Every finding on record at Care 4 U Hospice & Palliative Care Inc.

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. 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. 1 of 1 (100%) record review of a patient discharged due to death revealed the agency did not ensure that bereavement services were provided. Record 4: The patient elected hospice care on 10/7/2022. The patient expired on 10/8/2022. There was no evidence that bereavement services were made available to the family and others following the patient's death. The record review revealed no evidence of bereavement notes or a bereavement plan of care. During an interview on 2/27/2023, the CEO confirmed the finding and stated that this patient had no bereavement records. 1 of 1 (100%) of clinical records reviewed with discharge due to death revealed the agency did not ensure that bereavement services were performed and documented.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation, [and] consistent with the hospice aide training. THIS IS A CONTINUED REQUIRED ACTION. This standard was not met as evidenced by clinical record review and interview. 1 of 5 (20%) records reviewed revealed the agency did not ensure that the hospice aide provided services consistent with the plan of care. Record 2: The patient elected hospice care on 9/1/2022. The plan of care dated 9/1/2022 ordered "HHA 3 x w x9." The clinical record review revealed a completed HHA visit dated 9/1/2022. There was no evidence of three times the week of 9/1/2022. During an interview on 2/27/2023, the CEO confirmed the finding and stated, "Oh, I see what you mean because there are not really enough days that first week." THIS IS A CONTINUED REQUIRED ACTION. The agency did not ensure that the aide provided services consistent with the plan of care.

It is required that if a patient revokes the election of hospice care, or is discharged from hospice in accordance with 418.26, the hospice must forward to the patient's attending physician a copy of the hospice discharge summary and the patient's clinical record if requested. This standard was not met as evidenced by a review of clinical records and interviews. 3 of 5 (60%) records reviewed of discharged patients revealed the hospice did not ensure that a hospice discharge summary was forwarded to the patient's community attending physician. Clinical Record 1: The patient elected hospice care on 11/30/2021. A record review revealed that the patient's hospice services ended on 12/9/2021. There was no evidence that a discharge summary was forwarded to the patient's community attending physician. Clinical Record 2: The patient elected hospice care on 9/1/2021. A record review revealed that the patient was discharged from hospice services on 12/9/2021 due to no longer meeting hospice criteria. There was no evidence that a discharge summary was forwarded to the patient's community attending physician. Clinical Record 3: The patient elected hospice care on 9/25/2021. A record review revealed that the patient was discharged on 9/25/2021 due to moving out of the service area. There was no evidence that a discharge summary was forwarded to the patient's community attending physician. During an interview, the Chief Executive Officer confirmed no discharge summaries were in the records.

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; 3. The patient’s latest physician orders; any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. THIS IS A CONTINUED REQUIRED ACTION. This standard was not met as evidenced by clinical record review and interview. 4 of 5 (80%) records reviewed of discharged patients revealed the hospice did not ensure that the hospice discharge summary, including the patient's medications, treatments, current plan of care, and physician orders, was forwarded to the patient's community attending physician or receiving facility. Clinical Record 1: The patient elected hospice care on 11/30/2021. A record review revealed the patient's hospice services ended on 12/9/2021. There was no evidence that a discharge summary was completed. Clinical Record 2: The patient elected hospice care on 9/1/2021. A record review revealed that the patient was discharged from hospice services on 12/9/2021 due to no longer meeting hospice criteria. There was no evidence that a discharge summary was completed. Clinical Record 3: The patient elected hospice care on 9/25/2021. A record review documented that the patient was discharged on 9/25/2021 due to moving out of the service area. There was no evidence that a discharge summary was completed. Clinical Record 5: The patient elected hospice care on 7/16/2021. The patient was transferred to a medical facility on 9/21/2021. The clinical record included the hospice's "Discharge Summary" form, which was faxed to the facility. The discharge summary did not include a medication list, physician orders, or interventions. During an interview, the Chief Executive Officer confirmed the clinical records included no discharge summaries. THIS IS A CONTINUED REQUIRED ACTION. 4 of 4 (100%) clinical records with live discharges revealed that the agency did not ensure that a hospice discharge summary including medications, treatments, current plan of care and physician orders was provided to patient's community attending physician.

It is required that the hospice obtains a criminal background check on all hospice employees who have direct patient contact or access to patient records. Hospice contracts require that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. THIS IS A CONTINUED REQUIRED ACTION. This standard was not met as evidenced by document review and interview. The agency did not ensure that contracts required criminal background checks for contract employees who have direct patient contact or access to patient records. A review of the agency's therapy contract titled "Advanced Theracare Staffing," dated and executed 11/13/19, revealed the contract did not include language requiring criminal background checks for all contracted therapy staff with direct patient contact or access to patient records. During an interview, the CEO confirmed the finding and stated, "I am sending it back to them to add the language." THIS IS A CONTINUED RQUIRED ACTION. The agency did not ensure that contracts included the requirement for criminal background checks for all employees who would direct contact with patients or access to patient records.

It is required that organization policy and procedure state the requirements for a medical or a spiritual exemption to being fully vaccinated for COVID-19 per state and federal law and regulation. A medical exemption from being fully vaccinated for COVID-19 includes: documentation of information specifying which of the authorized COVID-19 vaccines is clinically contraindicated for the individual to receive, and the recognized clinical reasons for the contraindications; and a documented statement by the authenticating practitioner recommending that the individual be exempted from the hospice requirement to be fully vaccinated for COVID-19 based on the recognized clinical contraindications; and a statement signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable state and local law and regulation. A spiritual exemption from being fully vaccinated for COVID-19 includes documentation of the Organization’s defined criteria of an individual’s sincerely held religious belief, practice, or observance per federal law and regulation. This standard was not met as evidenced by a review of documents and interviews. A review of administrative documents and the agency's policies and procedures on 2/27/2023 revealed that the agency had not established a policy and procedure that contained verbiage that defined the requirements for a medical or spiritual exemption to being fully vaccinated. During an interview on 2//27/23, the CEO confirmed the finding and stated "I will get some policies written."