Every finding on record at Athc - Hospice, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; [and] other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measures are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure all patients' drug profiles were complete. Clinical Record 9: The patient elected hospice care on 12/31/2024 with a diagnosis of sepsis. The skilled nurse (SN) assessment dated 12/31/2024 documented that the patient was using oxygen at 6 liters (L) per minute per nasal cannula (NC). The agency's medication profile dated 12/31/2024 did not include documentation of oxygen. Clinical Record 13: The patient elected hospice care on 12/31/2024 with a diagnosis of Parkinson's disease. The SN assessment dated 12/31/2024 documented that the patient used oxygen at 2 L per NC and became short of breath upon exertion and at night. The agency's medication profile dated 12/31/2024 did not include documentation of oxygen. Clinical Record 15: The patient elected hospice care on 08/12/2024 with a diagnosis of chronic pulmonary disease (COPD). The SN assessment dated 08/12/2024 documented the patient was short of breath and required continuous oxygen. The plan of care dated 08/12/2024 documented interventions to assess oxygen safety and effectiveness. The medication profile did not include documentation of oxygen. The Regional Director of Clinical Operations reviewed the clinical records on 01/08/2024, confirmed the findings, and stated that a plan of correction was already implemented.

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 6 of 19 (32%) clinical records reviewed, the agency did not ensure that all interventions identified in the assessment were included in the plan of care. Clinical Record 3: The patient elected hospice care on 02/27/2024 with the diagnoses of senile degeneration of the brain and acute respiratory failure. The plan of care dated 12/23/2024 - 02/20/2025 ordered an oxygen concentrator and oxygen supplies and "Oxygen 2 liters per minute (LPM) via nasal cannula (NC) as needed for shortness of breath (SOB)." The plan of care did not document interventions related to the patient's oxygen use and respiratory status. Clinical Record 5: The patient elected hospice care on 01/02/2025 with a diagnosis of secondary malignant neoplasm of the lymph node. The skilled nurse (SN) assessment dated 01/02/2025 documented that the patient was at risk of rehospitalization, end of life, and "End of Life risk assessment medium - increase nursing visits to no less than 3 times a week with one visit on Friday to assess weekend needs." The plan of care ordered skilled nursing (SN) 2wk13 and 1w1. The plan of care did not document an increase in SN visits to three (3) times per week. Additionally, the assessment documented, "Fall risk, make sure that the plan of care includes goals and interventions." The plan of care dated 01/02/2025 documented fall precautions under safety measures, but the plan of care did not include documentation of goals or interventions related to fall risk. Clinical Record 7: The patient elected hospice care on 12/19/2024 with a diagnosis of intrahepatic bile duct carcinoma. The SN assessment dated 12/19/2024 documented that the patient had a double-lumen port in place that was not accessed and planned to have a drain placed so that he could perform paracentesis at home. The SN visit note dated 12/26/2024 documented that the patient was scheduled to have a drain placed on 12/27/2024. The SN visit note dated 01/06/2025 documented that the patient had an Aspira drain with 400 cc of fluid. A clinical record review revealed no patient or family goals for the double-lumen port dressing or the Aspira drain. Clinical Record 8: The patient elected hospice care on 12/06/2024 with a diagnosis of atherosclerotic heart disease. The initial SN assessment dated 12/06/2024 documented the patient's need for oxygen at 3 L per NC with head elevated to avoid shortness of breath. The plan of care dated 12/06/2024 did not document respiratory interventions or goals. Clinical Record 10: The patient elected hospice care on 12/06/2024 with a diagnosis of senile degeneration of the brain. The SN assessment dated 12/06/2024 noted that oxygen was ordered for the patient. The plan of care ordered "Oxygen 2-4 L per NC PRN." The plan of care did not include interventions related to the patient's respiratory status or oxygen safety. Clinical Record 13: The patient elected hospice care on 12/31/2024 with a diagnosis of Parkinson's disease. The SN assessment dated 12/31/2024 documented the patient was experiencing dyspnea, and the patient's breathing was critically impaired, requiring oxygen. The assessment documented the patient's use of oxygen at 2L per NC. The plan of care dated 12/31/2025 did not include interventions or goals related to the patient's respiratory status or oxygen safety. The Regional Compliance Director confirmed findings and stated on 01/08/2024 that the agency had begun a plan of correction.

It is required that each patient’s individualized written plan of care includes all drugs and treatments necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the plan of care included all drugs and treatments necessary to meet the patient’s needs. Clinical Record 1: The patient elected hospice care on 12/10/2024 with a diagnosis of hemiplegia. The skilled nurse (SN) assessment dated 12/10/2024 noted that the patient had a Foley catheter. The plan of care dated 12/10/2024 documented catheter supplies. The plan of care did not include documentation of the Foley catheter size or the care and maintenance of the catheter. Clinical Record 7: The patient elected hospice care on 12/19/2024 with a diagnosis of intrahepatic bile duct carcinoma. The SN assessment dated 12/19/2024 documented that the patient had a double-lumen port in place that was not accessed and planned to have a drain placed so that he could perform paracentesis at home. The SN visit note dated 12/26/2024 documented that the patient was scheduled to have a drain placed on 12/27/2024. The SN visit note dated 01/06/2025 documented that the patient had an Aspira drain with 400 cc of fluid. A clinical record review revealed no interventions for the double-lumen port dressing or the Aspira drain. The Regional Compliance Director confirmed the findings on 01/08.2024 and stated that the agency had implemented a plan of correction.

