Every finding on record at Angelic Arms Home Hospice, LLC

Based on record reviews, staff interview, and review of policy titled ";Verification of Physician Orders," dated May 2023, it was determined the hospice failed to develop a plan of care that included all services necessary for the palliation and management of the terminal illness and related conditions for two patients (P) (P#6, P#10) of 14 sampled patients. --- The findings include: Review of policy, ";Verification of Physician Orders", Policy No. 2-046.1, dated May 2023 reveals the following: Policy ";Orders will be obtained from a licensed physician (or other licensed practitioner) for care and services to be provided to hospice patients." Procedure 9. ";A copy of the order will be kept in the patients clinical record." 1. Record review reveals P#6 was admitted to hospice on 3/8/2024 with a diagnosis of Alzheimers (a type of dementia that affects memory, thinking, and behavior) and a stage four sacral wound (a deep wound on the bone located at the base of the spine that reaches the muscles, ligaments, or bones. It is the most severe form of bedsore). Review of clinical records for P#6 reveals visits by a Registered Nurse (RN) on dates of 3/8/2024 and 3/19/2024, noting the sacral wound and wound care consisting of cleansing with wound cleanser, packing with wet gauze in Dakin's solution (used to kill germs and prevent germ growth in wounds), covering with gauze and securing with dressing. Review of a physician's order for wound care is dated 4/4/2024. A review of clinical record reveals no physician orders regarding sacral wound interventions or goals prior to 4/4/2024. 2. Record review reveals P#10 was admitted to hospice on 12/14/2023 with a diagnosis of frontotemporal neurocognitive disorder (an umbrella term for a group of brain diseases that mainly affect the frontal and temporal lobes of the brain. These areas of the brain are associated with personality, behavior, and language). Review of clinical records reveal an RN visit dated 1/31/2024 stating P#10 has a Foley catheter (a semi-flexible plastic tube inserted into the bladder and attached on the other side to a bag that collects urine. It is used when you cannot urinate normally). Further review of the clinical record failed to reveal a physician order for Foley catheter insertion or ongoing care. No documentation was available of when the Foley was inserted. Interview with the Director of Nursing (DON) on 4/10/2024 at 11:00 a.m. confirmed P #6 lacked a physician order for management of the sacral wound before 4/4/2024 or any documentation of discussions with the physician regarding wound care. The DON acknowledged that no physician order for the Foley catheter for P#10 was obtained before being placed and that the clinical record lacked documentation of when the Foley was inserted.

Based on record reviews and staff interview, it was determined that the agency Interdisciplinary Team (IDT) failed to ensure Master of Social Worker (MSW) care and services were provided as ordered in the plan of care (POC) by the agency for three patients (P) (P#1, P#3, P#10) of 14 sampled records reviewed. --- The findings include: 1. Review of the POC for P#1 revealed the MSW services were ordered one time a month starting 2/25/24. It was determined the MSW failed to reveal services for P#1 during the month of March 2024. Additionally, the clinical record failed to reveal documentation of a missed visit note with physician notification of the missed visit therefore, resulting in an unauthorized missed visit. 2. Review of the POC for P#3 revealed the MSW services were ordered one time a month starting 1/20/24. It was determined the MSW failed to reveal services for P#1 during the month of March 2024. Additionally, the clinical record lacked documentation of a missed visit note with physician notification of the missed visit therefore, resulting in an unauthorized missed visit. 3. Review of the POC for P#10 revealed the MSW services were ordered one time a month starting 12/14/23. It was determined the MSW failed to reveal services for P#10 during the month of March 2024. Additionally, the clinical record lacked failed to reveal documentation of a missed visit note with physician notification of the missed visit therefore, resulting in an unauthorized missed visit. During an interview with the agency Director of Nurses (DON) on 4/10/24 at approximately 1:30 p.m., the DON was unable to locate MSW visit notes for the month of March for P#1, P#3 and P#10. The DON further revealed if a visit is missed the clinician is responsible for putting documentation in the record of the missed visit and the reason why the visit was missed. The DON did review the record and was unable to provide documentation of missed visit notes for the visits missed.