Every finding on record at Atx Hospice Inc

Based on record review and interview, the agency failed to ensure that care was provided according to the IDT's written plan of care in 5 of 11 records reviewed; 4 of 11 patients (Patients #2, #3, #9 and #10 did not receive hospice aide services as written in the plan of care, and 3 of 11 patients (Patients #7, #9 and #10 did not receive skilled nursing services as written in the plan of care. This failure could have placed the agency's former hospice patients at risk of a decline in health from not receiving the necessary care and treatment. The agency has not had an active client since December 2021. The findings included: 1. Closed record review of Patient #2's plan of care for certification period 10/18/2021 through 1/15/2022 revealed a start of care date of 10/18/2021 with a terminal diagnosis of Senile Degeneration of the Brain and orders for the hospice aide to visit three times a week. Subsequent IDG Meetings dated 10/22/2021, 11/5/2021 and 11/19/2021 noted the hospice aide frequency as 3 times a week. Further review of the clinical record revealed hospice aide services were provided only twice per week until patient #1's passing on 11/9/2022. The clinical record did not contain documentation as to why 3 hospice aide visits were not conducted 2. Closed record review of Patient #3's plan of care for certification period 9/7/2021 through 11/3/2021 revealed a start of care date of 9/7/2021 with a terminal diagnosis of Chronic Combined Systolic (Congestive) and Diastolic (Congestive) Heart Failure and orders for the hospice aide to visit once a week. A plan of care dated 10/21/2021 increase the hospice aide visits to twice a week. Further review of the clinical record revealed hospice aide services were provided only once per week until patient #2's passing on 10/3/2021. The clinical record did not contain documentation as to why 2 hospice aide visits were not conducted for the week of 10/24/2021. 3. Closed record review of Patient #7's plan of care for certification period 10/18/2021 through 1/5/2022 revealed a start of care date 10/8/2021 with a terminal diagnosis of Unspecified Protein-Calorie Malnutrition and orders for the skilled nurse to visit three times a week. An order dated 10/29/2021 decreased the skilled nursing visits to twice a week. Subsequent plan of care orders dated 10/30/2021 and 11/16/2021 noted the skilled nursing frequency as 2 times a week. Further review of the clinical record revealed skilled nursing services were provided only once per week for the weeks of 10/31/2021 and 11/7/2021. The clinical record did not contain documentation as to why 2 skilled nursing visits were not provided. 4. Closed record review of Patient #9's plan of care for certification period 10/22/2021 through 1/20/2022 revealed a start of care date 10/22/2021 with a terminal diagnosis of Malignant Neoplasm of head of Pancreas and no orders for skilled nursing or hospice aide services. Subsequent plan of care orders dated 11/7/2021 and 11/19/2021 noted the skilled nursing and hospice aide frequency as 3 times per week. Further review of the clinical record revealed hospice aide services were provided only twice for the week of 11/7/2021. The clinical record did not contain documentation as to why 3 hospice aide visits were not conducted 5. Closed record review of Patient #10's plan of care for certification period 9/7/2021 through 12/5/2021 revealed a start of care date 9/7/2021 with a terminal diagnosis of Malignant Neoplasm of upper outer quadrant of right breast and orders for skilled nursing 3 times a week. Subsequent plan of care orders dated 10/8/2021, 1022/2021 and 11/4/202 noted the skilled nursing frequency as 3 times per week. Further review of the clinical record revealed skilled nursing services were provided only twice weekly for the weeks of 10/3/2021 through discharge on 11/24/2021. The clinical record did not contain documentation as to why the 3rd visit was not addressed. 6. During an interview with the Executive Director of Operations on 6/8/2022 at 4:30 pm, the findings were discussed. This surveyor requested the EDOO review records in the event this surveyor might have missed documentation. During an interview with EDOO on 6/9/2022 at 12:30 pm, EDOO stated she did not have any additional information for the services not being provided according to the plan of care. Due to staff no longer with agency it could not be determined if visits were missed or if frequencies were entered in the plan of care in error. 7. Review of the agency policies and procedures revealed a policy entitled "The Plan of Care" revised April 2015. The policy read in part: "14. Care provided to the patient will be in accordance with the plan of care."