Every finding on record at Austin Community 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. This standard was not met as evidenced by clinical record review. 2 of 11 (18%) records reviewed revealed the agency did not ensure the drug profile contained the current prescription drugs. Record 9: The patient elected hospice care on 12/24/2022. The physician's order dated 01/11/2023 read, "Oxygen 2-4 liters per minute via nasal cannula as needed for shortness of breath." The Registered Nurse (RN) visit note dated 01/11/2023 documented the initiation of "Oxygen at 2 liters per minute via nasal cannula due to shortness of breath." Oxygen was not included on the patient's medication profile to date. Record 10: The patient elected hospice care on 12/07/2022. The physician's order dated 12/07/2022 read, "Oxygen 2 liters per minute via nasal cannula as needed for shortness of breath." The RN visit note dated 12/07/2022 documented the patient's utilization of "Oxygen at 2 liters per minute via nasal cannula due to shortness of breath." Oxygen was not included on the patient's medication profile to date.

It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient's family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. This standard was not met as evidenced by clinical record review and interview. 3 of 11 (27%) records reviewed revealed the agency did not ensure that an initial bereavement assessment was completed. Record 2: The patient's election of the hospice benefit was effective 05/20/2022. There was no evidence of a completed initial bereavement assessment to date. Record 9: The patient's election of the hospice benefit was effective 12/24/2022. There was no evidence of a completed initial bereavement assessment to date. Record 10: The patient's election of the hospice benefit was effective 12/07/2022. There was no evidence of a completed initial bereavement assessment to date. During an interview on 02/24/2023, the Administrator confirmed the finding and stated that the assessments were not completed to date.

It is required that All hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire. This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) records reviewed revealed the agency did not ensure that services provided were in accordance with the written plan of care (POC). Record 9: The patient elected hospice care on 12/24/2022. The POC dated 12/24/2022 ordered the Skilled Nurse (SN) "2xweek." A review of the record revealed the SN completed one visit for the week the 12/24/2022. There was no evidence of a documented missed visit or communication with the physician to change the SN visit frequency. In addition, the POC ordered the Chaplain (SC) "1xweek." There was no evidence of a Chaplain visit or a documented missed visit for the week of 1/1/2023. During an interview on 02/24/2023, the Administrator confirmed the finding and stated that the frequencies were not met and missed visit entries had since been entered to correct.

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. 7 of 11 (64%) records reviewed revealed the agency did not ensure that the individualized written plan of care (POC) included planned interventions and goals based on the problems identified in the comprehensive assessments. Record 1: The patient elected hospice care on 3/31/2022. The POC dated 01/25/2023 ordered Chaplain (SC) "1xmonth for spiritual support" and Hospice Aide "5xweek for assistance with personal care." There were no interventions or goals identified in the POC for the Chaplain or the Hospice Aide to date. Record 3: The patient elected hospice care on 3/25/2022. The POC dated 01/19/2023 ordered Hospice Aide "3xweek for assistance with personal care." There were no interventions or goals identified in the POC for the Hospice Aide to date. Record 6: The patient elected hospice care on 1/04/2023. The POC dated 01/25/2023 ordered Medical Social Worker (MSW) "1xmonth for psychosocial support" and Hospice Aide "3xweek for assistance with personal care." There were no interventions or goals identified in the POC for the MSW or the Hospice Aide to date. Record 7: The patient elected hospice care on 11/07/2022. The POC dated 01/06/2023 ordered Hospice Aide "3xweek for assistance with personal care." There were no interventions or goals identified in the POC for the Hospice Aide to date. Record 8: The patient elected hospice care on 11/28/2022. The POC dated 11/28/2022 ordered Chaplain "1xmonth for spiritual support" and Hospice Aide "3xweek for assistance with personal care." There were no interventions or goals identified in the POC for the Chaplain or the Hospice Aide to date. Record 9: The patient elected hospice care on 12/24/2022. The POC dated 12/24/2022 ordered MSW "1xweek for psychosocial support." There were no interventions or goals identified in the POC for the MSW. Record 11: The patient elected hospice care on 02/10/2023. The POC dated 02/10/2023 ordered Chaplain "1xmonth for spiritual support" and Hospice Aide "3xweek for assistance with personal care." There were no interventions or goals identified in the POC for the Chaplain or the Hospice Aide to date. During an interview on 02/242023, the Administrator confirmed the finding and stated that associated goals and interventions had been inadvertently omitted from the POCs and had since been corrected.

