Every finding on record at A-1 Hospice Care, Inc.

Observed in Record Review. In 1 of 4 patient records reviewed, for active patients, the organization failed to respect the patient's rights to participate in decisions about their care, treatment, and services. For example: on review of RRHV#2 during the admission process the patient/responsible party failed to elect or decline the Notification of Hospice Non-Covered Items, Services and Drugs as section was left blank on the election form. Further, there was a blank Notification of Hospice Non-Covered items, Services, and Drugs addendum signed by the responsible party noted in the record. This observation was reviewed with the Administrator/DPCS. Observed in Record Review. In 2 of 2 patient records reviewed, for live discharge for extended prognosis, the organization failed to ensure the patient's right to participate in decisions about their care, treatment, or services. In review of RRDC#1, RRDC#2 the patient was discharged for extended prognosis and given the Notice of Medicare Non-Coverage timely as required however the form failed to provide the contact number for the Quality Improvement Organization (QIO). Further, on review of the Hospice Election in the admission packet the QIO information was noted to be not specific as it specified a website to go to to obtain the QIO contact information but did not specifically name the QIO and how to contact. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 1 of 4 patient records reviewed, for active patients, the organization failed to maintain complete and accurate patient records. On review of RRNHV#4 there was documentation in the most recent nurses note with details of the wound with measurements of length, width, and depth, and the wound treatment provided, yet later in the narrative the nurse provided conflicting documentation that the wound was healed. This observation was reviewed with the Administrator/DPCS.

Observed in Record Review. In 4 of 4 patient records reviewed, for active patient records, the organization failed to ensure the plan of care reflect the patient and family goals that were specific, measurable, and time bound. Throughout the records reviewed there were goals that were noted to be non-specific, and not measurable or time-bound. The issues were particularly seen in the psychosocial and spiritual goals. Examples were: in RRHV#1 a spiritual goal was “peaceful presence compassionate companionship” with no achieve by date established. In RRHV#2 a documented short-term psychosocial goal that read like an interventions and was not time-bound was MSW will provide emotional support, counseling and community resources referrals as needed. In RRHV#4 a goal read patient’s social/emotional needs will be met as evidenced by: ongoing visits and referrals to the community within 90 period of time, which was non-specific and not measurable. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 2 of 4 patient records reviewed, for active patient records, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#2 there was documentation of skin irritation from itching/scratching on the thighs and buttocks with the addition of medicated cream for treatment yet the issue was not reflected on the care plans. In RRHV#3 there was documentation of leg swelling with orders for decreased sodium, elevation, and lab work yet there was no care plan to guide the care. Further, the MSW documented efforts to assist the patient with the funeral planning yet the issue was not reflected in the care planning process. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 2 of 5 patient records reviewed, for live discharge, the organization failed to ensure documentation of the hospice discharge summary and, if requested, a copy of the patient's clinical record was provided upon patient discharge to hospital as required. On review of RRDC#3 and RRDC#5 the patient revoked services to enter the hospital yet there was no documentation of discharge summary sent or coordination of care with the receiving hospital. This observation was reviewed with the Administrator/DPCS.

Observed in Record Review. In 11 of 11 patient records reviewed, Prior to care the organization did not provide to the patient/caregiver in writing an approximate dollar amount they would be responsible for, even if that amount was zero, as this information was not included in the financial section of the admission documents. This observation was reviewed with the DPCS and the QA RN.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization failed to ensure the comprehensive assessment was updated by the IDG team no less frequently that every 15 days. For example: upon review of RR#9 there was a 29 day gap in RN visits to conduct an update to the comprehensive assessment. All visits between were conducted by the LVN. Similar findings were noted in RR#8 with a 25 and a 22 day gap and RR#5 with a 28 day gap. There observations were reviewed with the DPCS and the QA RN.

Observed in Record Review. In 2 of 11 patient records reviewed, The organization failed to provide a statement of the scope and frequency of services necessary to meet the specific patient and family needs. For example: upon review of HV#2 the chaplain service was noted to be declined prior to the initial assessment, however the subsequent IDG meetings the chaplain statement noted that spiritual care services continue with a statement of tolerating our sessions well. Upon recertification, the recert plan of care continued to contain the order stating SC services 1 time for assessment and then 1 time a month, yet services were not being provided . Example 2: upon review of RR#9 it was noted that the spiritual care services were ordered 1 time a month yet no visit was noted in the record for February in benefit period 8. Further, the Repoc for benefit period 8 orders hospice aide 2 times a week yet aide services were discontinued in the pervious benefit. This observation was reviewed with the DPCS and the QA RN.

Observed in Data Session. During the infection control session it was noted that the organizations written infection prevention and control plan failed to include a goal to address limiting the spread of infections associated with procedures. This observation was reviewed with the DPCS and QA RN. Observed in Data Session. During the infection control session it was noted that the organization failed to establish a goal related to limiting the spread of infections associated with the use of medical equipment, devices, and supplies. This observation was reviewed with the DPCS and QA RN. Observed in Data Session. During the infection control session it was noted that the organization failed to establish a goal that included limiting unprotected exposure to pathogens as part of their infection prevention and control plan. This observation was reviewed with the DPCS and QA RN. Observed in Data Session. During the infection control session discussion it was noted that the organization failed to establish a goal to address prioritized risks assessed as part of their infection prevention and control plan. This observation was reviewed with the DPCS and the QA RN.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization failed to provide detailed written patient care instructions for the hospice aide. For example: Upon review of the Hospice Aide assignment for HV#1 it was noted there was a frequency for the patient bath of 2 times a week. For all other assigned tasks, the frequency was left blank. This observation was reviewed with the DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to ensure the clinical record contained information that reflected the patient's care, treatment, and services provided. For example: upon review of HV#2, and RR#7 the chaplain's summary in the IDG meeting stated SC continues to provide spiritual support to patient and PCG. Patient is tolerating our sessions well yet the chaplain had not yet visited the patient. This observation was reviewed with the DPCS and QA RN.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization failed to ensure the clinical record included information that reflected the patient's care, treatment, and services. For example: upon review of RR#4, the RN documented the patient had suprapubic tenderness, urinary frequency, and burning. Further was documented plan for next visit was to monitor for response to antibiotics. There was no documentation of changes to the medication profile, orders for antibiotics, nor any documentation of education to the patient and/or family of the medication addition. This observation was reviewed with the DPCS and QA RN.