Every finding on record at Careplus Hospice LLC

Upon observation, and interview with the Administrator, it was identified that there was no contract/agreement with other facilities/agencies/Hospices to receive CarePlus Hospice patients in the event that CarePlus Hospice cannot provide care to their patients during an emergency.

Upon patient record review, 1 of 6 (Patients #2) did not contain a current/comprehensive Medication Profile, and/or that a Drug Regimen Review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient #2: Physician-ordered Oxygen was not on the Medication Profile.

Upon patient record review, 1 of 6 (Patient #1) did not contain a Plan of Care which included all services necessary for the palliation and management of the terminal illness and related conditions, specifically: Equipment and Supply needs. Patient #1: During Surveyor-attended home visit on 01/20/22, it was noted that the patient had both a Wheel Chair and a Walker in the home. Neither of these DME were included on the Hospice POC.

Upon patient record review, 1 of 6 (Patient #1) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care. Patient #1: The Initial POC dated 11/03/21 included orders for: 1) Oxygen 2 lpm prn NC; and 2) Hospital Bed. During the Surveyor-attended home visit on 01/20/22, upon observation and interview with the patient and in-home caregiver, the patient had not been provided either Oxygen, nor a hospital bed from the Hospice.

Upon personnel record review, 1 of 1 applicable Aide (Personnel #8) did not contain evidence that an Aide Skills Competency Assessment had been conducted, which included all CMS-required skills, and/or per CMS requirement. Personnel #8: An RN conducted an Aide Skills Competency Assessment on 01/28/2021. However, the document was checked off as "no" for conducted in a patient home, and hand-written in, that the skills evaluation was conducted "in the office." The skills of Nail and Skin care were not evaluated for. The following tasks were evaluated/documented as via verbal discussion: Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff; Reading and recording temperature, pulse, and respiration; Bed bath; Sponge, tub, and shower bath; Shampoo, sink, tub, and bed; Oral hygiene; Toileting and elimination; Safe transfer techniques and ambulation; Normal range of motion and positioning.

Upon patient record review, 4 of 4 applicable (Patients #2, 4, 5, and 6) did not contain evidence of an Aide Plan of Care, assigned by an R.N. member of the Interdisciplinary Group, and which Aide POC specified the assigned Aide tasks, and other pertinent clinical information: Patient #2,4,5,6: The Aide assignment states to obtain vitals every visit but did not include parameters for reporting to the RN. Patient #4,56: Patient had a Physician-ordered D.N.R. This was not included on the aide assignment.

Upon patient record review, 2 of 2 applicable revoked patients (Patients #5 and 6) did not have evidence that the Discharge Summary included all CMS-required information, as follows. For both of these DC Summaries, there was not evidence of the following content: • The patient's current Plan of Care • The patient's latest Physician orders

Upon observation, there was not evidence that the Hospice has been providing a copy of the Hospice's written policies and procedures on the management and disposal of Controlled Drugs to the patient or patient representative and family. The admitting RNs have been documenting discussion with the patient, related to the disposal of Controlled Drugs. However, the Administrator confirms that the Hospice has not been providing such written P/P to the patients.