Every finding on record at Avery Hospice LLC

It is required that each patient’s individualized written plan of care reflects patient and family goals, identifies planned interventions based on problems identified in the initial and updated comprehensive assessments and includes all services necessary for the palliation and management of the terminal illness, including the following: intervention to manage pain and symptoms, drugs and treatment necessary to meet the needs of the patient, and medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by home visit observation, review of clinical records with the Director of Nursing and interview. In 1 of 5 (20%) clinical records, there was no documented evidence that the patient's plan of care and/or physician's orders included patient/family goals and specific tube feeding interventions for the artificial nutritional supplements that are identified in the initial nursing assessment. Record #95015 - During the home visit on 11/9/21, the sister caregiver stated "I am giving the nutritional supplement to him by feeding syringe in the stomach tube and sometimes use the feeding pump". A enteral feeding pump that was attached to an IV pole was observed next to the patient's hospital bed. The Initial Nursing Assessment dated 10/15/21 included, in part, "patient is receiving Nepro nutritional supplements five times a day" and "gastrostomy". There were no patient/family goals and planned interventions in the physician's orders and/or the plan of care for the specific nutritional supplements that the patient is receiving through the Gastrostomy tube by feeding syringe and/or enteral feeding pump. The "IDG Meeting" plan of care dated 10/19/21 and 11/2/21, as well as current hospice plan of care, did not include the patient/family goals and interventions relating to the artificial nutritional supplements that the patient is receiving five times a day by syringe and/or enteral feeding pump. The "Plan of Care Order" and hospice plan of care dated 10/15/21, which was signed by the Medical Director, included, in part "DME: Enteral Pump and IV pole", and in the comments section "diagnosis" to include "gastrostomy" and "requires artificial nutritional supplements five times a day". However, the specific type of artificial nutritional supplements was not identified in the physician's order and/or plan of care and that the patient may receive the nutritional supplements by feeding syringe or enteral feeding pump. During joint clinical record review and interview, the Director of Nursing stated, "There are no patient/family goals or interventions for the artificial nutritional supplements that the patient is receiving on the hospice plan of care", "The Nepro nutritional supplement is included in the initial nursing assessment but not included in the hospice plan of care and/or on a physician's order" and "there are no physician's orders and/or plan of care for the Nepro nutritional supplements to be administered by feeding syringe and/or feeding pump".

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 a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by review of clinical records and interview. In 1 of 1 (100%) applicable clinical records of patients who received Hospice Aide services, there was no documented evidence that the RN prepared clear and concise written patient care instructions to the Hospice Aide. Record #94952 - Date of admission was 5/20/21, the terminal diagnosis was Alzheimer's Disease and the patient expired 5/23/21. The "RN Initial Assessment" dated 5/20/21, included, in part, "disoriented to person, place and time", and "patient suffered a stroke in July of last year leading to her functional impairment". The "MSW Assessment" dated 5/21/21 included, in part, "lives in home with daughter". The "Aide Plan of Care" dated 5/20/21 included, in part, "complete bed bath every visit" and "complete shower every visit" with no additional instructions regarding the bed bath or the shower. The Hospice Aide visit note dated 5/21/21 included documentation, that stated in part, "bed bath completed" and "shower completed", and there were no documented comments or communication with the RN regarding the assignment on the Aide Plan of Care to complete a bed bath and a shower every visit. During joint clinical record review of the "Aide Plan of Care" and interview, the Director of Nursing stated, "I see that there are instructions on the aide plan of care for the aide to complete bed bath and a shower every visit". During joint clinical record review of the "Aide Visit" note dated 5/21/21 and interview, the Hospice Aide stated, "yes I see that a bed bath and shower were assigned to be completed every visit but I only gave the bed bath since the patient was bed bound".

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; the patient’s latest physician orders and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by review of clinical records and interview. In 1 of 1 (100%) applicable clinical records of a live discharged patient that signed a revocation statement, there was no documented evidence that the Discharge Summary included the patient’s current plan of care and the patient’s latest physician orders. Record #15630 - Patient was discharged on 10/18/21 due to aggressive treatment and signed a Revocation Statement. The "Discharge Summary" form completed on 10/18/21 did not contain the patient's plan of care and/or physician's orders. During joint clinical record review, the Director of Nursing stated "I completed the discharge summary and it does not contain the patient's plan of care or physician's orders".