Every finding on record at Choice Hospice, Inc.

Based on record review and interview, the hospice failed to ensure an individualized plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for thirteen (Patients #1, 2, 3, 5, 7, 9, 11, 12, 13, 14, 15, 16 and 19) of 19 patients reviewed. --- Patient #1 A plan of care dated 09/20/24 to 12/18/24 documented a primary diagnosis of unspecified diastolic (congestive) heart failure and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #2 A plan of care dated 09/29/24 to 12/27/24 documented a primary diagnosis of senile degeneration of the brain and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #3 A plan of care dated 11/21/24 to 01/19/25 documented a primary diagnosis of Parkinson's disease and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #5 A plan of care dated 11/30/24 to 01/28/25 documented a primary diagnosis of Alzheimer's disease and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #7 A plan of care dated 10/10/24 to 12/08/24 documented a primary diagnosis of Alzheimer's disease and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #9 A plan of care dated 11/22/24 to 01/20/25 documented a primary diagnosis of senile degeneration of the brain and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #11 A plan of care dated 10/18/24 to 12/16/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #12 A plan of care dated 01/22/24 to 04/20/24 documented a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #13 A plan of care dated 09/07/24 to 12/05/24 documented a primary diagnosis of malignant neoplasm of lower lobe, left bronchus or lung and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #14 A plan of care dated 11/30/24 to 01/28/25 documented a primary diagnosis of sarcopenia and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #15 A plan of care dated 09/12/24 to 12/10/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #16 A plan of care dated 11/27/24 to 02/24/25 documented a primary diagnosis of malignant neoplasm of esophagus and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #19 A plan of care dated 01/12/25 to 03/12/25 documented a primary diagnosis of senile degeneration of the brain and showed no patient specific individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 02/13/25 at 1:30 pm, Staff A stated the plans of care for Patients #1, 2, 3, 5, 7, 9, 11, 12, 13, 14, 15, 16 and 19 failed to include individualized services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to ensure the proper use of frequency ranges on the plan of care for six (Patients #1, 2, 5, 6, 8 and 10) of nineteen patients. --- Patient #1 A review of the plan of care dated 09/20/24 to 12/18/24 showed a chaplain frequency of 0 (zero) visits per month for one month and one visit per month for three months and a social worker frequency of 0 (zero) visits per month for one month and one visit per month for three months. Patient #2 A review of the plan of care dated 09/29/24 to 12/27/24 showed a chaplain frequency of 0 (zero) visits per month for one month and one visit per month for three months and a social worker frequency of 0 (zero) visits per month for one month and one visit per month for three months. Patient #5 A review of the plan of care dated 11/30/24 to 01/28/25 showed a chaplain frequency of 0 (zero) visits per month for one month and one visit per month for three months and a social worker frequency of 0 (zero) visits per month for one month and one visit per month for three months. Patient #6 A review of the plan of care dated 01/10/25 to04/09/25 showed a chaplain frequency of 0 (zero) visits per month for one month and one visit per month for three months and a social worker frequency of 0 (zero) visits per month for one month and one visit per month for three months. Patient #8 A review of the plan of care dated 01/22/25 to 04/21/25 showed a chaplain frequency of 0 (zero) visits per month for one month and one visit per month for three months and a social worker frequency of 0 (zero) visits per month for one month and one visit per month for three months. Patient #10 A review of the plan of care dated 01/17/25 to 03/17/25 showed a chaplain frequency of 0 (zero) visits per month for one month and one visit per month for three months and a social worker frequency of 0 (zero) visits per month for one month and one visit per month for three months. On 02/13/25 at 1:50 pm., Staff A stated the charting system would not allow the hospice to remove the 0 (zero) frequencies from the plans of care for Patients #1, 2, 5, 6, 8 and 10.

Based on record review and interview, the hospice failed to provide nursing services in a manner that is consistent with accepted standards of practice for one (Complainant #1) of six complaints. --- Complaint #1 A complaint dated 12/07/24 documented a hospice nurse Staff M brought Patient #21 some "pot" and was offering the patient marijuana. The complainant reported Patient #21 was "high". No physician orders were obtained for the use of any controlled substance which Staff M brought to Patient #21. On 02/13/25 at 12:30 pm., Staff A stated the nurse did take Patient #21 a controlled substance without a physician order and was terminated for acting in a manner not conducive to the accepted standards of practice held by the hospice.

Based on record review and interview, the hospice failed to the ensure plans of care were coordinated with the long-term care facility for four (Patients #2, 3, 7 and 13) of 19 patients reviewed. --- Patient #2 A plan of care dated 09/29/24 to 12/27/24 documented a primary diagnosis of senile degeneration of the brain and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #3 A plan of care dated 11/21/24 to 01/19/25 documented a primary diagnosis of Parkinson's disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #7 A plan of care dated 10/10/24 to 12/08/24 documented a primary diagnosis of Alzheimer's disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #13 A plan of care dated 09/07/24 to 12/05/24 documented a primary diagnosis of malignant neoplasm of lower lobe, left bronchus or lung and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. On 02/13/25 at 2:00 pm., Staff A stated the plan of care for Patients #2, 3, 7 and 13 did not outline the patient specific interventions to be to be provided by the nursing home or the hospice for the palliation and management of the terminal illness.