Every finding on record at Accurate Hospice and Palliative Care, Inc

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable Texas state law §558.283 Advance Directives: For a patient who is incompetent/incapacitated, was the written notice provided to the correct person as noted in the TX regulation? If the patient is incompetent/incapacitated, Texas order of who may sign is as follows (also in drop down): (1) the client's legal guardian; (2) a person responsible for the health care decisions of the client; (3) the client's spouse; (4) the client's adult child; (5) the client's parent; or (6) the person admitting the client. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #12) did not have evidence of the appropriate documentation for release of confidential information. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #1 LVN visit 12/04 documents a new skin issue "erythema Right inner buttocks, advised family to apply barrier cream BID , use gel cushion, and change position every 2 hours". Discussed in IDG 12/09. No updates to plan of care to reflect this concern/ problem.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 LVN visit 12/04 documents a new skin issue "erythema Right inner buttocks, advised family to apply barrier cream BID , use gel cushion, and change position every 2 hours". There is no evidence of an order for barrier cream.

Upon patient client record review, 1 of 14 (Patient #12) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #12 resides in a "Group Home". Documentation by the hospice MSW states, patient has no family, no MPOA, and is not verbal majority of time. MSW also notes that the hospitalization just prior to admission reported the patient only spoke one time during stay, speaking in Spanish, "feed me". The SN comprehensive assessment notes mental status as, "Disoriented, minimally responsive, confused, abnormal cognitive function". The Election Statement and all consents for Hospice were signed by a Nurse case manager at the group home. Further more, this patient was listed as a "Revocation", however; no evidence of a Revocation form found in record. Also the "discharge note" states, "Revoked per MD order". There is an order from the Hospice MD to "discharge patient". The coordination note indicates that the MSW contacted APS "for concerns of lack of care, and Group Home making decisions without legal Guardianship".

Upon client record review, 2 of 14 (Patient #13,14) did not have evidence that the discharge summary includes all required information. Patient 13, 14 were Live Discharges as a result of agency issue with CMS Geographical service area. The agency gave patients/ families the choice of being re-admitted to their agency in another area or establishing care with a different hospice. The records do not reflect the information and actions as follows: "The patient record must reflect discharge planning activities, coordination with other care providers, the patient's response and understanding to these activities, patient care instructions and a reasonable notice prior to discharge, whenever possible. The written discharge summary includes: ŸThe date and reason for discharge (these records state reason as "MOVED OUT OF SERVICE AREA" these patients did not move). Any instructions or referral information given to the patient or family (no documentation of discussion with patients or family). Discharge orders, instructions, (no d/c order or instructions found), if discharge is other than patient death, A brief description of services provided and ongoing needs that cannot be met (no documentation of this found). A summary of the patient's stay, including treatments, symptoms and pain management (no documentation of this found).