Every finding on record at Community Healthcare of Texas

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 30 (3%) clinical records reviewed, the agency did not ensure the initial comprehensive assessment was completed no later than five (5) calendar days after the election of hospice care. Clinical Record 8: The patient elected the hospice benefit on 3/13/23. On 3/16/23 the chaplain documented, "Spoke to patient's daughter and let her know that I will be seeing her tomorrow." The initial chaplain assessment was documented as completed on 3/22/23, with nine (9) days outstanding. The record did not contain documentation to indicate why the chaplain did not complete the visit on 3/17/23 per the conversation with the daughter, nor was there documentation of refusals or requests to reschedule the visit until 3/22/23. During an interview on 10/31/23,the Chief Compliance Officer confirmed the visit was made outside of the 5-day requirement and reported that the record did not include any documentation to support why this occurred.

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. In 2 of 30 (7%) clinical records reviewed, the agency did not ensure the plan of care was individualized with specific interventions based on the problems identified in the comprehensive assessment. Clinical Record 2: The patient elected hospice care on 8/4/23 with the diagnosis of senile degeneration of the brain. The initial comprehensive assessment completed on 8/4/23 documented the patient's MAHC (Missouri Alliance for Home Care) 10 Fall Risk score of "8: based on the score, the patient is: at risk for falling." The comprehensive assessment completed by the Registered Nurse (RN) on 10/16/23 documented, "the patient noted to have a weeping left lower extremity" and "the patient had a fall earlier this morning." On 10/28/23, the RN documented, "wound care performed to left lower extremity due to weeping edema." The plan of care, effective 8/4/23 to current, did not include documentation of the problems, goals, or interventions for fall prevention/safety or skin integrity/wounds as identified during the comprehensive assessments dated 8/4/23,10/16/23, and 10/28/23. Clinical Record 3: The patient elected hospice care on 10/26/23 with a diagnosis of Mesothelioma. The initial comprehensive assessment completed by the RN on 10/26/23 documented the patient had dyspnea on exertion and at rest and answered "yes" to the assessment question, "Does dyspnea significantly affect the patient." The clinical note for that visit stated, "he has had a Pleurx catheter for a right-sided malignant pleural effusion. At this time, he is draining it 4 times a week." The comprehensive assessment dated 10/27/23 documented the patient was using oxygen at 5 liters per minute. The plan of care, effective 10/26/23 to current, did not include documentation of the problems, goals, or interventions specific to the patient's dyspnea, oxygen use, or Pleurx catheter. During an interview and record review on 10/31/23, the Chief Compliance Officer confirmed that the plans of care did not include interventions to address the identified problems.

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: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 30 (3%) clinical records reviewed, the agency did not ensure the patient's plan of care (POC) included all medications and treatments necessary to meet the needs of the patient. Clinical Record 1: The patient elected hospice care on 10/13/23. During a PRN (as needed) nursing visit, on 10/26/23, the Registered Nurse (RN) documented the patient had labored respirations and "oxygen was on at 4 liters per min." The skilled nursing visits dated 10/27/23, 10/28/23, 10/29/23, and 10/30/23 documented the patient was on oxygen at 4 liters per minute. The plan of care did not include the oxygen. During an interview on 10/30/23, the Chief Compliance Officer reported that after a review of the clinical record the agency could not locate a physician order for the oxygen. The agency provided no further documentation as of the exit conference on 11/1/23 .

It is required that a hospice aide provides services: ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed, in which hospice aide services were accepted, the agency did not ensure that the hospice aide provided services ordered by the Interdisciplinary group and included in the plan of care. Clinical Record 9: The patient elected the hospice benefit on 8/18/23 with the diagnoses listed: Unspecified Protein-Calorie Malnutrition and Dementia. The Hospice aide care plan, effective 8/18/23 to current, revealed the aide visit frequency was five times a week and included the following relevant tasks: shampoo two times a week, and clean and file nails weekly. For the week of 10/23/23 the aide documented both of these tasks were completed for the following visits: 10/23/23, 10/24/23, 10/25/23, 10/26/23, 10/27/23. During an interview on 10/30/23, the Chief Compliance Officer confirmed the tasks were documented as completed on each visit and they should not have been.