Every finding on record at Bayou Hospice LLC

Based on record reviews, and interviews, the hospice failed to ensure all care and services provided to patients and their families followed the written individualized plan of care established by the hospice interdisciplinary group in collaboration with the attending Physician, the patient or representative for 3 of 16 (#3, #5 & #15) patients clinical records reviewed. The hospice agency failed to ensure that the skilled nurse and the hospice aide provided services in accordance with patients individualized plans of care. This failure could cause Hospice patients, and their families increased stress related to terminal illness, due to not provided according to their needs. --- Findings include: Patient #3 Record review of patient #3s POC (effective date of 09/17/2024) for benefit period from 09/15/2024 to 11/13/2024 revealed a terminal diagnosis of End Stage Renal Failure with a SOC dated 07/17/2024, and election of hospice care dated 07/17/2024. The POC revealed that patient was to receive HA services two times a week for ADL (Activities of Daily Living) Care and Aide Care Plan dated 09/25/2024 revealed three times a week to assist patient with personal care and functional limitations. Review of benefit period from 09/15/2024 to 11/13/2024 did not reveal any weekly visit from the HA for Week 1 (from 09/15/24 to 09/21/24) either the two times a week per POC or three times a week per Aide Care Plan to provide service. Patient #5 Record review of patient #5s POC (effective date of 07/10/2024) for benefit period from 07/10/2024 to 09/07/2024 revealed a terminal diagnosis of Chronic Obstructive Pulmonary disease, unspecified with a SOC dated 03/13/2024, and election of hospice care dated 03/13/2024. The POC revealed that patient was to receive HA services three times a week and Aide Care Plan dated 09/25/2024 revealed two times a week to assist patient with personal care and functional limitations. Review of benefit period from 07/10/2024 to 09/07/2024 did not reveal any weekly visit from the HA for the following weeks; • Week 3 (from 07/21/24 to 07/27/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 4 (from 07/28/24 to 08/03/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 5 (from 08/04/24 to 08/10/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 6 (from 08/11/24 to 08/17/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 7 (from 08/18/24 to 08/24/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 8 (from 08/25/24 to 08/31/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 9 (from 09/01/24 to 09/07/24) either the three times a week per the POC or two times a week per aide care plan to provide service. Further review revealed that there was no documentation of any communication records as to why HA services was not being provided to the patient per the POC and the Aide Care Plan. Patient #15 Record review of patient #15s POC (effective date of 08/21/2024) for benefit period from 08/14/2024 to 10/12/2024 revealed a terminal diagnosis of Senile degeneration of brain, not elsewhere classified with a SOC dated 04/16/2024, and election of hospice care dated 04/16/2024. The POC revealed that patient was to receive HA services five times a week with two as needed (PRN) visits for ADL Care. The POC revealed that patient was to receive SN services one times a week with two as needed (PRN) visits for symptom management. Review of benefit period from 08/14/2024 to 10/12/2024 did not reveal any SN services one times a week with two as needed (PRN) visits for symptom management per the POC for the following weeks;• Week 4 (from 09/01/24 to 09/07/24), the SN visit frequency was not met as ordered in the POC. The patient did not receive the one times a week with two as needed visits for symptom management per the POC. • Week 6 (from 09/15/24 to 09/21/24), the SN visit frequency was not met as ordered in the POC. The patient did not receive the one times a week with two as needed visits for symptom management per the POC. Review of benefit period from 08/14/2024 to 10/12/2024 did not reveal all five times a week with two as needed (PRN) visits per POC were done for HA services for the following weeks;• Week 3 (from 08/25/24 to 08/31/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visit frequency on 08/28/24, and 08/30/24. The patient did not receive the remainder three visits as ordered in the POC. • Week 4 (from 09/01/24 to 09/07/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visit frequency on 09/04/24, and 09/06/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 5 (from 09/09/24 to 09/13/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visit frequency on 09/11/24, and 09/13/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 6 (from 09/15/24 to 09/21/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 09/18/24, and 09/20/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 7 (from 09/22/24 to 09/28/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 09/25/24, and 09/27/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 8 (from 09/29/24 to 10/05/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 10/02/24, and 10/04/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 9 (from 10/06/24 to 10/12/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 10/09/24, and 10/11/24. The patient did not receive the remainder three visits as ordered in the POC. Further review revealed that there was no documentation of any communication records as to why HA services was not being provided to the patient per the POC. During an interview on 10/07/2024 at 4:25 PM with the DON, the SR inquired from the DON why the HA visits were not being done for patient #3 as ordered in the POC. The DON stated, ";I dont know why. I think initially the aide was declined and then they [the family] wanted one later on." During an interview on 10/07/2024 at 4:29 PM with the DON, the SR inquired from the DON if there were any communication records to reflect that patient #3 declined the HA services and then patient #3s family members wanted an HA later on. The DON stated, ";I dont see anything regarding a communication record... I think it was missed because we changed the aide and the first week would have been done. I dont think that the documentation was done, but I believe the visits were done." During an interview on 10/07/2024 at 4:31 PM with the DON, the SR inquired from the DON if the HA visit documentations was not done in the EMR (electronic medical record), can you tell me where those documentations would be. DON stated, ";We do have manual paper visit notes for each discipline, but I am not sure if it was done or not." During an interview on 10/08/2024 at 12:43 PM with the DON, the SR inquired from the DON why the HA visits were not being done for patient #15 as ordered in the POC. DON stated, ";I am looking at this and I am seeing again that the visits again should have been documented as three visits, rather than five as we both see. The nurse that did this is gone now. So, yeah. I should have been checking these frequencies closer instead of just checking to see if the POC had the disciplines frequencies on them. I check to make sure the frequencies are on the POCs predominately because of billing purposes. I should have been looking at these frequencies and making sure they were up to date; done right and reflecting what we are providing to the patients. I think I was having issues with the scheduling of those visits for the SNs and the HAs as well." During an interview on 10/08/2024 at 12:50 PM with the DON, the DON stated, ";I do believe that the visits was done but the documentation was done late. It is billing time, and I try to get on them (the HAs and the SNs) for that always, so it may have not been documented on time within the 14 days. But I will in-service the staff on making sure the notes are incorporated into the patients chart on time outside of billing purposes." During an interview on 10/08/2024 at 1:27 PM with the DON, the SR inquired from the DON, what potential harm may befall patient #3, if the frequency of visits as ordered in the POC is not met? DON stated, ";the patient could not be comfortable which is what we promote in hospice. The medication, the supplies, and everything the patient may need may not be done properly if we dont address the POC adequately." During an interview on 10/08/2024 at 1:28 PM with the DON, the SR inquired from the DON, who was responsible for ensuring that the patient #3 received the frequency of visits as ordered in the plan of care. The DON stated, ";The DON." The SR further inquired from the DON who was responsible for ensuring that the policies and procedures of the hospice were implemented accordingly. DON stated, ";The ADM and the DON." During an interview on 10/09/2024 at 11:19 AM with the HA, the SR inquired from the HA, for patient #3, can you tell why there was no further documentation for the HA visits when the POC ordered the HA frequency 3X (three times) a week. HA stated, ";... the patient no longer wanted the aide to come so thats when I stopped." SR inquired further if there was any communication record in the patients CR that reflected the patients request. HA stated, ";No, I reported that to my nurse." During an interview on 10/09/2024 at 11:22 AM with the HA, the SR inquired from the HA, for patient #15, why there was no documentation for the HA visits when the POC ordered the HA frequency 5X (five times) a week. The HA stated, ";Same reason, the patient no longer wanted the aide to come so thats why I stopped." SR inquired further if there is any communication record in the patients CR that reflected the patients request. The HA stated, ";No, I also reported that to my nurse." During an interview on 10/09/2024 at 12:53 PM with the DON. SR inquired from the DON, for patient #15, why there were no communication records to indicate why the HA and the SN visits was not followed per the POC. The DON stated, ";I dont think that it was properly communicated within the team about the directives on the frequency to the RN and then we didnt communicate with the Aide either. So, the communication just failed. It wasnt good. I want to say that my aides are very good at communicating, especially HA-A. She is one of the ones that over communicates. Im sure that she told us (the nurses) what it was and we (the nurses and I) just didnt do it properly." SR further inquired from the DON who was responsible for ensuring that the policies and procedures of the hospice are implemented accordingly. The DON stated, ";The ADM and the DON." During an interview on 10/09/2024 at 1:12 PM with the DON, the SR inquired from the DON, for patient #5 what did the POC order as the HA frequency. DON stated, ";Its supposed