Every finding on record at 24/7 Apollo Hospice & Palliative Care

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review, interview and observation. In 2 of 14 (14%) clinical records reviewed it was revealed that the agency did not ensure the plans of care included interventions based on the problems identified in the comprehensive assessments. CLINICAL RECORD 1: In the initial comprehensive nursing assessment, dated 07/11/2025, the RN documented that the patient had a Foley catheter 16 French in place. During the home visit (Home Visit 1) on 07/15/2025, conducted with the Chaplain (Personnel Record 6), the patient was observed with a Foley catheter in place. The plan of care (POC), dated 07/11/2025, did not include any problems, goals, or interventions related to the Foley catheter. The POC included the following statements for the genitourinary system problem; "Potential for altered bladder elimination related to disease process incontinence." The following interventions were listed; "Instruct patient/family/caregiver on proper incontinence care; on-going assessment of urinary eliminations status discomfort, complications and alterations; instruct patient/family/caregiver regarding new medication/treatment order and side effects; monitor/assess effectiveness of current and new medication/treatment." On 07/16/2025 during an interview the Director of Patient Care Services (DPCS) reported that this was a new admission, and the Foley catheter interventions were missed on the initial plan of care. CLINICAL RECORD 3: In the initial spiritual assessment, dated 05/02/2025, the Chaplain documented "source of distress/concern included anticipatory grief." On the visit note dated 06/21/2025 the Chaplain documented, "Chaplain to remain supportive and provide ongoing spiritual care and emotional encouragement for the duration of hospice services to ensure spiritual needs are met and addressed." The plan of care dated 04/30/2025 to 07/28/2025, did not include any problems, goals, or interventions related to anticipatory grief or spiritual issues. During an interview with the Administrator and DPCS on 07/16/2025 they confirmed the POC did not include any goals or interventions to address the spiritual issues. The Administrator said that the Chaplain discussed the patient needs during the interdisciplinary team meetings and because of that she didn't realize they weren't documented on the POC.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 14 (21%) clinical records reviewed it was revealed that the agency did not ensure the record included election of benefit forms that were completed and signed in accordance with regulation. Per the Code of Federal Regulations: § 418.24 Election of hospice care. (b) Content of election statement. The election statement must include the following: (4) The effective date of the election, which may be the first day of hospice care or a later date but may be no earlier than the date of the election statement. CLINICAL RECORD 2: The 'Election of Hospice Benefit' document was signed by the patient's power of attorney (POA) on 07/08/2025. The document included the hospice election statement, "I (patient name) choose to elect the Medicare hospice benefit and receive Hospice services from (Agency) to begin on (effective date)." The effective date of election was left blank. CLINICAL RECORD 5: The 'Election of Hospice Benefit' document was signed by the patient's spouse on 01/21/2025. The document included the hospice election statement, "I (patient name) choose to elect the Medicare hospice benefit and receive Hospice services from (Agency) to begin on (effective date)." The effective date of election was left blank. CLINICAL RECORD 6: The 'Election of Hospice Benefit' document was signed by the patient's power of attorney (POA) on 05/15/2025. The document included the hospice election statement, "I (patient name) choose to elect the Medicare hospice benefit and receive Hospice services from (Agency) to begin on (effective date)." The effective date of election was left blank. Personnel Record 1: During the interview on 07/16/2025 the Administrator and Director of Patient Care Services reviewed the election of benefit forms and reported that "somehow we missed the (effective) date on those forms." The Administrator also confirmed that all three were Medicare patients. Per the Code of Federal Regulations: § 418.24 Election of hospice care. (b) Content of election statement. The election statement must include the following: (4) The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement.

Upon patient record review, 1 of 5 (Patient # 3) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #3 had 9/20/21 order to “Maintain indwelling Foley catheter 18 Fr, secured snuggly by balloon with 10 cc. distilled water and change every 30 days as needed (prn).” The GU / Foley was not identified in problem list of IDG Plan of Care initial or subsequent updates. Patient also developed skin tear with subsequent treatment order 1/4/22 for Bacitracin Zinc Neomycin Sulfite Polymycin B Sulfate OTC (Curad Triple Antibiotic Ointment) 400 units-5 mg. Apply thinly over affected area twice a day. There was no evidence of a plan of care that included goals and interventions on the problem list.

Upon patient record review, 1 of 5 (Patient # 3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #3 had 9/20/21 order to “Maintain indwelling Foley catheter 18 Fr, secured snuggly by balloon with 10 cc. distilled water and change every 30 days as needed (prn).” The IDG Plan of care did not include GU/Foley catheter care and related CG education. Also, Patient developed skin tear with subsequent treatment order 1/4/22 for Bacitracin Zinc Neomycin Sulfite Polymycin B Sulfate OTC (Curad Triple Antibiotic Ointment) 400 units-5 mg. Apply thinly over affected area twice a day. There was no specification of affected location in this order.

Upon client record review, 1 of 5 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3 had 9/20/21 order to “Maintain indwelling Foley catheter 18 Fr, secured snuggly by balloon with 10 cc. distilled water and change every 30 days as needed (prn).” There was no documentation as evidence that the catheter was changed at all. Discussed with DPCS, who is also the visiting nurse. She states catheter was changed, but not documented.

Upon personnel record review, 1 of 1 applicable personnel files, (Personnel #3 ) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: ·(C) Shampoo, sink, tub, and bed Personnel Record #3: The competency assessment form utilized by the agency does not differentiate among types of shampoo to be demonstrated for competency. It is not clear that competency for tub, bath and sink shampoos were verified.

Upon patient client record review, 5 of 5 (Patient 1, 2, 3, 4, 5) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 All patient election statement did not include • The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement. An individual may not designate an effective date that is retroactive • Identification of the patient's chosen attending physician. The individual or representative must acknowledge the identified attending physician was his or her choice.

Upon patient client record review, 5 of 5 (Patient #1, 2, 3, 4, 5) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patients #1, 2, 3, 4: The Paper RN Comprehensive Assessment used had prefilled NA's written in different areas of the assessment. The assessment should be individualized and NA determined at time of actual assessment. Although the bold NA was noted, the assessing nurse had documented evidence of assessment where appropriate, resulting in the documentation of the assessment unclear in some areas. Patient #1 Hospice Social Worker's Assessment (addendum to Comprehensive Assessment) is dated 12/14/21. Administrator states that a regular visit note should have been used. Patient #5: Hospice Social Worker's Assessment (addendum to Comprehensive Assessment) is dated with SOC 8/2/21 with benefit period written in as 8/2/21-10-30/21. The nursing assessment and other components of record identify SOC as 1/20/21 and benefit period as 1/20/21-4/19/21. The patient discharged from service on 2/27/21. The Administrator verifies that the latter dates are correct for this patient.