Every finding on record at Bristol Hospice-Texas, 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 19 (5%) clinical records reviewed, the agency did not ensure that the hospice interdisciplinary group completed an initial comprehensive assessment within five (5) days of the patient's election of hospice care. Clinical Record 18: The patient elected hospice care on 02/02/2023. The Medical Social Worker (MSW) narrative note dated 02/02/23 documented, "MSW was updated on admission for patient by (Director of Patient Care Services) DCPS. MSW left a voicemail message for daughter to request a visit on Monday, 2/2/2023 to complete initial assessment." The MSW narrative note dated 02/14/2023 documented, "MSW has not received a return call from daughter to complete initial assessment. A call was made to daughter today, pending returned call to meet patient." The MSW narrative note dated 03/08/2023 documented in part, " MSW reached out to patient daughter and requested a visit for Friday afternoon at 1:00 pm. Patient is described as being asleep since last night. Final arrangements are in place for cremation." The MSW initial comprehensive assessment was completed on 03/14/2023, with forty days outstanding. The Director of Patient Care Services (DPCS) was interviewed on 09/21/2023 and, after reviewing the clinical record, stated, "The MSW should have made more attempts to get the assessment completed."

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; [and] other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 4 (5%) home visits observed, the agency did not ensure that the comprehensive assessment included a review of the patient's current medications. Home Visit 3/Clinical Record 3: The patient elected hospice care on 11/01/2022. The patient's medications were reviewed with the caregiver during the home visit on 09/19/2023. The medication "Olmesartan 40 mg one table every day" (dated 08/17/2022) was not documented in the agency's medication profile. The caregiver could not locate two (2) medications included in the medication profile: "hyoscyamine tablets 0.125 mg" and "Zofran ODT 4 mg disintegrating tablets." The caregiver stated, "I don't remember ever having those two medications." The most recent comprehensive assessment completed by the Registered Nurse (RN) on 08/21/2023 did not include a review of the Olmesartan. During an interview and a joint review of the record on 09/20/2020, the Director of Patient Care Services (DPCS), after speaking with the nurse stated, "The Olmesartan was not included, and the nurse had to order the hyoscyamine and Zofran."

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 and interview. Agency policy stated in part, "On admission, the social worker or hospice registered nurse will complete a bereavement risk assessment that is given to the bereavement coordinator." In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the initial bereavement assessment was completed. Clinical Record 5: The patient elected hospice care on 3/15/2023. The Chaplain and Medical Social Worker services were declined. There was no documented evidence that the Registered Nurse (RN) completed an initial bereavement risk assessment during the initial comprehensive assessment dated 03/15/2023. Clinical Record 7: The patient elected hospice care on 06/06/2023. The Chaplain and Medical Social Worker services were declined. There was no documented evidence that the RN completed an initial bereavement risk assessment during the initial comprehensive assessment dated 06/06/2023. The Director of Patient Care Services (DPCS) was interviewed on 09/20/2023 and stated, "Because Chaplain and Social Worker services were declined, the Registered Nurse should have done the initial bereavement assessment."

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. Bereavement counseling extends to residents of a SNF/NF (skilled nursing facility/nursing facility) or ICF/IDF (intermediate care facility/intellectual disability facility) when appropriate and identified in the bereavement plan of care. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered; [and] the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. In 1 of 3 (33%) clinical records reviewed of hospice patients with caregivers enrolled in the hospice bereavement program, the agency did not ensure that the bereavement plan of care was initiated. Clinical Record 17: The patient elected hospice care on 05/18/2023 and expired on 05/23/2023. The caregiver was enrolled in the Hospice Bereavement Program. There was no documented evidence that the bereavement services were initiated. During an interview and a joint review of the record on 09/21/2023, the Director of Patient Care Services (DPCS) and the Bereavement Coordinator stated, "The bereavement plan was not initiated."