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22 Page Report

22 Page Report

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Published by Paul Glickman
22-page report
22-page report

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Published by: Paul Glickman on Feb 21, 2013
Copyright:Attribution Non-commercial

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09/03/2014

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PRINTED:
05/27/2009
DEPARTMENT OF HEALTH AND

FORM APPROVED
CENTERS FOR MEDICARE
&
MEDlcfi:rD SERVICES
OIVlB
NO 0938-0391
(X3) DATE SURVEYX2) MULTIPLE CONSTRUCTIONX1) PROVIDER/SUPPLIER/CLIATATEMENT OF DEFICIENCIESCOMPLETEDDENTIFICATION NUMBER:ND PLAN OF CORRECTION
A.
BUILDING
C
B.
WING
_________
_
05C0001822
05/07/2009
NAME
OF
PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODE
9001
WILSHIRE BLVD SUITE 106
ALMONT AMBULATORY SURGERY CENTER, INCBEVERLY HILLS, CA 90211
(X4)
ID
PREFIXTAGSUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST
BE
PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMATION)IDPREFIXTAG,PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD
BE
CROSS-REFERENCED TO THE APPROPRIATE
(X5)
COMPLETIONDATE
DEFICIENCy)
Q 000000 INITIAL COMMENTSThe following reflects the findings
of
theDepartment
of
Public Healthand during a Complaint ValidationComplaint Intake I\lumber : CA00186703Representing the Department of Public Health:Rosalinda Ramos, HFENSylvia Villaflores, HFE IQ 003Q 003MANAGEMENT416.41 GOVERNING BODY ANDThe ambulatory surgical center must have agoverning body that assumes full legalresponsibility for determining, implementing, andmonitoring policies governing the center's totaloperation and for ensuring that these policies areadministered
so
as to provide quality health care
in
a safe environment. When services areprovided through a contract with
an
outsideresource, the center must assure that theseservices are provided
in
a safe and effectivemanner.This CONDITION is not met as evidenced
by:
The governing body
of
the ASC failed to ensurethat it was legally responsible for determining,implementing and monitoring polices governingthe ASC's total operation and for ensuring thatthese policies were administered so as to providequality health care
in
a safe environment.The governing body failed to adequately monitorinterventions for a serious medical condition suchas
an
adverse anesthetic complication (malignanthyperthermia) as the needed supplies andequipment were not readily available at the time
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE
(X6) DATE
Any deficiency statement ending with
an
asterisk
(*)
denotes a deficiency which the institution may
be
excused from correcting providing it
is
determined thatother safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are qisclosable
90
daysfollowing 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 continuedprogram participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 90S511 Facility
ID:
CA630011619
If
continuation sheet Page 1 of
22
 
PRINTED:
05/27/2009
DEPARTMENT OF HEALTH
AND
HWf'}SERVICES
FORM APPROVED
. CENTERS FOR MEDICARE
&
MEDICAW
SERVICES
OMB NO
0938-0391
STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/CLIA(X2) MULTIPLE CONSTRUCTION(X3) DATE SURVEYAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:COMPLETED
A.
BUILDING
B.WING
________
_
C
05C0001822
05/07/2009
NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODE
9001
WILSHIRE BLVD SUITE 106
ALMONT
AMBULATORY
SURGERY CENTER, INC.BEVERLY HILLS,
CA
90211
(X4)
ID
SUMMARY STATEMENT OF DEFICIENCIES
ID
PROVIDER'S PLAN OF CORRECTION
(X5)
PREFIX(EACH DEFICIENCY MUST BE PRECEDED BY FULLPREFIX(EACH CORRECTIVE ACTION SHOULD BETAGREGULATORY OR LSC IDENTIFYING INFORMATION)TAGCROSS-REFERENCED TO THE APPDEFICIENCy)ROPRIATE
Q 003 Continued From page 1Q 003
of
the survey (Q006).The governing body
of
the ASC failed to ensurethat there was an on-going evaluation
of
thequality
of
care provided (Q009),
The
governing body
of
the ASC failed to ensure
/
that the facility equipped and maintained a safeand sanitary environment to protect the healthand safety
of
patients (Q010)The governing body
of
the
ASC
failed to providefunctional and sanitary environment for theprovision
of
surgical services (Q011).The governing body
of
the ASC failed to equip theoperating room with a temperature and humiditymonitoring device and functioning scrub sinks(Q012).The governing body
of
the ASC failed to ensurethat the crash cart contained accurate count
of
listed medications and not expiredmedications/supplies (Q016).The governing body
of
the ASC failed to ensurethat licensed nursing personnel were trained incardio-pulmonary resuscitation prior to startingwork(Q018).The governing body
of
the ASC failed to ensurethat proctoring was conducted for the physiciansprior to the granting
of
surgical privileges (Q020).The governing body
of
the ASC failed to conductproctoring for a nurse anesthetist
who
wasgranted privileges (Q022).
The
governing body
of
the
ASC
failed to ensure
COMPLETION
DATE
FORM CMS·2567(02·99) Pre\lious Versions ObsoleteE\lent
ID:
90S511Facility
ID:
CA630011619
If continuation sheet Page 2 of
22
 
PRINTED:
OS/27/2009
DEPARTMENT OF HEALTH AND
Hurr1
SERVICES
FORM
APPROVED
CENTERS FOR MEDICARE
&
MEDICAID SERVICESOMB NO 0938-0391
STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION(X1) PROVIDERlSUPPLIERlCLIAIDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION
A.
BUILDING(X3) DATE SURVEYCOMPLETED
05C0001822
B.
WING
________
.,--_
C
05/07/2009
NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODE
ALMONT AMBULATORY SURGERY CENTER, INC
9001
WILSHIRE
BLVD
SUITE 106
BEVERLY HILLS, CA 90211
(X4)ID
PREFIXTAG
Q 003Q 006
SUMMARY STATEMENT OF DEFICIENCIES
ID
PROVIDER'S PLAN OF CORRECTION
(X5)
(EACH DEFICIENCY MUST
BE
PRECEDED BY FULLPREFIX(EACH CORRECTIVE ACTION SHOULD BE
COMPLETION
REGULATORY OR LSC IDENTIFYING INFORMATION)TAGCROSS-REFERENCED TO THE APPROPRIATE
DATE
DEFICIENCy)
Continued From page 2that patient care responsibilities were delineatedfor all nursing service personnel (Q024).The governing body
of
the ASC failed to maintaina system for the proper storage
of
patient records(Q026).The governing body
of
the ASC failed to providedrugs and biological
in
a safe and effectivemanner,
in
accordance with acceptedprofessional practice (Q029).The cumulative effect
of
these systemic practicesresulted
in
the failure
of
the governing body todeliver statutorily mandated compliance with theprovisions
of
the governing body condition
of
coverage.416.42(a) ANESTHETIC RISK ANDEVALUATIONA physician must examine the patientimmediately before surgery to evaluate the risk
of
anesthesia and
of
the procedure to be performed.Before discharge from the ambulatory surgicalcenter, each patient must be evaluated
by
aphysician for proper anesthesia recovery.This STANDARD is not met as evidenced
by:
Based on observation, interview and recordreview, the surgery center failed to adequatelymonitor interventions for a serious medicalcondition such as an adverse anestheticcomplication (malignant hyperthermia) as theneeded supplies and equipment were not readilyavailable at the time
of
the survey .Findings:On May 5,2009,
at
approximately 5:15 p.m., theQ 003Q 006
FORM CMS-2567(02-99) Previous Versions Obsolete
Event ID: 90S511Facility
ID:
CA630011619
If continuation sheet Page 3 of
22

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