to be three times a week and from my end it appears that the hospice aide documentation and/or visits falls off." SR inquired what caused that to happen. DON stated, ";It looks like it just stops. Looks like the POC was not updated. It looks like the visits were stopped in the middle of the certification period. Honestly, I dont know. Can I ask the HA?" During an interview on 10/09/2024 at 1:14 PM with the DON, the DON stated, ";I just asked the HA and she said that she doesnt see this patient anymore. I think the visits stopped 07/18/24. I know she must have told us, and we just didnt update the POC." The SR asked when the IDG meets, can you tell me what is being discussed in the IDG meetings? DON stated, ";Hmmm... yeah. Were not touching on the frequency. Thats what the problem is. Even I dont remember saying anything about the frequencies for this patient. Honestly, this maybe something we need to incorporate going forward because we honestly dont input anything about our Hospice aides in the IDGs. So, we should add that to our IDGs from now on." During an interview on 10/09/2024 at 1:21 PM with the DON, the SR inquired from the DON for patient #5, why there were no communication records to indicate why the HA visits was not followed per the POC, and/or declined by the patient. The DON stated, ";Honestly, we didnt communicate. We didnt do the coordination of care and we didnt really catch this in our IDG. Usually, if the Aide tells me that the patient doesnt want the aide anymore. Then we go ahead and cancel those services because its the patients rights. I will then tell the nurse directly to update the POC and then let the office know that we need to change the schedule. Or I would do it myself. I have never thought to capture all we said verbally in a communication note though, but thats a good idea. It would be easier to do that. I honestly, I never thought to do that. Again, this is something I will implement going forward." During an interview on 10/09/2024 at 1:24 PM with the DON, the SR inquired from the DON, who was responsible for ensuring that the policies and procedures of the hospice were implemented accordingly. DON stated, ";the ADM and DON." Policy:Record review of the Hospice policy and procedure manual entitled, ";Plan of Care" page 1 of 2 reads in part, ";The hospice interdisciplinary group (IDG) must prepare a written plan of care for each patient. The written plan of care must specify the hospice care and services necessary to meet the patient and the family-specific needs, as identified in the comprehensive assessment and as related to the terminal illness and related conditions..."

Based on record reviews and interview, hospice plan of care failed to include all services necessary for the palliation and management of the terminal illness and related conditions for 3 of 16 (#3, #5 & #15) patients whose were records reviewed, including the following; A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs. This failure may have negative outcomes on the Patients/families due to not ensuring the most appropriate level of service was identified to meet the needs of the patient and family. --- Findings include: Patient #3 Record review of patient #3s POC (effective date of 09/17/2024) for benefit period from 09/15/2024 to 11/13/2024 revealed a terminal diagnosis of End Stage Renal Failure with a SOC dated 07/17/2024, and election of hospice care dated 07/17/2024. The POC revealed that patient was to receive HA services two times a week for ADL (Activities of Daily Living) Care and Aide Care Plan dated 09/25/2024 revealed three times a week to assist patient with personal care and functional limitations. Review of benefit period from 09/15/2024 to 11/13/2024 did not reveal any weekly visit from the HA for Week 1 (from 09/15/24 to 09/21/24) either the two times a week per POC or three times a week per Aide Care Plan to provide service. Patient #5 Record review of patient #5s POC (effective date of 07/10/2024) for benefit period from 07/10/2024 to 09/07/2024 revealed a terminal diagnosis of Chronic Obstructive Pulmonary disease, unspecified with a SOC dated 03/13/2024, and election of hospice care dated 03/13/2024. The POC revealed that patient was to receive HA services three times a week and Aide Care Plan dated 09/25/2024 revealed two times a week to assist patient with personal care and functional limitations. Review of benefit period from 07/10/2024 to 09/07/2024 did not reveal any weekly visit from the HA for the following weeks; • Week 3 (from 07/21/24 to 07/27/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 4 (from 07/28/24 to 08/03/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 5 (from 08/04/24 to 08/10/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 6 (from 08/11/24 to 08/17/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 7 (from 08/18/24 to 08/24/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 8 (from 08/25/24 to 08/31/24) either the three times a week per the POC or two times a week per aide care plan to provide service. • Week 9 (from 09/01/24 to 09/07/24) either the three times a week per the POC or two times a week per aide care plan to provide service. Further review revealed that there was no documentation of any communication records as to why HA services was not being provided to the patient per the POC and the Aide Care Plan. Patient #15 