Every finding on record at Aariel Hospice

Upon patient record review, 2 of 14 (Patient #3,#5) 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:The medical record includes nursing documentation that the patient requires oxygen 2-5 liters per minute PRN for dyspnea, suction as needed for excess secretions and is at risk for aspiration due to dysphagia. There is no evidence that the plan of care includes problems, goals and interventions for the use and safety of oxygen, the use and safety of suction and the management of the risk of aspiration. Patient 5:The medical record includes documentation of a primary diagnosis of Alzheimer's. There is no evidence that the plan of care includes problems, goals and interventions for the management of the primary diagnosis.

Upon patient record review, 1 of 14 (Patient #2) 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 equipment and supply needs. Patient 2:The medical record includes documentation that the patient requires the use of side rails. There is no evidence that the plan of care includes side rails as part of the DME list.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 2:The plan of care includes seizure and bleeding precautions. There is no evidence that seizure and bleeding precautions are included on the aide care plan.

Upon patient record review, 5 of 11 (Patient #1, #2, #3, #7, #8,did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1: There was no evidence of an initial bereavement assessment in the medical record. Patient #2: There was no evidence of an initial bereavement assessment in the medical record. Patient #3: There was no evidence of an initial bereavement assessment in the medical record. Patient #7: There was no evidence of an initial bereavement assessment in the medical record. Patient #8: There was no evidence of an initial bereavement assessment in the medical record.

Upon patient record review, 1 of 11 (Patient #8) 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 #8: Upon admission, oxygen 2-5L PRN SOB was ordered. There was no evidence of goals or interventions addressed in the plan of care related to oxygen usage or safety.

Upon patient record review, 3 of 11 (Patient #1, #3, #10) 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 equipment and supply needs. Patient #1: Upon admission the RN documented in the initial comprehensive assessment patient uses walker and wheelchair. There was no evidence of wheelchair or walker addressed in the plan of care. Patient #3: Upon admission, the RN documented in the initial comprehensive assessment patient is dependent on walker or cane for ambulation. There was no evidence of walker or cane addressed in the plan of care. Patient #10: Upon admission, the RN documented in the initial comprehensive assessment patient has air mattress, suction machine, and hospital bed in the home. There was no evidence of air mattress, suction machine, or hospital bed being addressed in the plan of care.

Upon patient record review, 1 of 3 applicable medical records (Patient #10) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #10: There was no evidence of a bereavement plan of care in the medical record.