Every finding on record at A Brightstart Services Inc

It is required that the hospice designates a registered nurse member of the IDG to ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). The patient or patient representative, and the primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by review of clinical records and interview. 2 of 11 (18%) clinical records reviewed revealed the hospice did not ensure that services provided were consistent with the individualized plan of care as established by the IDG. Clinical Record #75098 was reviewed and identified the patient elected hospice care on 12/29/21. The ordered skilled nursing visit frequency initiated on 12/29/21 was 2 times a week times 1, then 1 time a week times 11. The clincical record revealed a missed visit by the skilled nurse the week of 2/6/2022, no visits were completed. There was no documentation explaining the missed visit. Clinical Record #79081 was reviewed and identified the patient elected hospice care on 4/8/2022. The ordered skilled nursing visit frequency initiated on 4/8/2022 was 1 time a week times 12. The clinical record revealed an extra visit by the skilled nurse the week of 4/8/2022, 2 visits were completed. There was no documentation explaining the extra visit. During an interview on 5/13/2022, the Administrator confirmed the visit frequencies did not occur as ordered in each patient’s plan of care, and that there was no documentation to support the reason the visit frequencies did not follow orders present in the patient’s plans of 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 includes all services necessary for the palliation and management of the terminal illness, including measureable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by review of clinical records and interview. 1 of 11 (9%) records reviewed revealed the hospice did not ensure the plans of care were individualized, reflecting problems identified in the assessments, with measurable outcomes. Clinical Record #50095 was reviewed and identified the patient elected hospice care on 4/5/2022. The documentation revealed the RN initial assessment completed on 4/5/2022 identified that medications are crushed and administered through the patient’s peg tube. The initial and comprehensive plan of care dated 4/7/2022 does not include planned interventions based on medications being crushed and administered through the patient’s peg tube. There was no evidence of peg tube medication interventions or a measurable outcome. During an interview on 5/13/2022, the Administrator confirmed the patient’s plan of care did not include orders or interventions for crushing medications and administering through the patient’s peg tube.