Every finding on record at Breeze of Life, Inc.

Observed in Record Review. In 2 of 5 patient records reviewed, that had been discharged from the hospice program, the organization was not in accordance with Medicare hospice regulations regarding revocation of hospice services. In review of the medical record for RRDC #3 and RRDC #5 there was no evidence of a signed revocation form by the patient. This was validated by the Administrator Designee/Volunteer Coordinator/LVN.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization had not completed the comprehensive assessment no later than five calendar days after the election of hospice care. In review of the medical record for RRHV#2 the Bereavement Risk Assessment had not been completed until 79 days following the start of care. This was validated by the Alternate Administrator/Volunteer Coordinator.

Observed in Record Review. In 1 of 14 patient records reviewed, the hospice did not conduct a comprehensive assessment that included survivor risk factors, such as the nature of the relationship with the patient, circumstances surrounding the death, behaviors before and after the death, availability of coping mechanisms, and potential for pathological grief reactions. In review of the medical record for RRHV#1 there was no evidence that a bereavement risk assessment was completed in accordance with the organization's policy no. 2-010.1 that states a bereavement risk assessment will be completed at the time of admission to hospice. This was validated by the Administrator Designee/Volunteer Coordinator/LVN.

Observed in Record Review. In 9 of 9 patient records reviewed, the plan of care was not individualized to the patient including goals and interventions to meet goals. For example, in review of RRHV#1 the Care Plan included a the problem Cardiac Activity intolerance related to decreased cardiac output with the goal that the patient will maintain optimum peripheral circulation daily and will be re-evaluated on the next IDG meeting, however failed to identify what optimum peripheral circulation was for that patient such as reduced edema of lower extremities. The Care Plan also included the problem of Respiratory Impaired gas exchange related to decreased oxygen supply to the heart with a goal that the patient will have optimum level of oxygen daily and will be reevaluated on the next IDG meeting, however failed to identify what an optimum level of oxygen is for that patient including PO2 levels or increased activity tolerance. This was also observed in review of the medical records for RRHV #2, RRHV #3, RRNHV #1, RRNHV #2, RRNHV #3, RRNHV #4, RRNHV #5 and RRNHV #6. This was validated by the Alternate Administrator/Volunteer Coordinator/LVN.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not provide care according to hospice plan of care. For RRHV #3 the plan of care included the problem: impaired glucose levels related to Insulin-dependent Diabetes Mellitus Goal: Patient`s blood glucose will remain within parameters throughout service period with interventions for comfort. Parameters: blood glucose will be greater than 70mg/dL and less than 400mg/dL with interventions daily for the next 2 weeks. The LVN failed to assess blood glucose levels during home visit or review the patient's logs of blood glucose levels. This was validated by the Administrator Designee/Volunteer Coordinator/LVN.

Observed in Record Review. In 5 of 9 patient records reviewed, the Hospice Interdisciplinary Group did not collaborate in the care of the patient and coordinate their efforts to support the goals outlined in the plan of care. In 5 of 9 records reviewed for RRHV # 2, RR HV # 3, RRNHV #4, RRNHV #5 and RRNHV #6 it was noted that the IDG was not providing hospice care when the Spiritual Counselor and MSW were visiting the patients only once every certification period regardless of issues identified in the medical record and on the plan of care. For example, in review of the medical record for RRHV #2 who lives alone the Psychosocial Assessment on admission was completed on the telephone with the MSW noting that there were identified concerns with the patients cognitive status, ability to perform ADLs due to weakness and chronic fatigue. The hospice surveyor noted during the home visit with the chaplain that the patient's living conditions were extremely cluttered and unsanitary and in discussion with the chaplain and in review of the medical record there was no evidence that the IDG team was addressing the patient's needs and living situation. The plan for the MSW and SC was to visit once every certification period. This was validated with the Alternate Administrator/Volunteer Coordinator.

Observed in Patient Home. In 1 of 3 home visits conducted, Hospice staff did not follow the organization's bag technique policy. For RRHV #2 the Hospice Chaplain placed her bag and personal belongings on the floor without a barrier in the patient's home which was visibly unkept and dirty. The organization's policy included that the bag should be placed on a clean surface. This was validated by the Alternate Administrator/Volunteer Coordinator.

Observed in Record Review. The organization had not filed a physician's certification of terminal illness statement in the patient record. In review of the medical record for RRHV#1 there was no evidence that a physician had reviewed the clinical information for the hospice patient and provided a written certification that the patient’s life expectancy is six months or less if the illness runs its normal course. This was validated with the Administrator Designee/Volunteer Coordinator/LVN.

Observed in Record Review. In 6 of 9 patient records reviewed, entries in the patient record were not authenticated in accordance with the organization’s policy no. 5-006.1 which states that the clinical note will include the signature of the clinician and his/her credentials. In review of the electronic medical record for RRHV # 1 the visit notes entered by the LVN were signed by the DPCS. This was also observed in review of RRHV #2, RRNHV #1, RRNHV #2, RRNHV #3, RRNHV #5 and RRNHV #6. This was validated by the Alternate Administrator/Volunteer Coordinator/LVN.