Every finding on record at Bristol Hospice - Oregon LLC

It is required that each patient’s individualized written plan of care reflects patient and family goals and 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 19 (5%) clinical records reviewed, the agency did not ensure that the plan of care (POC) identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 8: The patient elected hospice care on 06/17/2024 with a diagnosis of metabolic encephalopathy. The initial nursing comprehensive assessment dated 06/17/2024 documented, "Hospice Mental Status... noted increase confusion, noncompliance with care, yelling telling nurse to go away, and facility reports patient is at his norm." The initial social work assessment dated 06/17/2024 documented, "Mental health history...severe with agitation ...Orientation/Behavior... Patient Affect - Angry...Patient Attitude - Hostile." The POC dated 06/17/2024 did not document planned interventions and goal(s) to address the patient's identified problem with agitation. During an interview on 07/17/2024, the Executive Director, Director of Patient Care Services, and Clinical Supervisor confirmed that the POC did not include interventions based on problems identified in the initial comprehensive assessment.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed for patients that received Hospice Aide (HA) services, the agency did not ensure that the HA received patient-specific written care instructions from the Registered Nurse (RN). Clinical Record 1: The patient elected hospice care on 03/01/2024 with a diagnosis of metabolic encephalopathy. The plan of care (POC) dated 05/30/2024 ordered skilled nursing for wound care to the patient's "right heel." The HA care plan dated 05/30/2024 did not provide the HA with specific written instructions for how to manage and what to report related to the wound area on the patient's "Right heel" while giving the assigned bed bath. The HA visit notes dated 06/05/2024 and 06/12/2024 did not document how the HA managed the "right heel" wound while performing the assigned bed bath. Clinical Record 3: The patient elected hospice care on 06/10/2024 with a diagnosis of acute and chronic respiratory failure with hypoxia. The POC 06/10/2024 ordered: "Oxygen 3 - 5 liter/min both nostrils continuous for comfort with shortness of breath." The HA care plan dated 06/10/2024 did not provide the HA with specific written instructions for managing the oxygen while giving the assigned seated shower. The HA visit notes dated 06/26/2024 and 07/03/2024 did not document how the HA managed the oxygen while giving the assigned seated shower. During an interview on 07/17/2024, the Executive Director, Director of Patient Care Services, and Clinical Supervisor stated that the RN had provided the aide with clear and accurate written care instructions.