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. Bereavement counseling extends to residents of a SNF/NF (skilled nursing facility/nursing facility) or ICF/IDF (intermediate care facility/intellectual disability facility) when appropriate and identified in the bereavement plan of care. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes: the types of bereavement services to be offered [and the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. 2 of 2 (100%) records reviewed in which bereavement services were provided revealed the agency did not ensure that a bereavement plan of care (POC) was created to reflect the types of bereavement services to be offered and the frequency of service delivery. Record 8: The patient elected hospice care on 11/28/2022. The patient expired on 01/27/2023. There was documentation of a post-death bereavement assessment completed by the chaplain on 1/30/2023. There was no documented evidence of a bereavement POC. Record 9: The patient elected hospice care on 12/24/2022. The patient expired on 01/14/2023. There was documentation of a post-death bereavement assessment completed by the chaplain on 01/14/2023 and a 02/18/2023 follow-up phone call. There was no documented evidence of a bereavement POC.

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. 3 of 10 (30%) records reviewed in which hospice aide services were provided revealed the agency did not ensure that each task assigned to the hospice aide contained a specific frequency. Record 1: The hospice aide care plan dated 09/27/2022 included an "as needed" (PRN) task frequency for linen change and light housekeeping. The hospice aide assigned tasks did not include a specific frequency. Record 6: The hospice aide care plan dated 01/04/2023 included a "PRN" task frequency for linen change and light housekeeping. The hospice aide assigned tasks did not include a specific frequency. Record 9: The hospice aide care plan dated 12/27/2022 included a "PRN" task frequency for bath, shampoo, shave, linen change, light housekeeping, make bed, turn, and incontinence care. The hospice aide assigned tasks did not include a specific frequency.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group [and] included in the plan of care. This standard was not met as evidenced by clinical record review. 4 of 10 (40%) records reviewed in which hospice aide services were provided revealed the agency did not ensure the hospice aide provided services as ordered in the plan of care (POC). Record 1: The patient elected hospice care on 03/31/2022. The POC dated 01/25/2023 ordered hospice aide services "5xweek." A clinical record review revealed three (3) hospice aide visits completed the week of 01/25/2023: 01/25/2023, 01/26/2023, and 01/27/2023 to date. There was no evidence of communication with the physician or documented missed visits. Record 3: The patient elected hospice care on 03/25/2022. The aide care plan dated 01/19/2023 assigned the aide the task: 2xweek shower. The aide documented completion of the shower with each patient visit for 01/23/2023 through 02/17/2023, five times a week. There was no evidence the assigned tasks had changed and no evidence of communication with the registered nurse. In addition, the POC dated 01/19/2023 ordered hospice aide services "3xweek." A review of the clinical record revealed two (2) hospice aide visits completed the week of 01/19/2023, five (5) hospice aide visits completed the weeks of 01/23/2023, 01/30/2023, and 02/13/2023, and four (4) hospice aide visits completed the week of 02/06/2023. There was no evidence of communication with the physician to change the hospice aide visit frequency or documented missed visits. Record 5: The patient elected hospice care on 02/03/2023. The aide care plan dated 02/03/2023 assigned the aide the tasks: every visit bath and shave. The aide documented that the bath and shave were not completed for the aide visits dated 02/08/2023, 02/13/2023, 02/15/2023, 02/16/2023, and 02/20/2023. There was no evidence the assigned tasks had changed and no evidence of communication with the registered nurse. Record 8: The patient elected hospice care on 11/28/2022. The aide care plan dated 11/28/2022 assigned the aide the tasks: 1xweek for shampoo. The aide documented the completion of the shampoo for the visits dated 02/09/2023 and 02/13/2023. There was no evidence the assigned tasks had changed and no evidence of communication with the registered nurse. In addition, the POC dated 11/28/2022 ordered hospice aide services "3xweek." A review of the clinical record revealed two (2) hospice aide visits completed the week of 12/28/2022: 12/28/2022 and 12/30/2022 to date. There was no evidence of communication with the physician to change the hospice aide visit frequency or documented missed visits.

It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. This standard was not met as evidenced by clinical record review and interview. 3 of 11 (27%) records reviewed revealed the agency did not ensure that all entries in the patient record contained credentials with associated signatures for authentication. Record 1: There were no credentials with the associated signature and date for the registered nurse (RN) visit note dated 12/27/2022, and the interdisciplinary group (IDG) notes dated 01/24/2023, 02/07/2023, and 2/21/2023 entered by the RN. Record 2: There were no credentials with the associated signature and date for the IDG notes dated 01/19/2023, 01/24/2023, 02/07/2023, and 02/21/2023 entered by the RN. Record 5: The physician order dated 02/03/2023, entered by the RN, did not include the RN's credential with the associated signature and date. During an interview on 02/24/2023, the Administrator confirmed the finding and stated that signatures were missing credentials.