[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-160148-en":3,"doc-seo-160148-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},160148,962084925782,"Chloe Bennett","https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc",7,"Healthcare","Health Regulation & Licensing Administration - Statement of Deficiencies and Plan of Correction - 04/11/2014","Survey documentation detailing findings following an onsite investigation by the Department of Health/Health Regulation and Licensing Administration regarding alleged noncompliance involving Premium Select Home Care, Inc. The report summarizes record reviews and interviews connected to PCA services, including authorization details, patient admission and discharge timelines, and references to related Medicaid prior authorization notices. It records the case context involving a patient who died while awaiting PCA services and provides structured deficiency statements with a corresponding plan of correction framework.","# Health Requlation &Licensing Administration\n\n\n| STATEMENT OF DEFICIENCIES  \u003Cbr>AND PLAN OF CORRECTION   |  | (X1)PROVIDER/SUPPLIER/CLIA  \u003Cbr>IDENTIFICATION NUMBER:  \u003Cbr>HCA-0009   | (X2)MULTIPLE CONSTRUCTION  \u003Cbr>A.BUILDING  \u003Cbr>B.WING_   |  | (X3)DATE SURVEY  \u003Cbr>COMPLETED  \u003Cbr>C  \u003Cbr>04/11/2014   |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| STREETADDRESS,CITY,STATE,ZIP CODE  \u003Cbr>NAME OF PROVIDER OR SUPPLIER  \u003Cbr>5513 ILLINOIS AVENUE,NE  \u003Cbr>PREMIUM SELECT HOME CARE,INC  \u003Cbr>WASHINGTON,DC 20011   |  |  |  |  |  |  |\n| (X4)ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | SUMMARY STATEMENT OF DEFICLENCIES  \u003Cbr>(EACH DEFICIENCY MUST BE PRECEDED BY FULL  \u003Cbr>REGULATORY OR LSC IDENTIFYING INFORMATION)   |  | ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | PROVIDER'S PLAN OF CORRECTICN  \u003Cbr>(EACH CORRECTIVEACTION SHOULD BE  \u003Cbr>CROSS-REFERENCED TO THE APPROPRIATE  \u003Cbr>DEFICIENCY)   |  | (X5)  \u003Cbr>COMPLETE  \u003Cbr>DATE   |\n| H 000   | |INITIAL COMMENTS  \u003Cbr>On April 2,2014,the Department of Health/Health  \u003Cbr>Regulation and Licensing Administration  \u003Cbr>(DOH/HRLA)received information alleging that a  \u003Cbr>patient died awaiting PCA services from Premium  \u003Cbr>Select Home Care,Inc.Due to the nature of the  \u003Cbr>information presented,on April 3,2014,  \u003Cbr>DOH/HRLA initiated an onsite investigation,to  \u003Cbr>verify compliance with the basic standards of  \u003Cbr>practice and Title 22,Chapter 39(Home Care  \u003Cbr>Agencies Regulations).The findings of the  \u003Cbr>investigation were based on record reviews and  \u003Cbr>interviews.  \u003Cbr>Please Note:Listed below are abbreviations used  \u003Cbr>in this report.  \u003Cbr>Cardiopulmonary Resuscitation(CPR)  \u003Cbr>Department of Health (DOH)  \u003Cbr>Department of Health Care Finance(DHCF)  \u003Cbr>Health Regulation and Licensing Administration  \u003Cbr>(HRLA)  \u003Cbr>Home Care Agency(HCA)  \u003Cbr>Home Health Aide(HHA)  \u003Cbr>Human Resources(HR)  \u003Cbr>Personal Care Aide(PCA)  \u003Cbr>Plan of Care(POC)  \u003Cbr>She/He(S/he)  \u003Cbr>Purified Protein Derivative(PPD)  \u003Cbr>Allegation\\#1-Patient\\#1 died while awaiting PCA  \u003Cbr>services from Premium Select Home Care,Inc.  \u003Cbr>Findings-Record reviews and interviews starting  \u003Cbr>at approximately 9:00 am,on April 3,2014  \u003Cbr>through April 11,2014 revealed the following:  \u003Cbr>-Review of \"Notification of Approved Personal  \u003Cbr>Care Aide(PCA)Services Initial Assessment\",   |  | H 000   |  |  |  |\n\nHealth Regulation &Licensing Administration  \n   14  \nLABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVES SIGNATURETITLESTATE FORMunlala十a儿  \n698  \nSDKB11  \nHealth Requlation &Licensing Administration  \n\n| STATEMENT OF DEFICIENCIES  \u003Cbr>AND PLAN OF CORRECTION   |  | (X1)PROVIDER/SUPPLIER/CLIA  \u003Cbr>IDENTIFICATION NUMBER;  \u003Cbr>HCA-0009   | (X2)MULTIPLE CONSTRUCTION  \u003Cbr>A.BUILDING.  \u003Cbr>BWING.   |  | (X3)DATE SURVEY  \u003Cbr>COMPLETED  \u003Cbr>C  \u003Cbr>04/11/2014   |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| STREETADDRESS,CITY,STATE,ZIP CODE  \u003Cbr>NAME OF PROVIDER OR SUPPLIER  \u003Cbr>5513ILLINOIS AVENUE,NE  \u003Cbr>PREMIUM SELECT HOME CARE,INC  \u003Cbr>WASHINGTON,DC 20011   |  |  |  |  |  |  |\n| (X4)ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | SUMMARY STATEMENT OF DEFICIENCIES  \u003Cbr>(EACH DEFICIENCY MUST BE PRECEDED BY FULL  \u003Cbr>REGULATORY OR LSC IDENTIFYING INFORMATION)   |  | ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | PROVIDER'S PLAN OF CORRECTION  \u003Cbr>(EACH CORRECTIVEACTION SHOULD BE  \u003Cbr>CROSS-REFERENCED TO THEAPPROPRIATE  \u003Cbr>DEFICIENCY)   |  | (X5)  \u003Cbr>COMPLETE  \u003Cbr>DATE   |\n| H 000   | |Continued From page 1  \u003Cbr>dated March 12,2014,revealed Patient\\#1's  \u003Cbr>physician requested PCA service on March 5,  \u003Cbr>2014;  \u003Cbr>-Review of hospital discharge records from  \u003Cbr>Medstar Health,dated March 10,2014,revealed  \u003Cbr>that Patient\\#1 was admitted to the Georgetown  \u003Cbr>hospital on March 6,2014,from a licensed \"long  \u003Cbr>term care facility\";  \u003Cbr>-Review of \"Notification of Approval Personal  \u003Cbr>Care Aide(PCA)Services Initial Assessment\",  \u003Cbr>dated March 12,2014,revealed that Patient\\#1  \u003Cbr>was assessed on March 8,2014,by Delmarva  \u003Cbr>for PCA services while at Georgetown hospital.  \u003Cbr>According t","cbCaijNCkDwl00vk","https://ap.wps.com/l/cbCaijNCkDwl00vk","pdf",1223408,1,8,"English","en",105,"# Initial Comments\n## Investigation basis and timeline\n## Record review findings\n## Interviews and confirmation","[{\"question\":\"What triggered the investigation by the Department of Health/Health Regulation and Licensing Administration?\",\"answer\":\"The investigation was initiated after receiving information alleging a patient died while awaiting PCA services provided by Premium Select Home Care, Inc.\"},{\"question\":\"What sources were used to determine the findings?\",\"answer\":\"Findings were based on record reviews and interviews conducted from approximately 9:00 am on April 3, 2014 through April 11, 2014.\"},{\"question\":\"What timeframe was included in the PCA service authorization information?\",\"answer\":\"The documentation states PCA services were authorized for eight hours a day, seven days a week, with service dates spanning from March 8, 2014 through September 6, 2014, and also includes Medicaid approval information from March 5, 2014 through August 31, 2014.\"}]","Health Regulation & Licensing Administration - Statement of Deficiencies and Plan of Correction - 04/11/2014 | 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triggered the investigation by the Department of Health/Health Regulation and Licensing Administration?","Question",{"text":75,"@type":76},"The investigation was initiated after receiving information alleging a patient died while awaiting PCA services provided by Premium Select Home Care, Inc.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"What sources were used to determine the findings?",{"text":80,"@type":76},"Findings were based on record reviews and interviews conducted from approximately 9:00 am on April 3, 2014 through April 11, 2014.",{"name":82,"@type":73,"acceptedAnswer":83},"What timeframe was included in the PCA service authorization information?",{"text":84,"@type":76},"The documentation states PCA services were authorized for eight hours a day, seven days a week, with service dates spanning from March 8, 2014 through September 6, 2014, and also includes Medicaid approval information from March 5, 2014 through August 31, 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