1. On 08/11/23 Surveyor #4 reviewed the personnel files for 6 of 6 staff (#402, #403, #404, #405, #406, #407). The review showed: a. Staff #402 signed a disclosure form on 09/17/20. No subsequent disclosure form was found in the record. b. Staff #403 signed a disclosure form on 10/13/19. No subsequent disclosure form was found in the record. c. Staff #404 signed a disclosure form on 12/10/18. No subsequent disclosure form was found in the record. d. Staff #405 signed a disclosure form on 11/21/19. No subsequent disclosure form was found in the record. e. Staff #406 signed a disclosure form on 11/16/20. No subsequent disclosure form was found in the record. f. Staff #407 signed a disclosure form on 10/01/18. No subsequent disclosure form was found in the record. 2. Surveyor #4 interviewed the agency Director (Staff #401) about the missing disclosure forms. Staff #401 acknowledged the findings and stated that the agency had not been renewing disclosure statements.
Every finding on record at Horizon Health Care Hospice
Spokane, Washington · CCN 501535
1 finding across 1 survey, in the inspector's own words.
The inspector’s own words from form CMS-2567, unedited, including CMS’s own spacing. Names and some dates are redacted by CMS.
Survey of August 11, 2023
1 finding← Back to the Horizon Health Care Hospice record
Federal survey findings only. State licensure findings for hospices are not shown.
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