:00 p.m. During the interview the CD stated that the facility does not give access to anyone outside our company. When asked if the SA could have access only to the five (5) medical records requested the CD responded, we are not able to give you access to our system and our SE would assist with reviewing the records and navigating the system. A review of Georgia Department of Community Health, Healthcare Facility Regulation, Rules and Regulations for Hospice 111-8-37.01 revealed the purpose of the rules (111-8-37) are to provide for inspection and issuance of license for hospice and to establish minimum requirements for facilities operating under hospice license. A review of Georgia Department of Community Health, Healthcare Facility Regulation, Rules and Regulations for Hospice 111-8-37.05(3) revealed for the purposes of any inspection, investigation, or survey conducted by the Department, the hospice must provide to properly identified representatives of the Department meaningful access to all books, records, papers, or other information related to the initial or continued licensing of the hospice. The facility failed to provide meaningful access to medical records as dictated per state licensure compliance.