Every finding on record at Arl Ventures,LLC

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not assess/reassess the patient according to defined time frames. The hospice interdisciplinary group did not complete the comprehensive assessment within five (5) calendar days of the patient's election of hospice care. In review of the record for HV#3 and RR#6, the initial spiritual and bereavement assessments were completed/documented six (6) calendar days of the patient's hospice election/admission. This was reviewed and verified with the Director of Nursing/Owner.

Observed in Record Review. In 1 of 3 bereavement records reviewed, the hospice organization did not conduct and document a comprehensive assessment/reassessment that identified the caregiver's/family's need for hospice bereavement services, including survivor risk factors after the death. In BR#1, a Post-Death Bereavement Risk Assessment was not completed/documented as outlined in the organization's established bereavement program. Bereavement services were provided based on the initial risk assessment and plan of care. This was reviewed and verified with the Administrator.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization did not plan the patient's care by ensuring all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatments, were included in the plan of care. In review of the record for HV#2, it was noted the patient's plan of care included Albuterol nebulizer treatments every 4 hours PRN for shortness of breath, and Albuterol inhaler 2 puffs every 4 hours PRN for shortness of breath. There was no clear indications for use for the two prn orders for Albuterol (which route to take when). In RR#1, the plan of care included wound care orders per the contracted wound care provider: Apply Tetracyte, Therahoney or Santyl (if available), and Cuticerin to the wound bed, followed by Durafiber. There was no clear indication in the wound care order as to which treatment product was to be applied. In RR#8, the medication profile in the plan of care included Lorazepam 2mg/ml Concentrate Solution - 0.5 ml sublingual every 4 hours as needed for Anxiety/Agitation and Haloperidol Lactate 2mg/ml Solution - 0.5 ml sublingual every 6 hours as needed for Anxiety with no clear indications for use. This was reviewed and verified with the Director of Nursing/Owner.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not provide care, treatment, or services according to the patient's individualized plan of care. In review of the record for HV#3, the hospice aide plan of care indicated nail care, placing objects within the reach of the patient, applying deodorant, and visualizing condition of the skin every visit. These tasks were not completed/documented on the aide visit note. In RR#2, the aide plan of care indicated dressing the patient, changing linens, and tidying the patient's room. These tasks were not performed/documented on aide visit note. This was reviewed and verified with the Director of Nursing/Owner.

Observed in Record Review. In 4 of 11 patient records reviewed, the organization did not supervise staff effectively by assessing the quality of care and services provided by the hospice aide, and ensuring that services ordered met the patient's needs. In RR#1, the RN did not supervise the hospice aide during an on-site visit to the patient's home at least every 14 days, with 17 days between aide supervisory visits noted. In RR#2, there were 16 days between aide supervisory visits by the RN. In RR#3, there was no aide supervisory visit documented by the RN in 26 days. In RR#8, there were no supervisory visits documented for 35 day and 28 day periods. This was reviewed and verified with the Director of Nursing/Owner.

Observed in Record Review. In 5 of 11 patient records reviewed, the organization did not accept the patient for care, treatment, or services based on its ability to meet the patient's needs. In review of the record for HV#1, HV#3, RR#3, RR#5, and RR#6, the physician/Medical Director did not provide written certification that the patient's life expectancy was six months or less if the illness ran its normal course. The signed Certificate of Terminal Illness (CTI) did not contain a written narrative summary by the physician. This was reviewed and verified with the Director of Nursing/Owner.

Observed in Record Review. In 6 of 11 patient records reviewed, the patient record did not contain information that reflected the patient's care, treatment, or services, including initiation and maintenance of documentation of the patient's plan of care. In review of the record for HV#1, HV#3, RR#3, RR#5, RR#7, and RR#8, it was noted that the spiritual care counselor and/or the medical social worker did document patient/caregiver plan of care needs, interventions provided, and goals in some of the evaluation, visit, and IDT notes. This information , however, was not documented in the patient's designated interdisciplinary plan of care in the hospice electronic record per the organization's established record of care process. This was reviewed and verified with the Director of Nursing/Owner.