Every finding on record at American Compassionate Hospice Care, Inc

Observed in Patient Home. In 3 of 3 home visits conducted, it was noted that there was no documentation of the patient/family having been educated on the state requirements for advance directives. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 2 of 2 patient records reviewed, where patients were discharged for extended prognosis, the organization did not respect patients’ rights to participate in decisions about care, treatment, or services. In the record of RR#3 the Notice of Medicare Non-Coverage was signed the same day as the patient was discharged. And there was no Notice of Medicare Non-Coverage signed in the record of RR#5 the This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 6 of 11 patient records reviewed, the organization did not document patient specific comprehensive assessments and re-assessments that identified the need for spiritual and bereavement services, and psychosocial support. In the records of HV#1, HV#3, RR#1, RR#2, RR#3, RR#4, RR#5, RR#6, RR#7 and RR#8 no spiritual, psychosocial or bereavement assessments were documented at certification and re-certification. Additionally, post death bereavement assessments were not documented in the records of RR#7 and RR#8. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not ensure that patient records were complete and accurate. For example, in the record of HV#1 there was an order for oxygen, however, no need for oxygen was documented in assessments nor was there a concentrator or tank in the home. In the record of HV#2 that same oxygen order was found, as well as another order for oxygen via trach 5 liters per minute via ventilator. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders. Observed in Patient Home. In 1 of 3 home visits conducted, The organization did not ensure that the patient record was complete, accurately documented, and readily accessible. For example, at HV#2 the surveyor noted that there was no POLST in the home folder or on the refrigerator. According to family, the patient was moved to the daughter’s home from another location and the document was left behind. Clinical staff did not recognize that it was missing in the three weeks since the patient’s move. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not ensure that all services necessary to meet the patient's needs were addressed in the plan of care. For example, in the record of HV#3 it was noted in the admission note that the patient had a tracheostomy and was ventilator dependent. However, there were no orders for the ventilator settings. In the record of RR#2 the nurse advised the care giver to apply Desitin to reddened skin but did not obtain an order from the physician. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders. Observed in Record Review. In 11 of 11 patient records reviewed, the organization did not plan patients’ care, treatment, or services based on needs identified by assessments. For example, during HV#1 the patient complained of constipation, but this was not added to the plan of care. At HV#2 the nurse stated that the patient complained of bilateral heel pain last week. She ordered booties but did not add this problem to the plan of care. In the record of RR#2 it was documented that the skin around a stoma was reddened. This new problem was not added to the plan of care. Similar omissions were found in every record that was reviewed. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 2 of 2 patient records reviewed, where oxygen was in use, the organization did not ensure that all services necessary to meet the patient's needs were represented in the plan of care. For example, in the record of HV#2 an order for oxygen was written for two liters via nasal cannula, may titrate up to 5 liters to keep saturation greater than 92%. It did not indicate if the treatment was to be provided continuously or as needed. In the record of HV#3 that same oxygen order was written, as well as another order for oxygen via trach 5 liters per minute via ventilator. The DON stated that the hospice uses standing orders. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 10 of 11 patient records reviewed, the organization did not ensure that all services necessary to meet the patient's needs were represented in the plan of care. For example, in the record of HV#1 the social worker frequency order was prn only. In HV#2, HV#3, RR#1, RR#2, RR#3, RR#4, RR#5, RR#6, RR#7, and RR#8 the same was found for both the social worker and spiritual counselor. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Patient Home. In 1 of 2 home visits conducted, The organization did not provide the patient with care, treatment, or services according to their individualized plan of care. At HV#3 it was observed that the RN neglected to check the liter setting on the oxygen concentrator for a ventilator dependent patient. The machine was set at 2.5 liters per minute, not 5 liters per minute as ordered. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Leadership Session. the organization did not provide an organized bereavement program for the provision of bereavement services because of frequent turnover in bereavement coordinators. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Leadership Session. Leaders did not provide for a sufficient number and mix of individuals to support safe, quality care, treatment and services as evidenced by the absence of an organized bereavement program for almost four years.

Observed in Record Review. In 4 of 4 patient records reviewed, where patients were discharged alive, a summary was not completed in the records of RR#3, RR#4, RR#5, and RR#6. As well, the attending physician was not notified of the discharge and the availability of the discharge summary. This RFI was reviewed, discussed, and validated with the Administrator and other hospice leaders.

Observed in Record Review. In 1 of 1 patient records reviewed, it was noted that the hospice aide visits were provided three times per week however the plan of care stated that the visit frequency would be twice per week. This was confirmed by the DPCS designee.

Observed in Record Review. In 1 of 1 patient records reviewed, it was noted that the supervisory visits for the hospice aide were not done at least every 14 days. For example, in record review #1 there was a period of 28 day, 15 days and 21 days without documentation for the supervisory visit. This was verified by the DPCS designee.