Every finding on record at Ardent Hospice Services, Inc.

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, document review and interview. In 3 of 14 (21%) clinical records reviewed revealed the patient's individual written plan of care (POC) lacked goal(s) and intervention(s) based on problems identified in the initial and updated comprehensive assessments. Document 1: Policy #9-017, "The Plan of Care (Dated: 11/2021)," stated in part, "Policy: The plan of care will be based on the initial, comprehensive and ongoing comprehensive assessments performed by members of the interdisciplinary group . . . This plan will focus on identified problems, goals, and interventions." Clinical Record 1: The patient elected the hospice benefit on 12/17/22. The certificate of terminal illness for the certification period of 12/17/22 - 3/16/23, stated the patient had a colostomy. The Interdisciplinary group (IDG) POC dated 12/17/22 had a goal to maintain good skin integrity. The record lacked evidence of a specific intervention(s) for the wound care ordered for the stoma, and specific intervention(s) for the colostomy. Clinical Record 2: The patient elected the hospice benefit on 5/19/23. The initial nursing assessment dated 5/19/23 stated the patient had urinary incontinence. The IDG POC dated 5/19/23 lacked a goal and intervention(s) for urinary incontinence. Clinical Record 4: The patient elected the hospice benefit on 3/15/23. There was a physician order dated 3/15/23 for Oxygen 2 liters (L)/minute (min) via nasal canula. The IDG POC dated 3/15/23 had a goal for respiratory comfort but lacked evidence of intervention(s) for oxygen with the specific L/min and route. Upon interview on 9/7/23, the Administrator and the Clinical Manager/Nurse Practitioner reviewed and agreed the agency did not ensure the POC included specific goal(s) and intervention(s) based on problems identified in the initial and updated comprehensive assessments.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IDF representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review, document review and interview. In 5 of 6 (83%) clinical records reviewed for patients that received routine hospice care in a Skilled Nursing Facility (SNF) revealed the records lacked delineation of services in the plan of care (POC) that specified which provider was responsible for performing the functions that were agreed upon and included in the POC. Document 4: Policy 1-030, "Provision of Care to Residents of SNF/NF or ICF/IID (Dated: 11/2021)", stated in part, "Procedure: 4. A written plan of care must be established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided must be in accordance with this plan of care. The plan of care must: A. Identify the care and services that are needed and specifically identify which provider is responsible for performing the respective functions." Clinical Record 2: The patient elected the hospice benefit on 5/19/23. The record lacked evidence of delineation of services in the POC that specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 5: The patient elected the hospice benefit on 6/9/23. The record lacked evidence of delineation of services in the POC that specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 11: The patient elected the hospice benefit on 7/20/23. The record lacked evidence of delineation of services in the POC that specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 8: The patient elected the hospice benefit on 7/31/23 and was transferred to this agency on 8/15/23. The record lacked evidence of delineation of services in the POC that specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 13: The patient elected the hospice benefit on 8/2/23. The record lacked evidence of delineation of services in the POC that specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Upon interview on 9/7/23, the Administrator and the Clinical Manager/Nurse Practitioner reviewed and agreed the agency did not ensure that the plan of care specified which provider was responsible for performing the functions that were agreed upon and included in the POC.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: Physician certification and recertification of the terminal illness. This standard was not met as evidenced by observation, document review and interview. In 1 of 1 (100%) patient observation visits at a skilled nursing facility (SNF) revealed the agency did not ensure the SNF was provided with the initial physician certification and recertification of the terminal illness. Home Visit 2: The patient elected the hospice benefit on 5/19/23. The hospice binder at the SNF was reviewed and lacked evidence of the initial physician certification and recertification of the terminal illness. Document 4: Policy #1-030, "Provision of Care to Residents of SNF/NF or ICF/IID (Dated: 11/2021)", stated in part, "Procedure: 7. The organization will provide the SNF/NF or ICF/IID the following information specific to each patient: Physician certification and recertification of the terminal illness." Upon interview on 9/7/23, the Administrator and the Clinical Manager/Nurse Practitioner reviewed and agreed the agency did not ensure the hospice binder included all the required documents that included the physician certification and recertification of the terminal illness.