Every finding on record at C&M Hospice LLC

It is required that each patient’s individualized written plan of care includes a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. This standard was not met as evidenced by clinical record review and interview. In 5 of 5 (100%) clinical records reviewed, the agency did not ensure the patient’s individualized plan of care included a detailed statement of the scope and frequency of services necessary to meet the patient and family needs. Clinical Record 1: The patient elected the hospice benefit on 8/14/2023 with a terminal diagnosis of malignant neoplasm of bone. Review of the plan of care dated 8/14/2023 revealed orders for the Registered Nurse once a week and prn [as need], the Chaplain once a month and prn, and Social Worker once a month and prn. The prn orders on the plan of care did not include how many prn visits were ordered for each discipline and did not include parameters or specific information related to when a prn visit would be indicated for the patient. Clinical Record 2: The patient elected the hospice benefit on 8/1/2023 with a terminal diagnosis of acute renal failure. Review of the plan of care dated 8/1/2023 revealed orders for the Registered Nurse once a week and prn, the Chaplain once a month and prn, and Social Worker once a month and prn. The prn orders on the plan of care did not include how many prn visits were ordered for each discipline and did not include parameters or specific information related to when a prn visit would be indicated for the patient. Clinical Record 3: The patient elected the hospice benefit on 8/14/2023 with a terminal diagnosis of malignant neoplasm of the brain. Review of the plan of care dated 8/14/2023 revealed orders for the Registered Nurse once a week and prn, the Chaplain once a month and prn, and Social Worker once a month and prn. The prn orders on the plan of care did not include how many prn visits were ordered for each discipline and did not include parameters or specific information related to when a prn visit would be indicated for the patient. Clinical Record 4: The patient elected the hospice benefit on 8/13/2023 with a terminal diagnosis of malignant neoplasm of the prostate. Review of the plan of care dated 8/13/2023 revealed orders for the Registered Nurse once a week and prn, the Chaplain once a month and prn, and Social Worker once a month and prn. The prn orders on the plan of care did not include how many prn visits were ordered for each discipline and did not include parameters or specific information related to when a prn visit would be indicated for the patient. Clinical Record 5: The patient elected the hospice benefit on 8/15/2023 with a terminal diagnosis of multiple myeloma. Review of the plan of care dated 8/15/2023 revealed orders for the Registered Nurse once a week and prn, the Chaplain once a month and prn, and Social Worker once a month and prn. The prn orders on the plan of care did not include how many prn visits were ordered for each discipline and did not include parameters or specific information related to when a prn visit would be indicated for the patient. During an interview and joint record review, the General Manager and Administrator agreed the plans of care did not include specific details related to the prn visit orders. In an interview and joint chart review of all 5 records with General Manager and Administrator it was found that the agency failed include specific details of scope and frequencies of interdisciplinary group members on the plan of care. Education was offered to agency regarding writing an order for visit frequencies and what they should include. Examples were also given.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review and observation. In 1 of 3 (33%) home visit observations, the agency did not ensure staff followed agency policy for hand hygiene. Agency policy stated in part, "Prior to administering care, hands are cleansed per CDC [Centers for Disease Control and Prevention] guidelines. Decontaminate hands prior to entry into supply bag. Decontaminate hands after contact with a patient's intact skin (e.g., when taking a pulse or blood pressure, and lifting a patient) even when gloves are worn. Hands are cleansed prior to returning clean equipment to bag." Home Visit 1: During the home visit observation with the Licensed Vocational Nurse, the nurse was observed entering the nursing bag without decontaminating hands prior to entering the bag. The nurse was also observed to return clean equipment to the nursing bag without first cleaning or decontaminating hands. Agency policy states in part, "Prior to administering care, hands are cleansed per CDC guidelines. Decontaminate hands prior to entry into supply bag. Decontaminate hands after contact with a patient's intact skin (e.g., when taking a pulse or blood pressure, and lifting a patient) even when gloves are worn. Hands are cleansed prior to returning clean equipment to bag."