Every finding on record at Bristol Hospice Georgia, LLC

Based on record reviews, review of the facility policy titled ";Missed Visits," and staff interviews, it was determined the agency failed to ensure hospice aide and nursing services were provided as ordered in the plan of care for five patients (P) (P#1, P#2, P#3, P#6, P#7) of ten sampled patients. --- Findings include: Review of the policy titled, ";Missed Visits," Policy No. 1-027, dated May 2020 reveals the following: Policy Missed visits will be documented in the clinical record. Procedure 2. If a visit is missed and not rescheduled the clinician will: B. Document in the patients clinical record the following information: 1. Patient name 2. Date and type of visit that was missed 3. Reason for the missed visit 4. Description of any unmet needs and how the patients needs were met 5. Any other follow-up needed 6. Other person(s) notified of the missed visit 7. Signature of staff member reporting the information 1. Review of the clinical record for P1 revealed the patient was admitted to hospice services on 4/29/2024. Review of the document titled ";Clinical Summary" revealed skilled nursing visits were ordered 3 times a week for the week of 4/29/2024 and one time a week beginning 5/6/2024. The clinical record revealed one visit was made on 4/29/2024 and failed to reveal further nursing visits before the patient transferred to another hospice on 5/6/2024. The clinical record failed to reveal skilled nursing missed visit notes for the weeks of 4/29/2024 – 5/4/2024 or 5/5/2024 until 5/6/2024. 2. Review of the clinical record for P2 revealed the patient was admitted to hospice services on 1/28/2024. The clinical record revealed skilled nursing visits were ordered once per week for 13 weeks. P2 received a nursing visit 3/15/2024 and no further visits until 3/29/2024. The clinical record failed to reveal skilled nursing missed visit notes for the week of 3/17/2024- 3/22/2024. 3. Review of the clinical record for P3 revealed patient was admitted to hospice services on 2/28/2024. Review of the clinical record revealed skilled nursing visits were ordered three times per week for 14 weeks. The clinical record revealed: 2 nursing visits from 3/3/2024 to 3/9/2024, 2 nursing visits from 3/10/2024 to 3/16/2024, 1 nursing visit for the week of 3/24/2024 to 3/30/2024, 2 nursing visits from 3/31/2024 to 4/6/2024, The clinical record failed to reveal missed skilled nursing visit notes for the dates 3/3/2024- 3/16/2024 or 3/24/2024- 4/6/2024. 4. A review of the clinical record for P6 revealed the patient was admitted on 3/28/2024. Review of the document titled ";Clinical Summary" revealed hospice aide visits were ordered three times each week beginning 3/31/2024. P6 received two hospice aide visits the week of 4/14/2024 to 4/20/2024. The clinical record failed to reveal hospice aide missed visit notes. 5. A review of the clinical record for P7 revealed the patient was admitted on 12/20/2022. Review of the document titled ";Clinical Summary" revealed nursing visits were ordered two times a week beginning 5/6/2024. The clinical record revealed a nursing visit on 5/2/2024 with no other nursing visits until the patient transferred to another hospice on 5/14/2024. The clinical record failed to reveal missed nursing visit notes for the week of 5/6/2024- 5/11/2024 and the week of 5/12/2024- 5/14/2024. During an office interview on 7/31/2024 at 11:00 am, the Executive Director (ED) did not provide any documentation of the missed visits. During a telephone interview on 7/31/2024 at 11:25 am with the Regional Vice President of Operations (RVPO) revealed daily morning meetings are utilized to report missed visits. He was not aware of any issues with missed visits.

Based on record review and staff interview, it was determined the hospice failed to assess the skills and competency of all individuals providing care for two employee files (RN AA, RN CC) of six employee files sampled. Specifically, employee files failed to reveal skills competency check-offs. --- Findings include: 1. Registered Nurse (RN) AA was hired on 3/4/2024. A review of the personnel file for RN AA failed to reveal a competency skills checklist to assure competency in performing required skills. 2. RN CC was hired on 7/19/2021. A review of the personnel file for RN CC failed to reveal a competency skills checklist to assure competency in performing required skills. During an interview with the Executive Director (ED) and Regional Vice President of Operations (RVPO) on 7/31/2024 at 1:30 pm revealed that the ED and RVPO confirmed missing competency assessments.

It is required that the hospice provides an initial orientation for each employee that addresses the employee’s specific job duties, including infection control and organization procedures and policies and procedures on advance directives. Orientation on the hospice philosophy is also provided to all employees and contracted staff who have patient and family contact. Orientation includes the following, as appropriate to the employee’s specific job duties: The needs and concerns of patients and families coping with a terminal illness; Education regarding the hospice’s policies and procedures on advance directives. This standard was not met as evidenced by a review of personnel records, documents, and interviews. The agency Human Resources Policy No. 1-002-HR stated in part, "Procedure 7. Completion of the orientation process will be documented in the personnel record." 1 of 9 (11%) personnel records reviewed identified that the agency did not have documentation of initial orientation. Personnel Record 9: Medical Social Worker's date of hire was 11/19/2019. The personnel record did not have documented evidence of initial orientation. The Alternate Administrator and the Office Manager were interviewed on 11/16/2022 and agreed that the initial orientation was not present in the personnel record.