Record review of patient #15s POC (effective date of 08/21/2024) for benefit period from 08/14/2024 to 10/12/2024 revealed a terminal diagnosis of Senile degeneration of brain, not elsewhere classified with a SOC dated 04/16/2024, and election of hospice care dated 04/16/2024. The POC revealed that patient was to receive HA services five times a week with two as needed (PRN) visits for ADL Care. The POC revealed that patient was to receive SN services one times a week with two as needed (PRN) visits for symptom management. Review of benefit period from 08/14/2024 to 10/12/2024 did not reveal any SN services one times a week with two as needed (PRN) visits for symptom management per the POC for the following weeks;• Week 4 (from 09/01/24 to 09/07/24), the SN visit frequency was not met as ordered in the POC. The patient did not receive the one times a week with two as needed visits for symptom management per the POC. • Week 6 (from 09/15/24 to 09/21/24), the SN visit frequency was not met as ordered in the POC. The patient did not receive the one times a week with two as needed visits for symptom management per the POC. Review of benefit period from 08/14/2024 to 10/12/2024 did not reveal all five times a week with two as needed (PRN) visits per POC were done for HA services for the following weeks;• Week 3 (from 08/25/24 to 08/31/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visit frequency on 08/28/24, and 08/30/24. The patient did not receive the remainder three visits as ordered in the POC. • Week 4 (from 09/01/24 to 09/07/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visit frequency on 09/04/24, and 09/06/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 5 (from 09/09/24 to 09/13/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visit frequency on 09/11/24, and 09/13/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 6 (from 09/15/24 to 09/21/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 09/18/24, and 09/20/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 7 (from 09/22/24 to 09/28/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 09/25/24, and 09/27/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 8 (from 09/29/24 to 10/05/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 10/02/24, and 10/04/24. The patient did not receive the remainder three visits as ordered in the POC.• Week 9 (from 10/06/24 to 10/12/24), the HA visit frequency was met 2 out of the 5 as ordered in the POC. The patient received HA visits on 10/09/24, and 10/11/24. The patient did not receive the remainder three visits as ordered in the POC. Further review revealed that there was no documentation of any communication records as to why HA services was not being provided to the patient per the POC. During an interview on 10/07/2024 at 4:25 PM with the DON, the SR inquired from the DON why the HA visits were not being done for patient #3 as ordered in the POC. The DON stated, ";I dont know why. I think initially the aide was declined and then they [the family] wanted one later on." During an interview on 10/07/2024 at 4:29 PM with the DON, the SR inquired from the DON if there were any communication records to reflect that patient #3 declined the HA services and then patient #3s family members wanted an HA later on. The DON stated, ";I dont see anything regarding a communication record... I think it was missed because we changed the aide and the first week would have been done. I dont think that the documentation was done, but I believe the visits were done." During an interview on 10/07/2024 at 4:31 PM with the DON, the SR inquired from the DON if the HA visit documentations was not done in the EMR (electronic medical record), can you tell me where those documentations would be. DON stated, ";We do have manual paper visit notes for each discipline, but I am not sure if it was done or not." During an interview on 10/08/2024 at 12:43 PM with the DON, the SR inquired from the DON why the HA visits were not being done for patient #15 as ordered in the POC. DON stated, ";I am looking at this and I am seeing again that the visits again should have been documented as three visits, rather than five as we both see. The nurse that did this is gone now. So, yeah. I should have been checking these frequencies closer instead of just checking to see if the POC had the disciplines frequencies on them. I check to make sure the frequencies are on the POCs predominately because of billing purposes. I should have been looking at these frequencies and making sure they were up to date; done right and reflecting what we are providing to the patients. I think I was having issues with the scheduling of those visits for the SNs and the HAs as well." During an interview on 10/08/2024 at 12:50 PM with the DON, the DON stated, ";I do believe that the visits was done but the documentation was done late. It is billing time, and I try to get on them (the HAs and the SNs) for that always, so it may have not been documented on time within the 14 days. But I will in-service the staff on making sure the notes are incorporated into the patients chart on time outside of billing purposes." During an interview on 10/08/2024 at 1:27 PM with the DON, the SR inquired from the DON, what potential harm may befall patient #3, if the frequency of visits as ordered in the POC is not met? DON stated, ";the patient could not be comfortable