It is required that each patient’s individualized written plan of care medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 5 of 15 (33%) clinical records reviewed of patients requiring medical supplies, the agency did not ensure that the patient's plan of care included medical supplies and appliances necessary to meet the patient's needs. Clinical Record 5: The patient elected hospice care on 01/02/2025 with a diagnosis of secondary malignant neoplasm of the lymph node. The skilled nurse (SN) assessment dated 01/02/2025 documented that the patient had a Foley catheter. The plan of care dated 01/02/2025 ordered a Foley catheter. The plan of care did not document the supplies for care and maintenance of the Foley catheter. Clinical Record 8: The patient elected hospice care on 12/06/2024 with a diagnosis of atherosclerotic heart disease. The initial SN assessment dated 12/06/2024 documented the patient's need for oxygen at 3 liters (L) per nasal cannula (NC). The plan of care ordered oxygen. Oxygen supplies were not documented in the plan of care. Clinical Record 10: The patient elected hospice care on 12/06/2024 with a diagnosis of senile degeneration of the brain. The SN assessment dated 12/06/2024 documented that oxygen was ordered for the patient. The plan of care dated 12/06/2024 documented, "DME and Supplies - NONE." Clinical Record 13: The patient elected hospice care on 12/31/2024 with a diagnosis of Parkinson's disease. The SN assessment dated 12/31/2024 documented that the patient was experiencing dyspnea, and breathing was critically impaired. Additionally, the assessment documented the patient used oxygen at 2L per NC. The plan of care dated 12/31/2024 did not document oxygen supplies. Clinical Record 15: The patient elected hospice care on 08/12/2024 with a diagnosis of chronic obstructive pulmonary disease (COPD). The SN assessment dated 08/12/2024 documented the patient was very short of breath and required continuous oxygen. The plan of care dated 08/12/2024 did not document oxygen supplies. The Regional Compliance Director confirmed the findings on 01/08/2024 and stated they have already begun an action plan.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by an RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 9 of 17 (53%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the written HA care plan prepared by the Registered Nurse (RN) included instructions to meet the patient's needs. Clinical Record 1: The patient elected hospice care on 12/10/2024 with a diagnosis of hemiplegia following cerebral infarction. The skilled nursing (SN) assessment dated 12/10/2024 documented that the patient had a sacral wound and a Foley catheter. The HA care plan dated 12/10/2024 assigned the HA the task of a bed bath, perineal care, and applying barrier cream to intact skin. The HA care plan did not provide the HA with instructions for catheter care or instructions for the wound/dressing. Clinical Record 2: The patient elected hospice care on 12/05/2024 with a diagnosis of lung cancer. The SN assessment dated 12/05/2024 documented multiple stage 2-3 ulcers on the patient's abdomen. The plan of care dated 12/05/2024 ordered wound care, maintaining a dry dressing, and replacing it if loosened or soiled. The HA care plan dated 12/05/2024 assigned the HA the task of a shower. The HA care plan did not provide the HA with instructions should the dressings become wet or dislodged during the shower. Clinical Record 3: The patient elected hospice care on 02/07/2024 with the diagnoses of senile degeneration of the brain and acute respiratory failure. The patient resided in an assisted living facility (ALF). The SN recertification assessment dated 12/16/2024 for the certification period dated 12/23/2024 through 02/20/2025 documented that the patient had as needed/pro re nata (PRN) oxygen in the room and "Patient is at risk for falling. Please ensure that the patient's plan of care includes goals and interventions related to fall precautions." The HA care plans dated 02/28/2024 and updated on 01/03/2025 did not address the fall precautions or the patient's use of oxygen. Clinical Record 4: The patient elected hospice care on 05/09/2023 with a diagnosis of senile degeneration of the brain. The patient resided in an assisted living facility (ALF). The SN recertification assessment dated 12/11/2024 for the certification period dated 12/29/2024 through 02/26/2025 documented the patient's high risk for falls and "Patient is at risk for falling. Please ensure that the patient's plan of care includes goals and interventions related to fall precautions." The HA care plan, which was last revised on 07/05/2024, assigned the HA the task of "transferring client from bed/chair." The HA care plan did not address the fall precautions. Clinical Record 7: The patient elected hospice care on 12/19/2024, with a double-lumen port in place and a dressing. On 12/27/2024, the patient received an Aspira drain for paracentesis. The HA care plan dated 12/19/2024 did not include information related to the port dressing, and the HA care plan updated on 01/07/2025 did not inform the HA about the Aspira drain and dressings. Clinical Record 13: The patient elected hospice care on 12/13/2024 with a diagnosis of Parkinson's disease. The patient resided in a skilled nursing facility (SNF). The SN assessment dated 12/13/2024 documented that the patient utilized oxygen. Information addressing the patient's oxygen use and safety precautions was not included in the HA care plan dated 12/13/2024. Clinical Record 14: The patient elected hospice care on 11/30/2022 with the diagnosis of malignant neoplasm of the female breast. The patient resided in an ALF. The SN recertification assessment dated 12/31/2024 documented that the patient was at risk for falls and "Patient at risk for falling- Please ensure that patient's plan of care includes goals and interventions related to fall precautions." The HA care plan dated 11/30/2022 assigned the HA the task of shower. The HA care plan did not document instructions for the HA addressing the fall precautions. There have been no updates to the HA care plan since admission. Clinical Record 15: The patient elected hospice care on 06/19/2024 with a diagnosis of unspecified cirrhosis of the liver. Upon admission, the SN assessment documented that the patient was a fall risk, required oxygen, and had a Foley catheter. The HA care plan dated 06/19/2024 did not include information related to oxygen. A clinical record review revealed a physician's order dated 08/06/2024 to remove the Foley catheter. Routine Foley care remained on the HA care plan with no updates as of 01/08/2025. On 08/20/2024, the physician ordered wound care for a new wound on the patient's left arm. The HA care plan was not updated to address the new wound and the wound dressing. Clinical Record 17: The patient elected hospice care on 05/16/2024 with a diagnosis of cerebral infarction. The patient was admitted with a percutaneous endoscopic gastrostomy (PEG) tube and a Foley catheter. The SN assessment dated 06/27/2024 documented that the patient utilized continuous oxygen. The HA care plan dated 05/16/2024 had no updates and did not provide the HA information or instructions addressing the Foley catheter, PEG tube, or oxygen. In an interview on 01/07/2025, the Regional Director of Clinical Operations confirmed the findings, stating, "We will clean them up now and then do some major education."

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure that the patient's clinical record included physician orders for care and services. Clinical Record 9: The patient elected hospice care on 12/31/2024 with a diagnosis of sepsis. The skilled nurse (SN) assessment dated 12/31/2024 documented that the patient was using oxygen at 6 liters (L) per minute per nasal cannula (NC). The plan of care included documentation of oxygen precautions and an intervention to assess the liter flow and effectiveness of oxygen. A clinical record review revealed no physician's order for oxygen, the liter flow, the administration route, or the administration frequency. Clinical Record 13: The patient elected hospice care on 12/31/2024 with a diagnosis of Parkinson’s disease. The SN assessment dated 12/31/2024 documented that the patient used oxygen at 2 L per NC and became short of breath upon exertion and at night. A clinical record review revealed no physician's order for oxygen, the liter flow, the administration route, or the administration frequency. Clinical Record 15: The patient elected hospice care on 08/12/2024 with a diagnosis of chronic pulmonary disease (COPD). The SN assessment dated 08/12/2024 documented the patient was short of breath and required continuous oxygen. The plan of care dated 08/12/2024 documented interventions to assess oxygen safety and effectiveness. A clinical record review revealed no physician's order for oxygen, the liter flow, the administration route, or the administration frequency. The Regional Compliance Director confirmed the findings in an interview on 01/08/2025, stating, "We will do education."

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record review of a patient transferred to a facility, the agency did not ensure that the receiving facility received a discharge summary. Clinical Record 18: The patient was admitted on 08/12/2024 with a diagnosis of chronic obstructive pulmonary disease ( COPD), sent to the emergency room on 09/02/2024 for complaints of severe pain and urinary retention, and admitted to the hospital. The clinical record contained no evidence of a revocation. A discharge summary was sent to the patient's physician but not to the hospital. The Regional Compliance Director reviewed documentation on 01/08/2025 and noted, "There is no evidence that a discharge summary was sent. I discuss this every month."

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid/MediCal-certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 41. I and the patient’s record, if requested. This standard was not met as evidenced by a review of clinical records, document review, and interview. 2 of 2 (100%) applicable records of patients who transferred to another hospice revealed transfer forms were filled out but it did not include what additional documents were sent to the receiving hospital along with the transfer summary per agency policy. Record #69955: The patient was admitted for hospice services on 11/23/2021 and transferred/discharged to a hospital on 01/04/2022 to seek aggressive treatment. Record #44409: The patient was admitted for hospice services on 01/05/2022 and transferred/discharged to a hospital on 03/31/2022 to seek aggressive treatment. Agency policy # 1-0025.3 revised 05/11/2020 stated in part, "When a patient is discharged, or transferred to another organization, relevant information will include: a summary of the care provided and the progress toward achieving goals, current plan of care, medication profile including discontinued medications, the latest physician orders, and continuing symptom management needs." These findings were reviewed during an interview with the Director of Clinical Services on 02/24/2022 she indicated that the discharge summaries were not sent to the receiving hospitals.