Every finding on record at Brite Hospice, LLC

Upon patient record review 5 of 19 (Patients 3, 4, 5, 7, 8) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patients 3, 4, 5, & 8: there is no initial spiritual assessment completed. No evidence found of any discipline assessing spiritual needs. Patient 7: there is no initial psychosocial assessment completed. No evidence found of initial MSW assessment or other discipline completing requirement.

Upon patient record review, 19 of 19 (Patients 1-19) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients 1-19: "PRN" frequency orders for N, M, SC, NP have a broad range from 10-50 PRN visits authorized per benefit period. There is no evidence of POC frequency individualized. Patients 5, 6 and 7: NP and MSW discipline visits are ordered "PRN". There is no evidence of detailed frequency required to meet pt. needs. Patients 1, 5, 8, 10, 11, 12, & 14: NP noted to be ordered "PRN". There is no evidence of detailed frequency required to meet pt. needs. Patients 4 & 14: SC noted to be ordered "PRN". There is no evidence of detailed frequency required to meet pt. needs.

Upon patient record review, 19 of 19 (Patient 1-19) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patients 1-19: the Initial Hospice Plan of Care order in each chart states, "Catheterize for signs and symptoms of urinary retention or stage 3 or 4 decubitus. Change foley catheter as indicated." Verified with staff this is considered a PRN order versus a standing order and no further MD communication or clarification would be needed to institute this treatment order. No evidence of further clarification such as size, flush, or the"indications" that would warrant changing the catheter.

Upon client record review, 2 of 19 (Patient #5, 9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 5: documentation reveals a Left abdominal wound with "dressing changed performed" upon admit and subsequent nursing visits. There is no evidence of wound care orders. Patient 9: initial nursing assessment reveals wound care performed to LLE consisting of "cleanse with NS, apply gauze pads, wrap with Kerlix." No evidence of order found.

Upon patient record review, 1 of 15 (Patient 12) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 12: Aide POC reflects assignment of "shower or bed bath".