Every finding on record at Barton Healthcare System

Observed in Record Review. In 1 of 1 patient records reviewed, where the patient had a planned discharge from the hospice program, there had been no Notice of Medicare Non-Coverage documented as given to and discussed with the patient. For example, in HOSRRDC 3, the patient had a planned discharged related to no decline in 60 days; however, there had been no NOMNC signed by the patient. This was validated with the Director of Home Health and Hospice.

Observed in Record Review. In 6 of 14 patient records reviewed, the Hospice Nurse Surveyor noted the Medical Social Worker (MSW) and/or Spiritual Care Provider (SC) had not completed their comprehensive assessment within 5 days of election of Hospice Benefit (EOHB). For example, In HOSRRHV 1, the MSW had completed the comprehensive assessment 9 days post EOHB, and the SC had no documented contact with the patient since EOHB 15 days ago. In HOSRRHV 2 the MSW had an initial visit documented 7 days post EOHB. In HOSRRHV 3, the MSW had not documented an initial comprehensive visit until 13 days post EOHB and there had been no communication notes to identify the reason for the delay in service. In HOSRRNHV 4, there had been no documented SC contact in the patient record. In HOSRRNHV 5, the initial MSW visit had been 11 days post EOHB and there had been no documentation to support the delay in service. In HOSRRNHV 7, the MSW and SC both documented that voice mail messages had been left for the patient to initiate contact; however, there had been no documented follow-up. This was validated with the Director of Hospice.

Observed in Record Review. In 4 of 14 patient records reviewed, the Hospice Nurse Surveyor noted an initial bereavement risk assessment (BR) had not been documented in the patient medical record. For example, in HOSRRHV 1, the patient had been admitted to Hospice 15 days ago. No initial BR had been documented. In HOSRRHV 2, no initial BR had been documented. In HOSRRNHV 9, there had been no initial BR documented, and in HOSDC 2, there had been no documented initial BR. The patient in HOSRRNHV 6, had an initial BR documented; however, there had been no documented spiritual care provider home visit or phone call to support how the assessment had been completed. This was validated with the Director of Hospice and the Bereavement Coordinator.

Observed in Record Review. In 14 of 14 patient records reviewed, the Hospice Nurse Surveyor had been unable to validate that volunteer services had been discussed and offered to the patient/care giver. for example, in HOSRRHV 1, the patient has a need for volunteer services. Discussed with the primary caregiver, and they indicated the services had never been explained, nor offered. The lack of documentation related to the need for volunteer services had not been present in all records reviewed. This was validated with the Director of Hospice.

Observed in Record Review. In 4 of 14 patient records reviewed, the Hospice Nurse Surveyor noted not all patient identified issues had been addressed on the patient plan of care (POC). For example, in HOSRRHV 1, the patient had a high Braden score (14) on the initial evaluation visit and skin tears; however, preventative measures had not been added to the POC. In HOSRRNHV 4 the patient had pain control issues; however, pain had not been included on the plan of care. HOSRRNHV 5 had been missing Pain and Skin from the POC, and in HOSRRNHV 6, pain had not been included on the patient POC. This was validated with the Director of Hospice.

Observed in Tracer Activities. The Hospice Nurse Surveyor noted the HCO had not documented volunteer recruitment activities. The recruitment activities conducted had been passive on the hospital web page and had not generated any volunteer prospects. This was validated with the Director of Hospice and the Volunteer Coordinator.

Observed in Tracer Activities. During a review of the Volunteer Program, the Coordinator had not been able to provide documentation of volunteer hours so there had been no documentation of the cost savings received from having volunteers as this had not been available during the survey. This was validated with the Director of Hospice and the Volunteer Coordinator.

Observed in Tracer Activities. The Hospice Nurse Surveyor had not been able to validated the HCO had met the 5% standard as the documentation was not available during survey. This was validated with the Director of Hospice and the Volunteer Coordinator.

Observed in Leadership Session. There was no evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by condition level finding at §418.78. volunteer services.

Observed in Patient Home. In 1 of 2 home visits conducted, where the patient had home oxygen, the Hospice Nurse Surveyor noted there had been no documentation to validate patient/care giver understanding of oxygen safety education and their ability to implement it. In HOSRRHV 3, there had been smoking materials in the patient home, a gas stove, and the patient had been smoking and putting the nasal cannula (with oxygen still flowing) into her pocket while she smoked. In review of the patient record, there had been no documentation to reflect that the patient and caregiver had an understanding of the home safety education and no follow-up education had been provided to mitigate the risks. This was validated with the Director of Hospice.

Observed in Record Review. In 2 of 11 patient records reviewed, During HOSHV#1 and HOSRR#6 it was noted the MSW did not visit the patient as part of the comprehensive assessment no later than 5 days after the election of hospice date.

Observed in Record Review. In 1 of 11 patient records reviewed, During HOSHV#1 it was noted an initial bereavement assessment was not documented in the patient record.

Observed in Record Review. In 10 of 11 patient records reviewed, During HOSHV#1-3, RR#2-8, it was noted the IDG notes reviewed lacked documented evidence of updates to the comprehensive assessments during IDG meetings. Some records had documentation by the RN to update the comprehensive assessment and all records reviewed lacked updates from MSW and Spiritual Counselor. In addition there was lack of documentation of response to the care being provided. The documented progress toward outcomes on the active records reviewed was not documented.

Observed in Record Review. In 7 of 11 patient records reviewed, During HOSRR#1, it was noted the spiritual counselor documented a frequency of visits 1-5 that lacked specificity to identify an individualized plan to meet the patient and family needs. During HOSHV#1 it was noted the SN documented a frequency of PRN visits 1-6 PRN that lacked specificity to identify an individualized plan to meet the patient and family needs. In addition the MSW documented the frequency of 1-11 visits for the certification period that lacked specificity to identify an individualized plan to meet the patient and family needs. During HOSHV#2 it was noted a frequency for the MSW of 1-9 visits in the certification period that lacked specificity to identify an individualized plan to meet the patient and family needs. During HOSHV#3 it was noted a frequency for the SN of 1-9 PRN visits in addition to another frequency of 1-2x/week. The order lacked specificity to identify an individualized plan to meet the patient and family needs. HOSRR#3 an order for MSW 1-4 PRN lacked the reason for the PRN visits. HOSRR#6 an order for SN of 1-14 PRN visits lacked the reason for the PRN visits and lacked specificity to identify an individualized plan to meet the patient and family needs. HOSRR#6 an order for MSW 1-6 PRN lacked the reason for the PRN visits to be performed. HOSRR#7 an order for SN 1-5 PRN lacked the reason for the PRN visits to be performed.

Observed in Record Review. In 2 of 8 patient records reviewed, who were discharged from Hospice due to death. During HOSRR#5 and #8, it was noted although bereavement mailings were documented as sent, there was lack of post death bereavement assessments documented to establish, in conjunction with the IDG, the POC for bereavement services.

Observed in Record Review. In 2 of 11 patient records reviewed, During RR#2, it was noted the type of bath was documented as bathe pt. that lacked the specificity of the type of bath to be performed by the aide. During HOSHV#2 it was noted the patient had a Foley catheter inserted after the initial RN assessment and after the initial aide assignment form was completed. The aide POC was not updated to include the Foley catheter (F/C) insertion with direction on F/C care during personal care.