Every finding on record at Bristol Hospice-Rogue Valley, LLC

It is required that the hospice provides infection control education to patients, family members, and other caregivers that is individualized to the needs of each patient. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 3 (33%) applicable patient COVID-19 positive clinical records reviewed, the hospice did not ensure the patient's caregiver received COVID-19 education. Clinical Record 12: The patient was COVID-19 positive on 12/4/22. An RN phone call entry documented 12/4/22 included, "Phone call from facility 12/4/22 to inform patient was COVID-19 positive and no visit necessary today," and a Nursing Visit Note dated 12/5/22. The RN phone call entry dated 12/4/22 and the Nursing visit note 12/5/22 were reviewed and did not include documented evidence that the patient's caregiver at the facility was educated on COVID-19 education. A review of the hospice plan of care identified a goal, "Caregiver will verbalize understanding of COVID-19 education," with no documented verbal understanding. The plan of care did not identify interventions for COVID-19 education. During an interview on 2/23/23, the Regional Director of Compliance confirmed the missing COVID-19 education of the caregiver.

It is required that the hospice medical director or physician designee reviews the clinical information for each patient being evaluated for admission and provides written certification that it is anticipated that the patient's life expectancy is six months or less if the illness runs its normal course. The physician considers the following when making this determination: the primary terminal condition, related diagnosis(es), if any, current subjective and objective medical findings, current medication and treatment orders, and information about the medical management of any of the patient's conditions unrelated to the terminal illness. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 13 (8%) clinical records reviewed, the hospice did not ensure the initial certification was obtained from the patient's attending physician. Clinical Record 5: A review of the clinical record revealed the signed Hospice Election form designated the name of the patient's community physician as the attending physician. There are no verbal or signed initial certification from the attending physician documented in the clinical record. During the interview on 2/23/23, the Executive Director and Regional Compliance Director confirmed the missing initial certification from the attending physician.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. Each patient’s record includes, at a minimum physician orders. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 3 (33%) applicable clinical records of patients receiving wound care, the hospice did not ensure wound care orders were documented in the clinical record. Clinical Record 8: A review of the clinical record revealed no documented physician's orders for wound care. The Nursing Visit Note 8/21/22 included, "Small wound right hand noted from phlebitis, cleansed wound with wound cleaner and left open to air" and "Blistered areas to the buttock." Nursing Visit Note 8/27/22 included, "Small open area noted left buttock, cleansed with wound cleanser and covered with a protective dressing." An RN entry dated 8/21/22 included, "Phone call from LPN, advised to cleanse with wound cleanser and apply Calmoseptine once daily, verbal orders for wound care obtained from the medical director." A review of the clinical record revealed no documented verbal or signed orders for wound care. During an interview 2/23/23, the Executive Director stated, "I did receive the verbal orders for the wound care" and "The verbal orders are not documented in the clinical record."