Every finding on record at Angel House Hospice Care Inc

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) 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 #1,2,3,4,5,6,7,8,9,10, Missing documentation of funeral home on initial psychosocial assessment. No evidence of psychosocial care plan addressing absence of funeral home planning.

Upon patient record review 1 of 14 (Patient #7) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #7, Aide completed meal prep with no evidence RN directed on care plan.

Upon patient record review, 1 of 5 records (Patient #1) 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 1: The medical record contained nursing documentation upon admission form identifying the patient utilized oxygen as needed for shortness of breath. There was no evidence of problems, goals, and interventions related to respiratory deficit included in the plan of care. Corrected on site.

Upon patient record review, 3 of 5 (Patient #1, #2, #3) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs Patient 1, 2, 3: The medical record contained order frequency for Registered Nurse as one time for initial assessment and every 14 days for supervisory visit or recertification. Also contained order for Skilled Nursing frequency once weekly and weekly PRN for pain or symptom management. The instructions for ordered frequency of combined nursing was unclear. The ordered frequency for Social Worker and Spiritual Care stated once for initial assessment and evaluation of patient and family needs and/or as needed. There was no defined amount of PRN visits or ordered ongoing frequency after the initial assessment. Corrected on site.

Upon patient record review, 3 of 5 records (Patients #1, #2, #3) 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 home visit observation, patient had bed rails on the hospital bed. There was no evidence of the bed rails included in the plan of care. Corrected on site. Patient 2: Upon home visit observation, patient had a shower bench present in the bathroom. There was no evidence of the shower bench included in the plan of care. Corrected on site. Patient 3: Upon home visit observation, patient had nebulizer present at bedside. There was no evidence of the nebulizer included in the plan of care. Corrected on site.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Upon observation during home visits with the LVN, the clinician was witnessed placing bag on uncleansed surfaces without barrier underneath within two patient homes, the agency policy indicated that bag was to be placed on a clean surface.

Upon patient record review, 2 of 2 applicable records (Patients #4, #5) did not have evidence that the discharge summary includes all required information. Patient 4: There was no evidence of a discharge summary to include patient treatments, symptom management, the current plan of care, the latest physician orders, and other documentation to assist with post-discharge continuity of care. Patient 5: There was no evidence of a discharge summary to include patient treatments, symptom management, the current plan of care, the latest physician orders, and other documentation to assist with post-discharge continuity of care.