which is what we promote in hospice. The medication, the supplies, and everything the patient may need may not be done properly if we dont address the POC adequately." During an interview on 10/08/2024 at 1:28 PM with the DON, the SR inquired from the DON, who was responsible for ensuring that the patient #3 received the frequency of visits as ordered in the plan of care. The DON stated, ";The DON." The SR further inquired from the DON who was responsible for ensuring that the policies and procedures of the hospice were implemented accordingly. DON stated, ";The ADM and the DON." During an interview on 10/09/2024 at 11:19 AM with the HA, the SR inquired from the HA, for patient #3, can you tell why there was no further documentation for the HA visits when the POC ordered the HA frequency 3X (three times) a week. HA stated, ";... the patient no longer wanted the aide to come so thats when I stopped." SR inquired further if there was any communication record in the patients CR that reflected the patients request. HA stated, ";No, I reported that to my nurse." During an interview on 10/09/2024 at 11:22 AM with the HA, the SR inquired from the HA, for patient #15, why there was no documentation for the HA visits when the POC ordered the HA frequency 5X (five times) a week. The HA stated, ";Same reason, the patient no longer wanted the aide to come so thats why I stopped." SR inquired further if there is any communication record in the patients CR that reflected the patients request. The HA stated, ";No, I also reported that to my nurse." During an interview on 10/09/2024 at 12:53 PM with the DON. SR inquired from the DON, for patient #15, why there were no communication records to indicate why the HA and the SN visits was not followed per the POC. The DON stated, ";I dont think that it was properly communicated within the team about the directives on the frequency to the RN and then we didnt communicate with the Aide either. So, the communication just failed. It wasnt good. I want to say that my aides are very good at communicating, especially HA-A. She is one of the ones that over communicates. Im sure that she told us (the nurses) what it was and we (the nurses and I) just didnt do it properly." SR further inquired from the DON who was responsible for ensuring that the policies and procedures of the hospice are implemented accordingly. The DON stated, ";The ADM and the DON." During an interview on 10/09/2024 at 1:12 PM with the DON, the SR inquired from the DON, for patient #5 what did the POC order as the HA frequency. DON stated, ";Its supposed to be three times a week and from my end it appears that the hospice aide documentation and/or visits falls off." SR inquired what caused that to happen. DON stated, ";It looks like it just stops. Looks like the POC was not updated. It looks like the visits were stopped in the middle of the certification period. Honestly, I dont know. Can I ask the HA?" During an interview on 10/09/2024 at 1:14 PM with the DON, the DON stated, ";I just asked the HA and she said that she doesnt see this patient anymore. I think the visits stopped 07/18/24. I know she must have told us, and we just didnt update the POC." The SR asked when the IDG meets, can you tell me what is being discussed in the IDG meetings? DON stated, ";Hmmm... yeah. Were not touching on the frequency. Thats what the problem is. Even I dont remember saying anything about the frequencies for this patient. Honestly, this maybe something we need to incorporate going forward because we honestly dont input anything about our Hospice aides in the IDGs. So, we should add that to our IDGs from now on." During an interview on 10/09/2024 at 1:21 PM with the DON, the SR inquired from the DON for patient #5, why there were no communication records to indicate why the HA visits was not followed per the POC, and/or declined by the patient. The DON stated, ";Honestly, we didnt communicate. We didnt do the coordination of care and we didnt really catch this in our IDG. Usually, if the Aide tells me that the patient doesnt want the aide anymore. Then we go ahead and cancel those services because its the patients rights. I will then tell the nurse directly to update the POC and then let the office know that we need to change the schedule. Or I would do it myself. I have never thought to capture all we said verbally in a communication note though, but thats a good idea. It would be easier to do that. I honestly, I never thought to do that. Again, this is something I will implement going forward." During an interview on 10/09/2024 at 1:24 PM with the DON, the SR inquired from the DON, who was responsible for ensuring that the policies and procedures of the hospice were implemented accordingly. DON stated, ";the ADM and DON." Policy:Record review of the Hospice policy and procedure manual entitled, ";Plan of Care" page 1 of 2 reads in part, ";The hospice interdisciplinary group (IDG) must prepare a written plan of care for each patient. The written plan of care must specify the hospice care and services necessary to meet the patient and the family-specific needs, as identified in the comprehensive assessment and as related to the terminal illness and related conditions. Procedure: D. The written plan of care, with a focus on palliative care, will include the following: f. A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs..."