Every finding on record at Appropriate Hospice Care LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, following CMS §418.24, the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 5 of 5 (100%) clinical records reviewed revealed the agency did not ensure the hospice Interdisciplinary Group (IDG) completed the initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. Clinical Record 1: The patient elected the hospice benefit on 08/12/2024 with a terminal diagnosis of Hemiplegia following cerebral infarction affecting the right dominant side. The initial nursing assessment on 08/12/2024 included documentation that the patient resided at home. The clinical record contained no evidence that the initial comprehensive assessment, including the psychosocial and emotional aspects, was completed within five (5) calendar days of the patient electing hospice care. Clinical Record 2: The patient elected the hospice benefit on 08/12/2024 with a terminal diagnosis of Hypertensive heart and chronic kidney disease (CKD) with heart failure and unspecified stage 1 - 4 CKD. The initial nursing assessment on 08/12/2024 included documentation that the patient resided at home. The clinical record contained no evidence that the initial comprehensive assessment, including the psychosocial and emotional aspects, was completed within five (5) calendar days of the patient electing hospice care. Clinical Record 3: The patient elected the hospice benefit on 08/12/2024 with a terminal diagnosis of unspecified disease of the digestive system. The initial nursing assessment on 08/12/2024 included documentation that the patient resided at home. The clinical record contained no evidence that the initial comprehensive assessment, including the psychosocial and emotional aspects, was completed within five (5) calendar days of the patient electing hospice care. Clinical Record 4: The patient elected the hospice benefit on 08/12/2024 with a terminal diagnosis of Hypertensive heart and chronic kidney disease (CKD) with heart failure and unspecified stage 1 - 4 CKD. The initial nursing assessment on 08/12/2024 included documentation that the patient resided at home. The clinical record contained no evidence that the initial comprehensive assessment, including the psychosocial and emotional aspects, was completed within five (5) calendar days of the patient electing hospice care. Clinical Record 5: The patient elected the hospice benefit on 06/10/2024 with a terminal diagnosis of Vascular dementia, unspecified severity, without behaviors, psychosis, moods, and anxiety. The initial nursing assessment on 06/10/2024 included documentation that the patient resided at home. The clinical record contained no evidence that the initial comprehensive assessment, including the psychosocial and emotional aspects, was completed within five (5) calendar days of the patient electing hospice care. During joint clinical record reviews and interviews on 09/11/2024, the Administrator and Alternate Administrator confirmed the clinical records identified contained no evidence that the initial comprehensive assessment was completed within five (5) calendar days of the patient electing hospice care.

It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 5 (80%) clinical records reviewed revealed the agency did not ensure the individualized written plan of care reflected patient and family goals and identified planned interventions based on problems identified in the initial comprehensive assessment. Clinical Record 1: The patient elected hospice services on 08/12/2024 with a terminal diagnosis of Hemiplegia following cerebral infarction affecting the right dominant side. The initial nursing assessment dated 08/12/2024 included documentation that the patient had dyspnea with moderate exertion, required intermittent oxygen, was anxious with a significant psychiatric history, and had non-pitting edema of bilateral lower extremities. The written plan of care dated 08/12/2024 did not reflect patient and family goals and planned interventions associated with the patient's dyspnea, anxiety, and edema identified in the comprehensive assessment. Clinical Record 2: The patient elected hospice services on 08/12/2024 with a terminal diagnosis of Hypertensive heart and chronic kidney disease (CKD) with heart failure and unspecified stage 1 - 4 CKD. The initial nursing assessment dated 08/12/2024 included documentation that the patient had dyspnea with minimal and moderate exertion and had non-pitting edema to bilateral lower extremities that required two oral antidiuretics to manage. The written plan of care dated 08/12/2024 did not reflect patient and family goals and planned interventions associated with the patient's dyspnea and edema identified in the comprehensive assessment. Clinical Record 3: The patient elected hospice services on 08/12/2024 with a terminal diagnosis of unspecified disease of the digestive system. The initial nursing assessment dated 08/12/2024 included documentation that the patient had dyspnea with moderate exertion. The written plan of care dated 08/12/2024 did not reflect patient and family goals and planned interventions associated with the patient's dyspnea identified in the comprehensive assessment. Clinical Record 4: The patient elected hospice services on 08/12/2024 with a terminal diagnosis of Hypertensive heart and chronic kidney disease (CKD) with heart failure and unspecified stage 1 - 4 CKD. The initial nursing assessment dated 08/12/2024 included documentation that the patient had dyspnea with minimal exertion that required continuous oxygen. The written plan of care dated 08/12/2024 did not reflect patient and family goals and planned interventions associated with the patient's dyspnea identified in the comprehensive assessment. During joint clinical record reviews and interviews on 09/11/2024, the Administrator and Alternate Administrator confirmed the written plans of care identified did not reflect the patient and family goals and planned interventions for problems, including anxiety, dyspnea, and edema, identified in the comprehensive assessments.

It is required that when controlled medications are first ordered, a copy of the hospice’s written policies and procedures for the management and disposal of controlled medications is provided to the patient or family or patient’s legal representative(s). This standard was not met as evidenced by clinical record review, interview and observation. In 2 of 2 (100%) clinical records reviewed revealed the agency did not ensure that a copy of the hospice's written policies and procedures for managing and disposing of controlled medications was provided to the patient or family when controlled medications were first ordered. Clinical Record 1: The patient elected hospice services on 08/12/2024 with a terminal diagnosis of Hemiplegia following a cerebral infarction affecting the right dominant side. The initial comprehensive assessment on 08/12/2024 documented a drug profile that included Percocet, a controlled medication. During the home visit (Home Visit 2) with the Registered Nurse (Personnel Record 1), the documentation provided to the patient by the hospice when the physician's order was obtained to continue the controlled medication on 08/12/2024 was reviewed and contained no evidence that a copy of the hospice's written policy and procedure for managing and disposing of controlled medications was provided to the patient and family. Clinical Record 3: The patient elected hospice services on 08/12/2024 with a terminal diagnosis of unspecified disease of the digestive system. The initial comprehensive assessment on 08/12/2024 documented a drug profile that included Oxycodone 10MG, a controlled medication. During the home visit (Home Visit 1) with the Registered Nurse (Personnel Record 1), the documentation provided to the patient by the hospice when the physician's order was obtained to continue the controlled medication on 08/12/2024 was reviewed and contained no evidence that a copy of the hospice's written policy and procedure for managing and disposing of controlled medications was provided to the patient and family. During joint clinical record reviews and interviews on 09/11/2024, the Administrator and Alternate Administrator confirmed that the paperwork provided to the patient upon electing hospice services did not include a copy of the hospice's written policy and procedure for managing and disposing of controlled medications. The leaders provided evidence of the policy and procedure for managing and disposing of controlled medications and reported a plan to include this policy and procedure in the information provided to patients upon electing hospice care.