Every finding on record at Bristol Hospice, LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) clinical records reviewed of patients that received chaplain services, the hospice did not ensure that the initial comprehensive assessment was made no later than five calendar days after the election of hospice care. Clinical Record 5: The patient elected the hospice benefit on 11/30/2023 with a diagnosis of Malignant neoplasm of bladder. The plan of care dated 11/30/2023 ordered Chaplain services two (2) times a month for three (3) months. The Chaplain completed the initial spiritual assessment visit on 12/06/2023, with six (6) days outstanding. During a joint review of the clinical record and interview, the Clinical Director confirmed that the Chaplain made the initial visit later than the required 5-day calendar days.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the hospice did not ensure that the patient’s plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 4: The patient elected hospice care on 03/19/2024. The physician's Certification of Terminal Illness (CTI), dated and signed 03/19/2024, documented that the patient was recently hospitalized for aspiration pneumonia. The pre-admit note completed by the Registered Nurse (RN) on 03/18/2024 and the initial comprehensive assessment completed by the RN on 03/19/2024 documented that the patient had dysphagia and was recently hospitalized for aspiration pneumonia. The plan of care dated 03/19/2024 through 06/16/2024 documented the patient's goal: "Patient will be free from signs and symptoms of aspiration." The plan of care did not include documentation of interventions based on the problems of dysphagia and aspiration pneumonia identified in the comprehensive assessment. During a joint review of the clinical record and interview, the Clinical Director confirmed there were no documented interventions based on problems identified in the comprehensive assessment.

It is required that a hospice aide provides services: ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; [and] consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the hospice did not ensure that the Hospice Aide provided services ordered by the Interdisciplinary Group, included in the plan of care. Clinical Record 5: The patient elected the hospice benefit on 11/30/2023 with a diagnosis of Malignant neoplasm of bladder. The plan of care for the certification period dated 12/3/2023 through 01/28/2024 ordered HA services three (3) times a week. For the weeks of 12/24/2023 through 12/30/2024 and 12/31/2023 through 01/06/2024, the HA documented two (2) visits weekly. A review of the clinical record revealed no evidence of documented missed visits or documented reasons why the visits were missed. During an interview and a joint review of the clinical record, the Clinical Director confirmed that the HA did not follow the frequency order on the plan of care.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record may be maintained electronically or on paper. 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 document review and interview. In 1 of 2 (50%) clinical records reviewed of live discharged patients, the hospice did not ensure that the patient's clinical record contained a copy of a Notice of Medicare Non-Coverage signed at least two calendar days before Medicare-covered services ended. Clinical Record 13: The patient elected the hospice benefit on 08/24/2023 with a diagnosis of Parkinson's disease. The interdisciplinary (IDG) team determined the patient was no longer terminally ill and agreed to discharge the patient on 01/02/2024. A review of the notification to the patient and family of the discharge and the Notice of Medicare Non-Coverage (NOMNC) form revealed that the patient was discharged on 01/02/2024. The form was signed on 01/04/2024. During a joint review of the clinical record and interview with the clinical director, it was confirmed there was no documented evidence that the patient and family were notified in the appropriate amount of time of the patient's discharge plan.