Every finding on record at A Hug Away Inc

Based on record review and interview, the agency failed to conduct and document in writing a patient-specific comprehensive assessment that identified the patient's need for physical, psychosocial and spiritual care for 2 of 2 reviewed (patient #1 & #2) in that: Comprehensive assessments did not include assessment of patients #1 & #2 by the SC and MSW. Patient #1 required assistance with ADLs and the agency did not send MSW to facilitate the provision of social services for the patient. This failed practice has the potential to harm agency patients due to needs of patients and their families' not being promptly identified and resources applied to address the needs. Findings include: Patient #1 Review of Patient #1's CR revealed SOC on 10/10/2021. POC for the benefit period 10/10/2021 - 1/7/2022 showed with terminal diagnosis of chronic kidney disease, stage 4. Services ordered include SN 1 every week, MSW as needed, and Hospice Aide 3 times a week. Review of CR showed that only initial nursing assessment was completed. There were no assessments by the MSW or Chaplain. There was no documentation in the CR that the patient declined the services. Interview with patient #1's FM on 12/29/2021 at 10:25 a.m., she stated the following: Patient #1 was bedbound and required assistance with ADLs. She stated that another FM had been assisting patient #1 with ADLs but had fallen ill and was unable to continue assisting Patient #1 with ADLs. The FM stated that she reached out to the agency in November that the patient had developed wound in sacrum and she and the other FM needed help to provide ADLs for the patient. The RN and DON came to assess the patient and an indwelling urinary catheter was inserted for the patient. The FM further stated that the DON told her that she would send the MSW to evaluate the situation and help the family obtain assistance, but the agency never sent the MSW. Patient #2 Review of Patient #2's CR revealed SOC on 10/7/2021. POC for the benefit period 10/7/2021 - 1/4/2022 showed the terminal diagnosis of malignant neoplasm of prostate. Services ordered include SN 1 every week and Hospice Aide 1 every week. Review of CR showed that only initial nursing assessment was completed. There were no assessments by the MSW or Chaplain. There was no documentation in the CR that the patient declined the services. Review of IDG meeting sign-in sheets dated 10/14/2021, 10/28/2021, 11/11/2021, 11/24/2021 & 12/9/2021 showed that MSW was not present at the meetings. The IDG meeting minutes did not indicate that social services problem identified for patient #1 was discussed during the meetings. During interview with DON and RN on 12/30/2021 at 3:15 p.m., DON stated that agency RNs are required to explain and offer MSW and Chaplain services to patients on admission. DON explained that if the patient accepts the services, the agency sends out the MSW and chaplain to conduct an assessment, and if the services are declined, the RN documents in the nursing assessment and the POC. The staff was asked if the services were offered to the above patients. RN stated that the services were declined by the patients on admission, but he forgot to document the declination in the patients' CR. The staff was asked if they identified need for assistance with ADLs for patient #1 when they assessed the patient on 11/23/2021. DON stated that they identified the need and they told the patient's FM that she needed to complete the Medicaid application for provider services for the patient, but the patient's daughter said she had no time to complete the application. DON was asked why she did not involve a MSW at this time. DON stated that she instructed the MSW to assess the patient and the MSW told her that she completed the assessment and provided the Medicaid application to the patient's FM. DON was asked why there was no documentation by the MSW. DON stated that the MSW went to see the patient but failed to document. During an interview with MSW on 12/30/2021 at 4:17 p.m., she stated that she worked for agency sporadically on PRN basis, maybe every six months. MSW added that she was supposed to see a patient for the agency two weeks ago, but she was later informed that the patient was sent to the hospital. MSW was unsure of the patient's name but stated that patient #1 was probably patient #1. MSW further stated she never saw patient #1. During follow up interview with DON on 12/30/2021 at 4:22 p.m., she stated that she only sent a text message to the MSW on 11/24/2021 to go out and assess patient #1 and the MSW responded to the text message that she would complete the assessment the following week. DON stated that she did not follow up to make sure the service was provided. Review of agency's policy titled "Patient Assessments", revised 01/01/2020, read in part: "The Hospice will conduct and document in writing a patient-specific comprehensive assessment that identifies the patient's need for hospice care and services, and the patient's need for physical, psychosocial, emotional, and spiritual care..... A. The IDG in consultation with the patient's attending physician (if any), will complete the comprehensive assessment no later than five (5) calendar days after the election of the hospice benefit........ Each assessment will be completed by qualified agency staff who have the necessary skills and training and comply with all federal and state laws and regulations......."

