Every finding on record at Bristol Hospice - Richmond, L.L.C.

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, document review and interview. Agency policy states in part "A comprehensive patient assessment will be performed by the interdisciplinary group no later than 5 calendar days after the election of hospice care in consultation with attending physician." 2 of 14 (14%) clinical records reviewed revealed that the interdisciplinary team did not complete the initial comprehensive assessments within the first 5 calendar days after the election of hospice care. Clinical Record 3: The patient was admitted to hospice services on 3/30/23 with a diagnosis of heart disease. The initial comprehensive social work assessment was not completed until 4/6/23 (7 days after the election of hospice care). In a joint review of the record and interview with the VP of Clinical it was noted there was no documented evidence that social work made any contact with the patient or family before 4/6/23. The VP of Clinical agreed that the initial social work visit was not compliant with policy. Clinical Record 10: The patient was admitted to hospice services on 3/13/23 with a diagnosis of senile degeneration of brain. In a joint review of the record and interview with the VP of Clinical it was found and agreed that no initial comprehensive assessment was completed by social work within the 5-day compliance window. There was no documentation found in the record to explain the delay. Agency policy states in part "A comprehensive patient assessment will be performed by the interdisciplinary group no later than 5 calendar days after the election of hospice care in consultation with attending physician."

It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient's family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and considered in the bereavement plan of care. This standard was not met as evidenced by clinical record review, document review and interview. Agency policy states in part, "On admission the social worker or hospice registered nurse will complete a bereavement risk assessment that is given to the Bereavement Coordinator." 5 of 14 (36%) clinical records reviewed revealed no documented evidence that initial bereavement risk assessments were completed by the interdisciplinary group. Clinical Record 7: The patient was admitted to hospice services on 4/21/23 with a diagnosis of Alzheimer's disease. In a joint review of the record with the VP of Clinical there was no documentation found that an initial bereavement risk assessment was completed by the social worker or registered nurse. Clinical Record 8: The patient was admitted to hospice services on 4/13/23 with a diagnosis of Senile Degeneration of Brain. In a joint review of the record with the VP of Clinical there was no documentation found that an initial bereavement risk assessment was completed by the social worker or registered nurse. Clinical Record 9: The patient was admitted to hospice services on 4/8/23 with a diagnosis of Malignant Neoplasm of Mouth. In a joint review of the record with the VP of Clinical there was no documentation found that an initial bereavement risk assessment was completed by the social worker or registered nurse. Clinical Record 13: The patient was admitted to hospice services on 4/10/23 with a diagnosis of Chronic Obstructive Pulmonary Disease. In a joint review of the record with the VP of Clinical there was no documentation found that an initial bereavement risk assessment was completed by the social worker or registered nurse. Clinical Record 14: The patient was admitted to hospice services on 3/17/23 with a diagnosis of Senile Degeneration of Brain. In a joint review of the record with the VP of Clinical there was no documentation found that an initial bereavement risk assessment was completed by the social worker or registered nurse. Agency policy states in part "On admission the social worker or hospice registered nurse will complete a bereavement risk assessment that is given to the Bereavement Coordinator."

It is required that the hospice designates a registered nurse member of the IDG to: 1. Provide coordination of care; 2. Ensure continuous assessment of each patient’s and family’s needs; 3. Ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by: 1. The hospice IDG in collaboration with the attending physician (if any); 2. The patient or patient representative; 3. The primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by clinical record review and interview. 1 of 14 (7%) clinical records reviewed revealed social work did not provide services in accordance with the plan of care. Clinical Record 10: The patient was admitted to hospice services on 3/13/23 with a diagnosis of Senile Degeneration of Brain. There was an order on the plan of care for social work services starting 5/10/23 at a visit frequency of one time a week for five weeks. The social worker documented that the visit for 5/11/23 was cancelled and a visit was rescheduled for 5/16/23. There was no documentation of a social work visit the week of 5/14/23 - 5/20/23 or the week of 5/21/23 - 5/27/23. In a joint review of record and interview with the VP of Clinical she stated that the social work visit was not made in compliance with the plan of care.

It is required that a hospice aide provides services: 1. Ordered by the Interdisciplinary Group; 2. Included in the plan of care; 3. Permitted to be performed under state law and regulation; 4. Consistent with the hospice aide training. This standard was not met as evidenced by clinical record review, document review and interview. 3 of 13 (23%) applicable clinical records with hospice aide services reviewed revealed that the hospice aide(s) did not follow the plan of care with respect to the frequency of tasks assigned. The agency policy states in part, "Hospice aides will document and provide care in accordance with the hospice aide assignment." Clinical Record 4: The patient was admitted to hospice services on 4/8/23 with a diagnosis of cerebral infarction. The aide plan of care assigned the patient to be shaved once a week and shampoo hair once a week. The aide visits documented that a shave and shampoo was completed on 4/10/23, 4/11/23, 4/12/23, 4/13/23, and 4/14/23. The tasks that were assigned once a week were documented to have been performed all 5 days of that week. Clinical Record 10: The patient was admitted to hospice services on 3/13/23 with a diagnosis of Senile Degeneration of the Brain. The aide plan of care assigned "Sweet Dreams" visits for the aide to make evening visits to "tuck in" patients. The aide documented that the Sweet Dreams routine was done during a visit documented on 4/12/23 at 10:45am, a visit documented on 4/13/23 at 12:01pm, and morning tasks were documented completed on an evening visit documented on 4/14/23 at 9pm. In an interview and joint review of the record with the VP of Clinical she agreed that aide did not follow the aide plan of care. Clinical Record 12: The patient was admitted to hospice services on 3/28/23 with a diagnosis of Cerebrovascular Disease. On the aide plan of care a bed bath was assigned at a frequency of 2 times a week. The aide documented that a bath was done on 4/3/23, 4/6/23, 4/7/23, and 4/8/23 (4 times in one week). In an interview and joint record review with the VP of Clinical, she agreed that the aide did not follow the aide plan of care. In a joint review of clinical records with the VP of Clinical Operations she agreed that the aide plans of care were not followed by the aides. In a joint review of clinical records with the VP of Clinical operations she agreed that the aide plan of care was not followed by the employees. The agency policy states in part "Hospice aides will document and provide care in accordance with the hospice aide assignment."

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review, document review and interview. The agency policy for Hospice Aide Services states in part, "Hospice aide must report changes in the patient's medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities." 3 of 14 (21%) clinical records reviewed revealed that the aide(s) failed to notify the RN of a change in the plans of care or tasks not performed. Clinical Record 1: the patient was admitted to hospice services on 3/12/23 with a diagnosis of chronic kidney disease. An assignment for a chair bath was on the aide plan of care. Visits made by aide on 3/20/23 and 3/21/23 documented that the patient refused the chair bath. There was no documentation found that the aide notified the RN of assigned tasks not performed. Clinical Record 3: The patient was admitted to hospice services on 3/30/23 with a diagnosis of heart disease. The aide plan of care assigned a shower/bath every visit. A visit made by aide on 4/10/23 documented the patient refused the shower/bath. There was no documentation found that the aide notified the RN of the assigned task not completed. Clinical Record 7: The patient was admitted to hospice services on 4/21/23 with a diagnosis of Alzheimer's disease. The aide plan of care assigned a shower to be done 1 time per week. It was documented that during the week of 4/24/23 through 4/28/23 the patient refused a shower on any day. There was no documentation that the aide notified the RN of the assigned task not completed. The agency policy for Hospice Aide Services it states in part "Hospice aide must report changes in the patient's medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities."