Every finding on record at Chicago Hope and Palliative Healthcare Inc

It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, the agency did not ensure the individualized written plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessment. Clinical Record 6: The patient elected the hospice benefit on 09/12/2024. The plan of care dated 09/12/2024 through 12/09/2024 included an order for "Social Work 1 time monthly." The plan of care did not include patient specific interventions related to the patient’s psycho-social status and assessment. Clinical Record 10: The patient elected the hospice benefit on 03/14/2024. On 03/14/2024, the physician ordered: "Xarelto [anticoagulant medication with side effect of increased risk of bleeding] 10 mg tablet by mouth daily." The plan of care dated 03/14/2024 through 07/11/2024 did not include interventions related to the patient being at risk for bleeding. Clinical Record 12: The patient elected the hospice benefit on 07/24/2024. On 07/24/2024, the physician ordered: "Eliquis [anticoagulant medication with side effect of increased risk of bleeding] 2.5 mg tablet by mouth every 12 hours." The plan of care dated 07/24/2024 through 10/21/2024 did not include interventions related to the patient being at risk for bleeding. Clinical Record 14: The patient elected the hospice benefit on 07/18/2024. On 07/18/2024, the physician ordered: "Eliquis 2.5 mg tablet by mouth every 12 hours and Norco 10mg-325mg tablet every 6 hours as needed for pain." The plan of care dated 07/18/2024 through 10/15/2024 did not include interventions related to pain or the patient being at risk for bleeding. During an interview and review of records on 11/26/2024, the Director of Nursing confirmed the plans of care did not include interventions for pain, bleeding risk, and psycho-social needs.

It is required that each patient’s individualized written plan of care, includes all services necessary for the palliation and management of the terminal illness, including the following measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, the agency did not ensure the individualized plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 6: The patient elected the hospice benefit on 09/12/2024. The plan of care dated 09/12/2024 through 12/09/2024 included an order for "Social Work 1 time monthly." The plan of care did not include measurable outcomes associated with psycho-social interventions. Clinical Record 10: The patient elected the hospice benefit on 03/14/2024. On 03/14/2024, the physician ordered: "Xarelto [anticoagulant medication with side effect of increased risk of bleeding] 10 mg tablet by mouth daily." The plan of care dated 03/14/2024 through 07/11/2024 did not include measurable outcomes associated with interventions related to the patient being at risk for bleeding. Clinical Record 12: The patient elected the hospice benefit on 07/24/2024. On 07/24/2024, the physician ordered: "Eliquis [anticoagulant medication with side effect of increased risk of bleeding] 2.5 mg tablet by mouth every 12 hours." The plan of care dated 07/24/2024 through 10/21/2024 did not include measurable outcomes associated with interventions related to the patient being at risk for bleeding. Clinical Record 14: The patient elected the hospice benefit on 07/18/2024. On 07/18/2024, the physician ordered: "Eliquis 2.5 mg tablet by mouth every 12 hours and Norco 10mg-325mg tablet every 6 hours as needed for pain." The plan of care dated 07/18/2024 through 10/15/2024 did not include measurable outcomes associated with interventions related to pain or the patient being at risk for bleeding. During an interview and review of records on 11/26/2024, the Director of Nursing confirmed the plans of care did not include measurable outcomes from interventions utilized for pain, bleeding risk, and psycho-social needs.

It is required that hospice aides are assigned to a specific patient by a Registered Nurse (RN) who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 5 of 14 (36%) clinical records reviewed with aide services provided, the agency did not ensure the hospice aide was provided with patient specific care instructions. Clinical Record 4: The patient elected the hospice benefit on 09/24/2024. The initial nursing assessment dated 09/24/2024 included documentation that the "Patient has a history of seizures." The clinical record included a physician order dated 09/24/2024 for "Aide services 2 times per week." The aide care plan assignment dated 09/24/2024 did not include instructions to the aide regarding the patient’s history of seizures and/or seizure precautions. Clinical Record 7: The patient elected the hospice benefit on 07/15/2024. The clinical record included a physician order dated 07/15/2024 for wound dressing changes to the patient's PleurX catheter [small flexible catheter that a doctor places within the patient’s chest to drain fluid from the pleural space around the lungs] site and included an order for "Aide services 2 times per week." The hospice aide care plan dated 07/15/2024 assigned the aide the tasks of "Bed bath at every visit." The aide care plan did not include instructions to the aide related to the PleurX catheter dressing, including how to care for the dressing during a bath and what to do should the dressing become wet or dislodged during the bed bath. Clinical Record 8: The patient elected the hospice benefit on 05/24/2024. The clinical record included a physician order dated 05/24/2024 for wound care and wound dressing changes to a wound on the patient's right leg. On 05/28/2024, the physician ordered "Aide services 3 times per week." The aide care plan dated 05/28/2024 assigned the aide the task of "Bed bath at every visit." The aide care plan did not include instructions to the aide related to the patient’s right leg wound dressing, including how to care for the dressing during a bath and what to do should the dressing become wet or dislodged. Clinical Record 12: The patient elected the hospice benefit on 07/24/2024. The clinical record included a physician order dated 07/24/2024 for wound care with wound dressing changes to wounds on the patient's right leg, right knee, right buttock, and right elbow and included an order for "Aide services 3 times per week." The aide care plan dated 07/24/2024 assigned the aide the task of "Bed bath at every visit." The aide care plan did not include instructions to the aide related to the patient’s right leg, right knee, right buttock, and right elbow wound dressings, including how to care for the dressings during a bath and what to do should the dressing become wet or dislodged. Clinical Record 13: The patient elected the hospice benefit on 08/28/2024. The clinical record included a physician order dated 08/28/2024 for wound care with wound dressing changes to wounds on the patient's bilateral hips, sacrum, left hand, and bilateral legs and included an order for "Aide services 3 times per week." The aide care plan dated 08/28/2024 assigned the aide the task of "Bed bath at every visit." The aide care plan did not include instructions to the aide related to the patient’s bilateral hip, sacrum, left hand, and bilateral leg wound dressings, including how to care for the dressing during a bath and what to do should the dressing become wet or dislodged. During an interview and review of records on 11/26/2024, the Director of Nursing confirmed that the aide care plans did not include wound dressing instructions or seizure precautions.

It is required that a hospice aide provides services: 1. Ordered by the Interdisciplinary Group; 2. Included in the plan of care; 3. Permitted to be performed under state law and regulation; 4. Consistent with the hospice aide training. This standard was not met as evidenced by review of records and interview. 1 of 4 (25%) clinical records reviewed that included hospice aide services revealed the hospice failed to provide hospice aide visits as directed by the plan of care. Record #21470: the most current order for hospice aide visits was 3XW, ordered on 12/14/2021. Hospice aide visits documented for the week of 2/6/2022-2/12/2022 were on the dates of 2/8/2022 and 2/10/2022. Hospice aide visits documented for the week of 2/13/2022-2/19/2022 were on the dates of 2/15/2022 and 2/17/2022. Hospice aide visits documented for the week of 2/20/2022-2/26/2022 were on the dates of 2/22/2022 and 2/24/2022. This did not meet the visit frequency order of 3XW. In an interview conducted with the Director of Nursing on 3/9/2022 it was confirmed the hospice aide visit frequencies did not follow the plan of care and there was no additional information to provide.

It is required that the hospice implements emergency preparedness (EP) policies and procedures, based on the emergency plan, the risk assessment, and the communication plan. The policies and procedures address: Development and inclusion of a plan for each hospice patient during a natural or man-made disaster as part of a patient/family comprehensive assessment; The documented discussion of the plan provided to the patient/family, and maintained by the hospice. This standard was not met as evidenced by clinical record review and interview. 11 of 11 (100%) clinical records reviewed revealed no individual emergency plan documented/discussed. Record # 59287 was reviewed and identified that the patient elected the hospice benefit on 9/1/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 95493 was reviewed and identified that the patient elected the hospice benefit on 8/13/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 27912 was reviewed and identified that the patient elected the hospice benefit on 9/14/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 57278 was reviewed and identified that the patient elected the hospice benefit on 11/1/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 41834 was reviewed and identified that the patient elected the hospice benefit on 7/2/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 97647 was reviewed and identified that the patient elected the hospice benefit on 12/14/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 89352 was reviewed and identified that the patient elected the hospice benefit on 6/9/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 36789 was reviewed and identified that the patient elected the hospice benefit on 11/5/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 25153 was reviewed and identified that the patient elected the hospice benefit on 11/1/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 32152 was reviewed and identified that the patient elected the hospice benefit on 10/21/2021. There was no documentation in the clinical record of the patients individual emergency plan. Record # 99918 was reviewed and identified that the patient elected the hospice benefit on 10/23/2020. There was no documentation in the clinical record of the patients individual emergency plan. The Administrator and Director of Nurses were interviewed on 1/25/2022. They were able to provide information on the patients emergency level, but did not have documentation of the individual plan for each of the patients. There was no additional information to provide

It is required that the hospice provides information on advance directives upon initiation of hospice care. Whether or not the patient has executed an advance directive is documented in a prominent part of the patient’s record. This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) clinical records reviewed revealed that there was no clearly documented advance directive in the clinical record. Record #27912 was reviewed and identified that the patient elected the hospice benefit on 9/14/21. The RN Initial Assessment had the patient listed as a full code, the IPOC dated 9/14/21 had the patient listed as a DNR. There was no clear Advance Directive present in the patients chart. The Director of Nurses was interviewed on 1/25/2022 and stated that she thought the POA had signed the DNR but that the signed copy did not make it to the record before the patient died. She had no additional information to provide.

It is required that the hospice conducts and documents a patient-specific comprehensive assessment that identifies the patient’s need for hospice care and services, and the patient’s need for physical, psychosocial, emotional, and spiritual care. The assessment includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions. THIS IS A CMS CONDITION-LEVEL DEFICIENCY This CONDITION was not met as evidenced by record review, observation, and interview and identified the agency failed to ensure the comprehensive assessment included an assessment of a patient's neck tumor present on admission (L524); failed to ensure the comprehensive assessment included required elements (L525); and failed to ensure the comprehensive assessment includes all current drugs/biologicals taken by the patient (L530). The cumulative effect of these systemic problems resulted in the hospice's inability to ensure the provision of quality health care in a safe environment.

it is required that the comprehensive assessment includes consideration of the following factors: The nature and condition causing admission, including the presence, or lack of, objective data and subjective complaints; Co-morbid psychiatric diagnosis or history; Complications and risk factors that affect care planning, including risk for drug diversion; Functional status and cognitive status, including the patient’s ability to understand and participate in her or his own care; Imminence of death; Symptoms and symptom severity, including: Dyspnea, nausea, vomiting, constipation; Restlessness, anxiety, emotional distress; Sleep disorders; Skin integrity; Confusion; Bowel regimen when opioids are prescribed; Patient and family support systems; Patient and family need for counseling and education. This standard was not met as evidenced by clinical record review, observation and interview. 1 of 11 (9%) clinical records reviewed revealed the comprehensive assessment failed to include an assessment of a patient's neck tumor present on admission. Record #25153 was reviewed and identified the patient elected the hospice benefit on 11/1/2021. In a home visit made with the RN on 1/26/22 the patient noted to have a tumor to her left neck. There was a dressing present to the tumor. The RN removed the dressing to observe the area. There was no documentation of the tumor in the nursing assessment. The Director of Nurses was interviewed on 1/27/2022 and stated that this patient was well known to the hospice. She stated that the tumor had been present on the patients neck for a long period of time. She had no additional information to provide.

It is required that the comprehensive assessment includes consideration of the following factors: The nature and condition causing admission, including the presence, or lack of, objective data and subjective complaints; Co-morbid psychiatric diagnosis or history; Complications and risk factors that affect care planning, including risk for drug diversion; Functional status and cognitive status, including the patient’s ability to understand and participate in her or his own care; Imminence of death; Symptoms and symptom severity, including: Dyspnea, nausea, vomiting, constipation; Restlessness, anxiety, emotional distress; Sleep disorders; Skin integrity; Confusion; Bowel regimen when opioids are prescribed; Patient and family support systems; Patient and family need for counseling and education. This standard was not met as evidenced by clinical record review and interview. 3 of 11 (27%) clinical records reviewed revealed that the comprehensive assessment did not included required elements. Record # 59287 was reviewed and identified the patient elected the hospice benefit on 9/1/2021. The RN initial assessment completed on 9/1/2021 did not provide documentation about why the patient was appropriate for hospice with a diagnosis of Alzheimer's Disease. The documentation did not include FAST, PPS, weight, wounds, infections or any information on why the patient was eligible for hospice. Record #97647 was reviewed and identified the patient elected the hospice benefit on 12/14/2021. The RN Initial Assessment completed on 12/16/21 did not provide documentation about why the patient was appropriate for hospice with a diagnosis of Brain CA. The documentation did not include PPS, weight or any changes that would document why the patient was eligible for hospice. Record #32152 was reviewed and identified that the patient elected the hospice benefit on 10/9/2021. The RN Initial Assessment completed on 10/8/21 provided no documentation of what qualifies the patient for Hospice care with a diagnosis of COPD. The clinical note stated in part that the patient was SOB with exertion but the patient was not on O2 and there were no O2 saturations documented. There was no documented PPS, weight changes or any additional documentation that would help to determine why the patient was eligible for hospice. The Director of Nurses was interviewed on 1/27/2021 and was not able to provide any additional documentation the provided evidence to support the assessment contained the required elements.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: Prescription and over-the-counter (OTC) drugs; Supplements; Herbal remedies; Other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: The effectiveness of drug therapy; Drug side effects; Actual or potential drug interactions; Duplicate drug therapy; Drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, observation and interview. 2 of 11 (18%) clinical records reviewed revealed the comprehensive assessment did not include all current drugs/biologicals taken by the patient. Record #89352 was reviewed. During a home visit with the CNA on 1/26/2022 the patient was asked about his current medications. The patient identified a row of medication bottles as the medications he currently takes. He did offer that his medications were filled in a medication pill planner by his nurse and showed me the filled box. The medication list provided by the hospice was compared with the medication bottles that the patient indicated were current. The following medications were not present on the medication profile: Acetaminophen 325 mg tabs; Naltrexone 50mg po BID and Diclofenac Gel apply to affected area BID Record #25153 was reviewed. During a home visit with the RN on 1/26/22 the caregiver was asked about the patients current medications. The caregiver in the home (granddaughter) contacted the POA (daughter) by phone. The daughter provided pictures of all the medication bottles of the patients' current medications. The medication list provided by the hospice was compared with pictures of the medications that the daughter stated the patient was taking. The following medications were not present on the medication profile: Tramadol 50mg PRN; Sertraline 50mg po daily and Exemestane 25mg daily. The Director of Nurses was interviewed on 1/27/2022 and could not provide information regarding why the family/patient would have identified these medications as current.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. THIS IS A CMS CONDITION-LEVEL DEFICIENCY This CONDITION was not met as evidenced by record review, observation, and interview and identified the agency failed to ensure the IDG established a plan of care to address known wounds (L537); failed to ensure the designated RN provided coordination of care to ensure continuous assessment of patient's needs and and implemented the IDG plan of care (L540); failed to ensure the hospice had an IDG established plan of care prior to providing wound care (L543); failed to ensure the plan of care included all services necessary for management of the terminal illness and related condition (L545); and failed to ensure there was documentation that the POC was reviewed/updated at min every 15 days (L547). The cumulative effect of these systemic problems resulted in the hospice's inability to ensure the provision of quality health care in a safe environment.

It is required that The hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) clinical records reviewed revealed that the IDG did not establish a plan of care to address known wounds. Record #57278 was reviewed and identified that the patient elected the hospice benefit on 10/21/21. The Initial RN Assessment noted a Wound: "Wound Site: Label: Bilateral 1st, 2nd digits toes. Stage: 2, Size: 1 Description: cleansed with normal saline, applied Iodosorb covered with gauze, wrapped with kerlix." and on the last note on 12/23/21 "Wound site: Label: bilateral 1st toes Stage: 2 Size: 1 Description: cleansed with normal saline, applied betadine covered with gauze, wrapped with kerlix." There is no MD order present for wound care. The wound is not on the most recent plan of care. The Director of Nurses was interviewed on 1/27/2022. She was not able to find an order for wound care for this patient and had no additional information to provide.

It is required that the hospice designates a registered nurse member of the IDG to: Provide coordination of care; Ensure continuous assessment of each patient’s and family’s needs; Ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review, observation and interview. 1 of 11 (9%) clinical records reviewed revealed that designated RN did not ensure coordination/assessment/implementation of POC. Record #25153 was reviewed and identified the patient elected the hospice benefit on 11/1/2021. In a home visit made with the RN on 1/26/22 the patient noted to have a tumor to her left neck. There was a dressing present to the tumor. The RN removed the dressing to observe the area. There was no documentation of the tumor in the nursing assessment and no care, treatment or safety precautions were identified on the POC related to the tumor. The Director of Nurses was interviewed on 1/27/2022 and stated that this patient was well known to the hospice. She stated that the tumor had been present on the patients neck for a long period of time. She had no additional information to provide.

It is required that Hospice care and services provided to patients and families follow the individualized plan of care established by: The hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) clinical records reviewed revealed that the hospice provided wound care in the absence of a IDG directed plan of care. Record #57278 was reviewed and identified that the patient elected the hospice benefit on 10/21/21. The Initial RN Assessment noted a Wound: "Wound Site: Label: Bilateral 1st, 2nd digits toes. Stage: 2, Size: 1 Description: cleansed with normal saline, applied Iodosorb covered with gauze, wrapped with kerlix." and on the last note on 12/23/21 "Wound site: Label: bilateral 1st toes Stage: 2 Size: 1 Description: cleansed with normal saline, applied betadine covered with gauze, wrapped with kerlix." There is no MD order present for wound care. The wound was not on the most recent plan of care. The Director of Nurses was interviewed on 1/27/2022. She was not able to find an order for wound care for this patient and had no additional information to provide.

It is required that each patient’s individualized written plan of care: Reflects patient and family goals; Identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; Includes all services necessary for the palliation and management of the terminal illness, including the following: a) Intervention to manage pain and symptoms; A detailed statement of the scope and frequency of services necessary to meet specific patient and family needs; Measurable outcomes anticipated from implementing and coordinating the plan of care; Drugs and treatment necessary to meet the needs of the patient; Medical supplies and appliances necessary to meet the needs of the patient; Includes the Interdisciplinary Group’s documentation of the patient’s or representative’s level of understanding, involvement, and agreement with the POC; The documentation in the patient’s record is in accordance with the hospice’s policies and procedure. This standard was not met as evidenced by clinical record review, observation and interview. 1 of 11 (9%) clinical records reviewed revealed that the plan of care did not include all services necessary for management of the terminal illness and related condition. Record #25153 was reviewed and identified the patient elected the hospice benefit on 11/1/2021. In a home visit made with the RN on 1/26/22 the patient noted to have a tumor to her left neck. There was a dressing present to the tumor. The RN removed the dressing to observe the area. There was no care, treatment or safety precautions identified in any plan of care reviewed related to the tumor. The Director of Nurses was interviewed on 1/27/2022 and stated that this patient was well known to the hospice. She stated that the tumor had been present on the patients neck for a long period of time. She had no additional information to provide.

