Every finding on record at American Carequest Hospice

Observed in Regulatory Review. In 1 of 14 patient records reviewed, the hospice did not conduct and document a patient-specific comprehensive assessment that identified the patient's need for physical, psychosocial, emotional and spiritual care, including survivor risk factors. In RRHV#1, the initial bereavement risk assessment was not completed. This was reviewed and verified with the Director of Operations.

Observed in Record Review. In 1 of 10 patient records reviewed, the plan of care did not include all services needed for he palliation and management of the terminal illness and related conditions, including interventions to manage pain/symptoms. In RRNHV#6, it was documented in the initial RN assessment that the patient had a history of multiple falls and mechanical traumatization accidents, progressive cognitive dyskinesia, weakness, unsteady gait, poor safety awareness, poor judgment, and refused to use the front wheeled walker at times. Safety and fall prevention was not included/documented in the patient's hospice plan of care. This was reviewed and verified with the Director of Operations.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not plan the patient's care by ensuring the hospice plan of care included all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatments necessary to meet the patient's needs. In RRNHV#1, the patient's plan of care included orders for Tylenol Children's Suspension every 6 hours prn for pain/fever and Acetaminophen Oral Solution every 4 hours prn for pain/fever. The plan of care also included Fleets Enema ordered as needed if no bowel movement in 3 days and Bisacodyl Rectal Suppository ordered daily if no bowel movement in 3 days. There was no clear indications for use of the duplicate medication orders for pain and constipation (which medication to take when). This was reviewed and verified with the Director of Operations.

Observed in Record Review. In 4 of 4 patient records reviewed, when the patient revoked the election of hospice care or was discharged, the organization did not provide the attending physician a copy of the discharge summary and, if requested, a copy of the patient's hospice clinical record. In RRDC#1, RRDC#2, RRNHV#1, and RRNHV#2, there was no evidence the organization provided the patient's physician a copy of the hospice discharge summary. This was reviewed and verified with the Director of Operations.

Observed in Patient Home. In 1 of 1 home visits conducted, the organization did not provide patient/family education and training based on the patient's condition and needs, including information on the safe storage, handling, and access to medical gases and supplies . In RRHV#2, it was noted the patient's oxygen E-tank was stored in a small cluttered closed closet due to the family's/caregiver's lack of knowledge related to safe storage of oxygen in a well-ventilated location. This was reviewed and verified with the RN/Director of Patient Care Services and corrected during the visit. Observed in Patient Home. In 3 of 3 home visits conducted, the organization did not provide education and training based on each patient's condition and assessed needs, including procedures to follow if care, treatment, or services were disrupted by a natural disaster or an emergency. In RRHV#1, RRHV#2, and RRHV#3, the patient's individualized emergency plan in the home was incomplete. It was noted the section for the patient's specific evacuation plan details was blank. This was reviewed and verified with the Director of Operations.