Every finding on record at Caris Healthcare, L.P.

Based on policy review, medical record review and interview, the facility failed to address a low heart rate and update the plan of care for 1 of 14 (Patient #10) active patients reviewed.The findings included:1. Review of the facility's "PLAN OF CARE- CONTENT" policy (reviewed 3/13/24) revealed, "...The plan of care reflects patient and family goals and interventions that are based on the problems identified in the initial, comprehensive and updated assessments...The patient's plan of care includes all services necessary for the palliation and management of the primary terminal illness and related diagnoses and conditions..."2. Medical record review for Patient #10 revealed a Start of Care (SOC) date of 5/9/24 with diagnoses that included Malignant Neoplasm of Colon and Adult Failure to Thrive.Review of the 5/9/24 through 8/6/24 Plan of Care (POC) revealed Skilled Nurse (SN) services 2 times weekly for 1 week then one time weekly for 12 weeks. The POC documented "...Hospice RN [Registered Nurse] to evaluate patient and develop a nursing plan of care...Hospice Nurse to instruct regarding cardiopulmonary symptom relief measures" Review of a 6/12/24 SN visit note revealed Patient #10's heart rate was 45 beats per minute.Further review of the SN visit note revealed, "...Vital signs and assessment completed..."There was no documentation the heart rate of 45 was addressed with Patient #10 or was addressed with the patient's physician.In an interview on 7/17/24 at 9:45 AM, the Regional Director of Clinical Care verified her expectation would have been for the nurse to address the patient's low heart rate and notify the patient's physician.

Based on policy review, medical record review and interview the facility failed to follow the Plan of Care (POC) for 1 of 14 (Patient #12) active patients reviewed.The findings included:1. Review of the facility's "PLAN OF CARE" policy (reviewed 3/13/24) revealed, "...The patient's plan of care specifies the care and services necessary to meet the needs of the patient/caregiver as identified in the initial, comprehensive and updated assessments of the patient..."Review of the facility's "Scheduling SOP [standard operating procedure] Local Office" policy (revised 11/22/23) revealed, "...Once the plan of care has been established, including visit frequency, the visits are assigned to the visiting staff...If a visit cannot be completed on the day assigned, every effort should be made to move the visit to another day within the week...If it has to [be] missed, document the reason the visit has to be missed..."2. Medical record review for Patient #12 revealed a Start of Care (SOC) date of 3/28/24 with diagnoses that included Parkinson's Disease. A POC for 6/26/24 through 9/23/24 revealed Skilled Nurse (SN) visit frequency of 1 time weekly for one week, then 2 times weekly for 12 weeks, beginning 6/26/24.Further record review revealed no SN visits documented the week of 6/26/24.There was no documentation of why the SN visit was missed the week of 6/26/24, and no documentation the physician was notified of the change in the POC.In an interview on 7/17/24 at 9:40 AM, the Regional Director of Clinical Care verified there was no documentation of a SN visit the week of 6/26/24.