Every finding on record at Anthem Hospice Providers, Inc.

Observed in Record Review. In 1 of 2 patient records reviewed, the patient revoked hospice for RR live DC#2, the revocation statement could not be found on the patient record. This was discussed with the administrator and administrator designee.

Observed in Record Review. In 1 of 3 patient records reviewed, the nurse completing the visits for RRHV#2 did not document a complete assessment for six of the scheduled visits. The system assessment areas were blank, i.e., CV, integumentary, GI/GU. This was discussed with the administrator and administrator designee.

Observed in Record Review. In 3 of 10 patient records reviewed, for RRHV#2, RRHV#3, RRNHV#2 the documentation showed wound care was completed, but did not indicate the treatment provided to the wound. This was discussed with the administrator and administrator designee.

Observed in Record Review. In 1 of 3 patient records reviewed, the surveyor noted the prn visit number was quantified, but no additional information was provided on the plan of care to determine what qualifies as a prn visit. This was discussed with the administrator.

Observed in Record Review. In 6 of 11 patient records reviewed, the agency did not follow the bereavement plan of care. For example, in RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#6, RRNHV#7, RR live discharge#1, the agency failed to send mailings for 3, 6 month post death and did not make documented calls according to the bereavement plan of care.

Observed in Leadership Session. The agency did not provide at least 5% of total patient care hours of all paid hospice employees and contracted staff. The agency percentage rate was 6.06%. This was discussed with the administrator and administrator designee.

Observed in Record Review. In 3 of 10 patient records reviewed, for RRHV#2, RRHV#3, RRNHV#2, the wound care documentation failed to identify the wound locations and treatment performed. This was discussed with the administrator and the administrator designee.

Observed in Record Review. In 2 of 2 patient records reviewed, for RR live DC#1 and RR live DC#2, the organization did not show evidence that the summary of care was provided to the agency after the transfer of services. This was discussed with the administrator and administrator designee.

Observed in Record Review. In 1 of 2 patient records reviewed, for bereavement services it was noted that at start of care the only documentation for bereavement risk was stated as Bereavement was declined at this time. MSW will be available upon request and post death there was no bereavement risk assessment documented. This was discussed with and confirmed by the QAPI nurse and the MSW.

Observed in Record Review. In 11 of 11 patient records reviewed, it was noted that the plan of care for all patients was not individualized and all of the target dates for goals were at the end of the certification period. This was discussed with and confirmed by the administrator and the QAPI nurse.

Observed in Record Review. In 11 of 11 patient records reviewed, it was noted that the plan of care did not contain measurable outcomes. Examples include the following, in record review #1 for a sleep issue the goal was written as: Promote optimal rest status for Pt/Family/PCG after hospice pharmacological and non pharmacological management and for the pain issue the goal was written as: Keep pain below SIT level for comfort after pharmacological and non pharmacological management. In another example, in record review #2 for the problem of constipation the goal was stated as: Optimal bowel elimination and comfort within hospice care. In another example, record review #3 the problem for genitourinary issues had a stated goal: Pt/Family/PCG will verbalize having urinary elimination needs met at an acceptable level. This was discussed with and confirmed by the administrator and QAPI nurse.

Observed in Record Review. In 2 of 11 patient records reviewed, it was noted that the plan of care was not updated or revised to reflect new problems. For example, in record review #4, the patient developed a UTI and was treated with Bactrim however the plan of care was not updated to reflect this new issue. Additionally in the same record the patient was placed on a bowel regime however the plan of care did not list constipation as a problem. In another example, record review #5 it was noted that the patient had developed a UTI and was treated with Bactrim and additionally was having increased depression/crying spells for which antidepressant medications were increased and spiritual care visits were increased however neither of these issues were on the plan of care. This was discussed with and confirmed by the administrator and QAPI nurse.

Observed in Tracer Visit. In 2 of 3 home visits conducted, the LVN was observed placing the BP cuff back into its plastic container following use on the patient and then cleaning the cuff and again placing it in the container. This was observed by the administrator who was present on the visit.

Observed in Document Review. During review of the Infection Control Plan and discussion with leadership it was noted that the organization had not identified infection risks based on the following: Its geographic location, community, and population served, the care, treatment, or services it provides and analysis of its surveillance activities and other infection control data. This was confirmed by the administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, for bereavement services it was noted that there was no plan of care documentation. The survivors were being seen monthly by the spiritual counselor and receiving mailings however there was no plan of care outlining these interventions or associated goals. This was discussed with the QAPI nurse and the MSW.

Observed in HR File Review. In 1 of 1 HR files reviewed, for a CHHA it was noted that the most recent competency evaluation was done by an LVN. This was confirmed by the HR staff.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted that the current medication sheet included a medication that the patient was no longer taking. For example, in review of record for home visit #1 the medication sheet listed Metoclopromide hydrochloride 10 mg BID however this medication was not in the home and the family member stated it had been discontinued. This was observed by the administrator on site during the visit.