Every finding on record at Accentcare Hospice & Palliative Care of Rhode Island, LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #HOS-044 "Initial Hospice Assessment" (revision date 11/01/2022) stated in part, "Based on the initial assessment, the plan of care will be initiated on the day of admission. The registered nurse, in consultation with other members of the interdisciplinary Group (IDG) and the attending physician, if any, will consider the information gathered from the nursing assessment as they develop the plan of care, and the group will determine who should visit the patient/family during the first five (5) days of hospice care to complete the comprehensive assessment. At a minimum, each patient will have a nursing and a social work assessment." In 3 of 12 (25%) clinical records reviewed, the agency did not ensure that the initial comprehensive was completed no later than five (5) calendar days after the election of hospice care. Clinical Record 1: The patient elected hospice care on 05/30/2024. The Chaplain completed the spiritual assessment on 06/06/2024, seven (7) days after the election of care. A clinical record review revealed no evidence that an initial assessment of the patient's spiritual needs was completed no later than five calendar days after the election of hospice care. Clinical Record 2: The patient elected hospice care on 05/02/2024. An administrative discharge was completed on 05/27/2024 due to the untimely receipt of a written physician's order for hospice care. The patient re-elected hospice care on 05/28/2024. A clinical record review revealed no evidence that an initial assessment of the patient's spiritual needs was completed as part of the comprehensive assessment. Clinical Record 11: The patient elected hospice care on 04/16/2024. A clinical record review revealed no evidence that an initial assessment of the patient's spiritual needs was completed as part of the comprehensive assessment. The Executive Director and Regional Director of Clinical Operations confirmed the findings during a joint record review and interview on 07/31/2024.

It is required that each patient’s individualized written plan of care: reflects patient and family goals; identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; [and] includes all services necessary for the palliation and management of the terminal illness. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #HOS 2-030 "The Plan of Care" (revision date 09/12/2023) stated in part, "The written care plan shall contain, but will not be limited to, the following: U. Measurable outcomes anticipated from implementing and coordinating the plan of care." In 2 of 12 (17%) clinical records reviewed, the agency did not ensure that the individualized plan of care reflected the patient's and family's goals. Clinical Record 7: The patient elected hospice care on 07/11/2024 with a diagnosis of hypertensive heart disease. A physician order was obtained on 07/23/2024 for Cefuroxime 250 mg for seven days for treatment of an uncomplicated urinary tract infection and possible cellulitis. The plan of care did not document goals for the intervention addressing the uncomplicated urinary tract infection or possible cellulitis. Clinical Record 9: The patient elected hospice care on 06/13/2024. A physician order was obtained for wound care on 06/17/2024. The physician ordered, "cleanse with NS and cover with dry permeable dressing (dpd) once per week by hospice nurse or as needed for wet or compromised dressing." The clinical record lacked evidence that the individualized plan of care included measurable outcomes addressing skin integrity/wound. During a joint interview and record review on 07/31/2024, the Executive Director and Regional Director of Clinical Operations confirmed the findings, stating, "We are retraining on care plans, but it is our practice that there is a care plan for active problems."

It is required that counseling services include spiritual counseling. The hospice provides an assessment of the patient’s and family’s spiritual needs. Spiritual counseling to meet spiritual needs is provided in accordance with the patient’s and family’s acceptance of the services and in a manner consistent with the patient and family beliefs and desires. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy # HOS 2-007 Spiritual Care Counseling Services revision date 03/01/2024 stated in part "The Spiritual Care Counselor will contribute to the comprehensive assessment and ongoing updates to the comprehensive assessment based on the needs of the patient and their chosen family as soon as possible after admission." In 2 of 12 (17%) clinical records reviewed, the agency did not ensure that spiritual counseling to meet spiritual needs was provided in accordance with the patient’s and family’s acceptance of the services. Clinical Record 2: The patient elected hospice care on 05/02/2024. An administrative discharge was completed on 05/27/2024 due to the untimely receipt of a written physician's order for hospice care. The patient re-elected hospice care on 05/28/2024. The RN's initial comprehensive assessment documented the patient's acceptance of spiritual services and the need for an evaluation of spiritual care services. A clinical record review revealed no evidence that the patient refused the services and no evidence of communication with the patient regarding spiritual care services. There was no evidence that an assessment of the patient's spiritual needs was completed. Clinical Record 11: The patient elected hospice care on 04/16/2024. The RN's initial comprehensive assessment documented the patient's acceptance of spiritual services and the need for an evaluation of spiritual care services. A clinical record review revealed no evidence that the patient refused the services and no evidence of communication with the patient regarding spiritual care services. There was no evidence that an assessment of the patient's spiritual needs was completed. During a joint record review and interview on 07/31/2024, the Executive Director and Regional Director of Clinical Operations confirmed the findings and stated in part, "The chaplain visit was plotted for 06/01/2024, I'm not sure why this wasn't completed."