Every finding on record at Compassionate Care Hospice of the Delmar Peninsula, LLC

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: medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records, document review and interview. Agency policy AA-005 states in part "The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including but not limited to medical supplies and equipment necessary to meet the needs of the patient." 3 of 13 (23%) clinical records reviewed revealed that the agency failed to include durable medical equipment necessary for patient care on the plans of care. Clinical Record 9: In the admission assessment done by RN on 7/30/22 it was documented that the hospice ordered and provided an eggcrate mattress, bedrails, hospital bed, bedside commode, over-bed table, O2 (oxygen) concentrator and cylinder. On the initial POC dated 7/30/22 durable medical equipment was not listed. In a joint review of the clinical record and interview with the Director of Operations it was confirmed that this equipment was in or had been delivered to the patient's home. Clinical Record 8: In the admission assessment done by the RN on 12/21/22, durable medical equipment in the patient's home, needed to provide adequate patient care was documented as: bedrails, bedside commode, hospital bed, over-bed table, O2, and walker. These items were not listed on the initial plan of care. In a joint review of the clinical record and interview with the Director of Operations it was confirmed that this equipment was in, or had been delivered to, the patient's home. Clinical Record 13: In the admission assessment done by the RN on 11/28/22 it specified that equipment in the patient's home or ordered by the hospice included: bedrails, hospital bed, over-bed table, bedside commode and wheelchair. These items were not listed on the initial plan of care dated for the episode dated 11/28/22 -2/25/22. In a joint review of the clinical record and interview with the Director of Operations it was confirmed that this equipment was in, or had been delivered to, the patient's home. In joint review of clinical records and interview with the Director of Operations, she agreed that the durable medical equipment should be listed on the patient's plan of care. Agency policy AA-005 states in part "The plan of care mush include all services necessary for the palliation and management of the terminal illness and related conditions, including but not limited to medical supplies and equipment necessary to meet the needs of the patient." In joint review of clinical records and interview with the Director of Operations, she agreed that the durable medical equipment should be listed on the patient's plan of care.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by a review of clinical records, documents, and interviews. The Agency Policy # TX-016, reads in part, "The aide shall observe and report changes in the patient's medical, nursing, rehabilitative, and social needs to the registered nurse." 4 of 13 (31%) clinical records reviewed, of patients who received hospice aide services, revealed no documentation that the hospice aide notified the RN case manager to obtain approval to omit tasks on the plan of care and changes in the patient's needs Clinical Record 5: The Aide Plan of Care (POC) dated 10/23/22 specified that the patient's weight be documented and reported to RN case manager on every visit. It also specified that shampoo and oral care be done every visit. The Aide visits made on 10/25/22, 11/15/22, and 12/20/22 failed to document the patient's weights and that shampoos were completed. There was no documentation that the RN case manager had been notified of the tasks not completed. Clinical Record 4: There were missed visits documented on 8/24/22 and 8/27/22. The aide documented that the visits were missed due to care already provided. There was no documentation found of to whom the aide reported the missed visits. Also, the box marked “Patient frequency is more than once a day" (communication of which visit was missed must be documented in additional comments below); no additional comments were documented by the aide. In a joint review of the clinical record and interview with Director of Operations (DOO), she agreed that there was no documentation of reported missed visits, however, she stated that notifications are sent by a team chat to their supervisor. These chats expire after 30 days so evidence that the reporting process occurred could not be validated. Clinical Record 11: The aide plan of care, developed by the RN, specified a shampoo to be done every visit. On aide visits made 10/17/22, 10/28/22, 11/01/22, and 11/08/22, no shampoo was completed. No documentation was found that the RN case manager had been notified. Clinical Record 12: The aide plan of care, developed by the RN, for the episode 8/13/22 – 11/10/22 specified that barrier cream, shave, shampoo, peri care, skin/back care and nail care be done every visit. It was also specified that the aide record and report patient's last bowel movement every visit. On the visit made by the aide on 8/23/22, barrier cream, nail care, shave, and shampoo were not completed. There was no documentation found that the RN had been notified of change in the plan of care. There was also no documentation found that the aide documented and reported the patient's last bowel movement. On an aide visit made on 9/1/22, oral care, shampoo, shave, skin/back care, peri care and barrier cream were not completed. There was no documentation that the aide notified the RN of the tasks not completed. There was also no documentation that the patient's last bowel movement had been documented and reported to RN. In a joint review of clinical records with the Director or Operations, she stated that there was no documented evidence in the record of notification of RNs. She also stated that the aide sends the notifications on a computer "chat app". Those notifications expire after 30 days so evidence that the reporting process occurred could not be validated. This standard was not met as evidenced by clinical record review, staff interview and review of company policy. Policy # TX-016, reads in part, "The aide shall observe and report changes in the patient's medical, nursing, rehabilitative, and social needs to the registered nurse." In joint review of clinical records with Director or Operations she stated that there was no documented evidence in the record of notification or RN's. She stated that the aide sends it on a computer chat app. Those notifications expire after 30days so no evidence could be provided of notifications.