Based on record review and interview, the IDG failed to provide the care and services offered by the hospice, and the group, in its entirety, did not supervise the care and services for 2 of 2 patients for 2 of 2 reviewed (patient #1 & #2) in that: Comprehensive assessment did not include assessment of patients #1 & #2 by the SC and MSW, and there was no documentation that the patients declined the services. Patient #1 required assistance with ADLs and the agency did not send a MSW to facilitate the provision of social services for the patient. There was no documentation that the MSW participated in the IDG meetings since October 2021. This failed practice has the potential to harm agency patients due to care needs not being promptly identified and addressed by the professional group to ensure that resources are applied to meet the needs. Findings include: Patient #1 Review of Patient #1's CR revealed SOC on 10/10/2021. POC for the benefit period 10/10/2021 - 1/7/2022 showed with terminal diagnosis of chronic kidney disease, stage 4. Services ordered include SN 1 every week, MSW as needed, and Hospice Aide 3 times a week. Review of CR showed that only initial nursing assessment was completed. There was no assessment by the MSW and Chaplain. There was no documentation in the CR that the patient declined the services. Patient #2 Review of Patient #2's CR revealed SOC on 10/7/2021. POC for the benefit period 10/7/2021 - 1/4/2022 showed the terminal diagnosis of malignant neoplasm of prostate. Services ordered include SN 1 every week and Hospice Aide 1 every week. Review of CR showed that only initial nursing assessment was completed. There were no assessments by the MSW or Chaplain. There was no documentation in the CR that the patient declined the services. Review of IDG meeting sign-in sheets dated 10/14/2021, 10/28/2021, 11/11/2021, 11/24/2021 & 12/9/2021 showed that MSW was not present at the meetings. There was no documentation that the IDG met after 12/9/2021. The IDG meeting minutes did not indicate that social services problem identified for patient #1 was discussed during the meetings. Interview with patient #1's FM on 12/29/2021 at 10:25 a.m., she stated the following: Patient #1 is bedbound and requires assistance with ADLs. The patient's husband who is her father has been assisting patient #1 with ADLs, but lately her father's health has deteriorated. It has become increasingly difficult for her father to help the patient with ADLs, especially since he started radiation treatment for cancer. The patient's husband was diagnosed with cancer and has started radiation treatment in past few weeks. She (patient's daughter) and her son also helped when they are at home, but she works long hours to support the family and her son works as well. She reached out to the agency in November that the patient had developed wound in sacrum and her father needed help to provide ADLs for the patient. The RN and DON came to assess the patient and an indwelling urinary catheter was inserted for the patient. The DON also said that she will send the MSW to evaluate the situation and help the family obtain assistance, but the agency did not send the MSW. Interview with RN on 12/30/2021 at 2:54 p.m., he was asked why the IDG meeting minutes did not indicate that patient #1's need for social services was not discussed during the meetings. RN stated that the issue was discussed during the meetings. RN explained that virtual meetings were conducted since Covid-19 started and the secretary wrote the minutes, but he documented in the patient's CR. RN was asked why there was no MSW in the meetings. RN stated that the meetings were virtual meetings and the MSW must have been at the meeting. RN was asked if he was sure the MSW participated in the meetings. RN stated that he did not know if the MSW attended the meetings. Review of Patient #1's IDG POCs 11/24/2021 & 12/9/2021 for the IDG meetings after the visit on 11/23/2021 did not include any plan by the MSW. During interview with DON and RN on 12/30/2021 at 3:15 p.m., DON stated that agency RNs were required to explain and offer MSW and Chaplain services to patients on admission. DON explained that if the patient accepted the services, the agency sent out the MSW and chaplain to conduct an assessment, and if the services were declined, the RN documented in the nursing assessment and the POC. The staff was asked if the services were offered to the above patients. RN stated that the services were declined by the patients on admission, but he forgot to document the declination in the patients' CR. The staffs were asked if they identified need for assistance with ADLs for patient #1 when they assessed the patient on 11/23/2021. DON stated that they identified the need and they told the patient's FM that she needed to complete the Medicaid application for provider services for the patient, but the FM said she had no time to complete the application. DON was asked why she did not involve a MSW at this time. DON stated that she instructed the MSW to assess the patient and the MSW told her that she completed the assessment and provided the Medicaid application to the FM. DON was asked why there was no documentation by the MSW. DON stated that the MSW went to see the patient but failed to document. Interview with MSW on 12/30/2021 at 4:17 p.m., she stated that she works for agency on PRN basis, maybe once every six months. MSW added that she was supposed to see a patient for the agency two weeks ago, but she was later informed that the patient was sent to the hospital. MSW was unsure of the patient's name but stated that patient #1 was probably patient #1. MSW further stated she never saw patient #1. The IDG failed to identify that the MSW failed to assist Patient #1 with acquiring ADL services. During follow-up interview with DON on 12/30/2021 at 4:22 p.m., she stated that she only sent a text message to the MSW on 11/24/2021 to go out and assess patient #1 and the MSW responded to the text message that she would complete the assessment the following week. DON stated that she did not follow-up to make sure that the service was provided. Review of agency's policy titled "Interdisciplinary Group Roles and Responsibilities", revised 12/01/19, read in part: "The IDG, in collaboration with the attending physician (if any), will prepare a written plan of care for each patient/family, which specifies the care and services necessary to meet the patient/family-specific needs identified in the comprehensive assessment, as those needs relate to the terminal illness and related conditions. The IDG, in its entirety, will supervise the care and services ... ..." "IDG meetings will be held during the course of patient care to monitor and evaluate the patient's interdisciplinary POC progress, at least every fifteen (15) days, or more frequently if warranted by the patient's condition."