Every finding on record at Champion Health Services, Inc.

Based on review of clinical record (CR), and staff (EMP) interview, it was determined the hospice failed to ensure the Plan of Care (POC) included interventions to manage pain and symptoms for four (4) of thirteen (13) CRs reviewed. (CR #1, #3, #5, & #9) Findings included: Review of CR #1 on 11/16/2022 at approximately 11:30am revealed start of services (SOS) 9/13/2022. Period reviewed 9/13/2022-10/30/2022. CR revealed upon initial assessment that the patient reported pain in the right knee at times and also that the patient was referred to hospice after hospitalization for a small bowel perforation. POC failed to include interventions to manage pain or GI (gastrointestinal) symptoms. Review of CR #3 on 11/16/2022 at approximately 12:15pm revealed SOS 10/28/2022. Period reviewed 10/28/2022-11/4/2022. CR revealed upon initial assessment that nausea impacts food and fluid intake. POC failed to include interventions to manage nausea. Review of CR #5 on 11/16/2022 at approximately 1:10pm revealed SOS 10/31/2022. Period reviewed 10/31/2022-11/11/2022. CR revealed upon initial assessment patient has chronic constipation and also takes multiple narcotics. POC failed to include interventions to manage constipation. Review of CR #9 on 11/17/2022 at approximately 10:45am revealed SOS 10/25/2022. Period reviewed 10/25/2022-11/17/2022. CR revealed upon initial assessment patient has chronic constipation. POC failed to include interventions to manage constipation. Exit interview with Administrator on November 18, 2022, at approximately 2:30pm confirmed above findings.

Based on review of clinical record (CR), staff (EMP) interview, and surveyor observation, it was determined the hospice failed to ensure the Plan of Care (POC) included medical supplies and appliances necessary to meet the needs of the patient for eight (8) of thirteen (13) CRs reviewed. (CR#1, #2, #4, #5, #6, #9, #10, & #12) Findings included: Review of CR #1 on 11/16/2022 at approximately 11:30am revealed start of services (SOS) 9/13/2022. Period reviewed 9/13/2022-10/30/2022. Narrative note written at SOS documented patient need for a scoop mattress, fall mats, and a raised toilet seat. Additional information obtained upon assessment revealed the need for a nebulizer machine, nebulizer supplies, wound care supplies, and incontinent supplies. POC failed to include these items as equipment/supplies. Review of CR #2 on 11/16/2022 at approximately 12:00pm revealed SOS 10/20/2022. Period reviewed 10/20/2022-10/31/2022. Narrative note written at SOS documented patient need for a commode, a hospital bed, and a walker. Additional documentation obtained upon assessment revealed the need for wound care supplies and incontinent supplies. POC failed to include these items as equipment/supplies. Review of CR #4 on 11/16/2022 at approximately 12:45pm revealed SOS 10/31/2022. Period reviewed10/31/2022-11/8/2022. Narrative note written at SOS documented patient need for a low air loss mattress. POC failed to include this item as equipment/supplies. Review of CR #5 on 11/16/2022 at approximately 1:10pm revealed SOS 10/31/2022. Period reviewed 10/31/2022-11/11/2022. Narrative note written at SOS documented patient need for a walker. POC failed to include this item as equipment/supplies. Review of CR #6 on 11/17/2022 at approximately 9:50am revealed SOS 8/19/2022. Period reviewed 8-19-2022-11/16/2022. Narrative note written at SOS and additional information obtained upon assessment revealed the need for tracheostomy and ventilator supplies, a ventilator, incontinent supplies, catheter supplies, and wound care supplies. POC failed to include these items as equipment/supplies. Review of CR #9 on 11/17/2022 at approximately 10:45am revealed SOS 10/25/2022. Period reviewed 10/25/2022-11/17/2022. Information obtained upon assessment revealed the need for oxygen supplies, an oxygen concentrator, a nebulizer machine, and nebulizer supplies. POC failed to include these items as equipment/supplies. Review of CR #10 on 11/17/2022 at approximately 10:55am revealed SOS 11/11/2022. Period reviewed 11/11/2022-11/17/2022. Narrative note written at SOS documented patient need for fall mats. Additional documentation obtained upon assessment revealed the need for incontinent supplies and wound care supplies. POC failed to include these items as equipment/supplies. Review of CR #12 on 11/17/2022 at approximately 11:15am revealed SOS 11/9/2022. Period reviewed 11/9/2022-11/17/2022. Narrative note written at SOS documented patient need for incontinent supplies. Surveyor observation at HV # 2 revealed patient to be wheelchair bound. POC failed to include these items as equipment/supplies. Exit interview with Administrator on November 18, 2022, at approximately 2:30pm confirmed above findings.

Based on review of clinical record (CR), agency policy, and staff (EMP) interview, it was determined the hospice failed to ensure post death bereavement assessment completed per agency policy for four (4) of five (5) bereavement records reviewed. (CR #4, #7, #8, & #13) Findings included: Review of agency policy/procedure on November 17, 2022, at approximately 1:30pm revealed: Agency fails to possess/implement a formal policy/procedure for bereavement. Template utilized by bereavement coordinator to outline steps to take notes no mention of post death bereavement assessment, only that "...initial phone call to bereaved within 5 days of death..." Additional handwritten note by bereavement coordinator on listing of mailings notes "Phone call 48hrs..." Review of CR #4 on 11/16/2022 at approximately 12:45pm revealed SOS 10/31/2022. Period reviewed10/31/2022-11/17/2022. CR revealed patient died on 11/8/2022. Post death bereavement assessment completed 11/15/2022, 7 days post death. Review of CR #7 on 11/16/2022 at approximately 2:20pm revealed SOS 6/24/2021. Period reviewed 6/24/2021- 1/17/2022. CR revealed patient died on 6/27/2021. No documentation available of post death bereavement assessment. Review of CR #8 on 11/16/2022 at approximately 2:25pm revealed SOS 6/18/2021. Period reviewed 6/18/2021- 11/17/2022. CR revealed patient died on 6/21/2021. Post death bereavement assessment completed 7/10/2021, 19 days post death. Review of CR #13 on 11/16/2022 at approximately 2:30pm revealed SOS 7/13/2021. Period reviewed 7/13/2021-11/17/2022. CR revealed patient died on 7/14/2021. Post death bereavement assessment completed 8/5/2021, 22 days post death. Exit interview with Administrator on November 18, 2022, at approximately 2:30pm confirmed above findings.