It is required that each patient’s individualized written plan of care: Identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) clinical records reviewed revealed that the plan of care did not include all services necessary for management of the terminal illness and related condition. Record #57278 was reviewed and identified that the patient elected the hospice benefit on 10/21/21. The Initial RN Assessment noted a Wound: "Wound Site: Label: Bilateral 1st, 2nd digits toes. Stage: 2, Size: 1 Description: cleansed with normal saline, applied Iodosorb covered with gauze, wrapped with kerlix." and on the last note on 12/23/21 "Wound site: Label: bilateral 1st toes Stage: 2 Size: 1 Description: cleansed with normal saline, applied betadine covered with gauze, wrapped with kerlix." There is no MD order present for wound care. The wound is not on the most recent plan of care. The Director of Nurses was interviewed on 1/27/2022. She was not able to find an order for wound care for this patient and had no additional information to provide.

It is required that the Interdisciplinary Group, in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan: As frequently as the patient's condition requires; No less frequently than every 15 calendar days. A revised plan of care includes: Information from the patient’s updated comprehensive assessment; Record of the patient’s progress toward the outcomes and goals specified in the plan of care. This standard was not met as evidenced clinical record review and interview, 11 of 11 (100%) clinical records reviewed revealed that there was no documentation that the POC was reviewed/updated at min every 15 days. Record # 59287 was reviewed and identified that the patient elected the hospice benefit on 9/1/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 95493 was reviewed and identified that the patient elected the hospice benefit on 8/13/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 27912 was reviewed and identified that the patient elected the hospice benefit on 9/14/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 57278 was reviewed and identified that the patient elected the hospice benefit on 11/1/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 41834 was reviewed and identified that the patient elected the hospice benefit on 7/2/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 97647 was reviewed and identified that the patient elected the hospice benefit on 12/14/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 89352 was reviewed and identified that the patient elected the hospice benefit on 6/9/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 36789 was reviewed and identified that the patient elected the hospice benefit on 11/5/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 25153 was reviewed and identified that the patient elected the hospice benefit on 11/1/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 32152 was reviewed and identified that the patient elected the hospice benefit on 10/21/2021. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. Record # 99918 was reviewed and identified that the patient elected the hospice benefit on 10/23/2020. There was no documentation in the clinical record of IDG review of the updated comprehensive assessment or any record of the patients progress toward the outcomes and goals that were specified in the plan of care. The Director of Nurses was interviewed on 1/25/2022. She was able to provide the agenda from all of the IDG meetings with the names of the new admissions, deaths, live discharges and upcoming recertification's listed on the agenda; however, the clinical records did not contain notes of the review that occurred during the IDG meetings. She had no additional information to provide.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: A copy of the hospice discharge summary; This standard was not met as evidenced by clinical record review and interview. 1 of 2 (50%) clinical records reviewed revealed that the discharge summary was not sent to the physician when revocation/discharge occurred. Record # 41834 was reviewed and identified that the patient revoked hospice services on 12/27/2021 to seek aggressive treatment. There was no evidence that a discharge summary was sent to the Attending Physician. The Director of Nurses was interviewed on 1/27/2022 and agreed that the discharge summary was not sent to the attending physician. She had no additional information to provide.

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; 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 standard was not met as evidenced by clinical record review and interview. 1 of 2 (50%) clinical records reviewed revealed that the discharge summary did not include all required elements. Record #41834 was reviewed and identified that the patient revoked the hospice benefit on 12/27/2021. The discharge summary did not contain the required information. The discharge order only stated that "Pt transferring to VA hospital for aggressive treatment." The Director of Nurses was interviewed on 1/27/2022 and agreed that the discharge summary did not contain the required information. She had no additional information to provide.