Every finding on record at Best Choice Hospice Service, Inc.

It is required that during the initial assessment visit and in advance of providing care, the hospice provides the patient or his or her representative with verbal and written notice of the patient’s rights and responsibilities. This standard was not met as evidenced by interview and observation. In 1 of 3 (33%) patients who received a home visit revealed the hospice did not ensure the patient or their representative received written notice of the patient's rights and responsibilities. Home Visit 1: The patient’s benefit election was dated 12/15/2023. The patient's daughter stated she did not receive a copy of the patient's rights and responsibilities. The RN completing the home visit confirmed there was no patient rights and responsibilities documentation given to the patient/family. The DPCS designee was interviewed on 2/14/2024 and confirmed the finding. In 1 of 3 (33%) patients who received a home visit revealed the hospice did not ensure the patient or their representative received written notice of the patient's rights and responsibilities.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions such as hand hygiene. This standard was not met as evidenced by document review, interview and observation. In 1 of 3 (33%) patients who received a home visit with observation of handwashing, revealed the hospice organization did not ensure adherence to agency infection prevention and control policies and procedures. Home Visit 1: The patient’s benefit election was dated 12/15/2023. During a home visit on 2/13/2024 at 1400, the RN, Staff 3 was observed removing his gloves after providing patient care. He did not wash his hands after removing his gloves. Document 1: The agency policy titled Hand Hygiene, Policy No. 7-009 revised January 2021, reads in relevant parts, “Hand decontamination using an alcohol-based hand rub should be performed after removing gloves." The DPCS designee was interviewed on 2/14/2024 and confirmed the finding. In 1 of 3 (33%) patients who received a home visit with observation of handwashing, revealed the hospice organization did not ensure adherence to agency infection prevention and control policies and procedures.

It is required that the hospice provides nursing care under the supervision of a registered nurse. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed in which a licensed vocational/practical nurse (LPN/LVN) provided services revealed that a registered nurse (RN) did not perform LPN/LVN supervisory visits. Clinical Record 4: The patient’s benefit election was dated 12/9/23. The LVN visited 12/16/2023, 12/29/2023, 1/1/2024, 1/12/2024, 1/16/2024, 1/26/2024, and 1/31/2024. The RN assess the patient on 12/23/2023, 1/6/2024, 1/20/2024, and 2/3/2024. There was no agency policy concerning nursing care being provided under the supervision of the Registered Nurse. The section in the electronic medical record (EMR) to capture LVN supervision was left blank and there was no documented discussion between the RN and the LVN in the IDG meeting notes. The DPCS designee was interviewed on 2/14/2024 and acknowledged that the EMR was not being utilized to reflect nursing services being provided under the supervision of the RN. In 1 of 1 (100%) clinical records reviewed in which a licensed vocational/practical nurse (LPN/LVN) provided services revealed that a registered nurse (RN) did not perform LPN/LVN supervisory visits.

It is required that the hospice medical director or physician-designee provides written and signed recertification of the terminal illness to meet the hospice care benefit requirement. Recertification for the hospice care benefit is informed by the medical director or physician designee’s review of the patient’s clinical information. Recertification is completed no later than two (2) calendar days after the first day of each benefit period, and no more than fifteen (15) days before the next benefit period begins. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed in which a written recertification was required revealed the hospice did not ensure the written recertification was completed. Clinical Record 3: The patient’s benefit election was dated 12/15/2023. The patient transferred to the hospice with 2 days left in the 6th benefit period. There was no evidence that a written certification of terminal illness was completed by the medical director for the 7th benefit period certification dated 12/17/2023-2/14/2024. The DPCS designee was interviewed on 2/14/2024 and confirmed the finding. In 1 of 1 clinical records reviewed in which a written recertification was required revealed the hospice did not ensure the written recertification was completed.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by clinical record review and interview. In 3 of 6 (50%) clinical records reviewed revealed the hospice did not ensure that the explanation of hospice Medicare benefits was completed. Clinical Record 3: The patient’s benefit election was dated 12/15/2023. There was no evidence of an effective start of care (SOC) date on the election of benefit (EOB). Clinical Record 4: The patient’s benefit election was dated 12/9/2023. There was no evidence of an effective SOC date on the EOB. Clinical Record 5: The patient’s benefit election was dated 12/5/2023. There was no evidence of an effective SOC date on the EOB. The DPCS designee was interviewed on 2/14/2024 and confirmed the finding. In 3 of 6 (50%) clinical records reviewed revealed the hospice did not ensure that the explanation of hospice Medicare benefits was completed.