Every finding on record at Continuum Care of King LLC

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 4 of 23 (17%) clinical record reviews it was revealed that the agency did not ensure that the Interdisciplinary Group (IDG) completed the initial comprehensive psychosocial and spiritual assessment within 5 days. Clinical Record 11: The patient's Start of Care was on 08/28/2024. The initial psychosocial assessment and spiritual assessment was completed on 09/09/2024, which was 12 days after the patient elected the hospice benefit. There was no documented reason for the delay. Clinical Record 17: The patient's Start of Care was on 10/9/2023. The initial psychosocial assessment was completed on 10/17/2023, and the spiritual assessment was completed on 10/18/2023, which was 8 and 9 days, respectively, after the patient elected the hospice benefit. There was no documented reason for the delay. Clinical Record 19: The patient's Start of Care was on 05/22/2024. The initial psychosocial assessment and spiritual assessment was completed on 05/29/2024, which was 7 days after the election of the hospice benefit. There was no documented reason for the delay. Clinical Record 20: The patient's Start of Care was on 11/25/2024. The initial psychosocial assessment and spiritual assessment was completed on 12/02/2024, which was 7 days after the patient elected the hospice benefit. There was no documented reason for the delay. During a joint record review and interview on 12/20/2024, the Clinical Director agreed with the finding and stated, more education is needed on documentation and getting these completed on time.

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; and other alternative treatments that could affect drug therapy. 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, document review and observation. In 2 of 23 (9%) clinical record reviews and home visit observations it was revealed that the agency did not ensure the drug profile was updated at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. Clinical Record 19/Home Visit 2: During the home visit on 12/17/2024 with the Registered Nurse (RN) [Personnel Record 3], the hospice medication profile, dated 12/17/2024, was compared to the facility medication list. The hospice medication profile included Dulcolax 10mg rectal suppository daily as needed but this was not on the facility medication list. Clinical Record 22/Home Visit 5: During the home visit on 12/18/2024 with the Medical Social Worker (MSW) [Personnel Record 6], the hospice medication profile reviewed on 12/18/2024, was compared to the facility medication list. The hospice medication profile included Cymbalta 30mg once daily. The facility medication list included Cymbalta 30mg twice daily. During a joint record review and interview on 12/20/2024, the Clinical Director agreed with the finding and stated, the nurses are relying more on verbal confirmation rather than physically looking, more education is needed.

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 drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, interview and observation. In 3 of 23 (13%) clinical records reviewed and home visits observed, it was revealed that the agency did not ensure that the plan of care included drugs and treatment necessary to meet the needs of the patient. Clinical Record 19/Home Visit 2: During the home visit on 12/17/2024 with the Registered Nurse (RN) [Personnel Record 3], the hospice plan of care dated 10/19/2024 - 12/17/2024 was compared to the facility plan of care. The hospice plan of care included Dulcolax 10mg rectal suppository daily as needed but was not on the facility plan of care. Clinical Record 20/Home Visit 3: During the home visit on 12/17/2024 with the RN [Personnel Record 4], the hospice plan of care dated 11/25/2024 - 02/22/2025 was compared to the facility plan of care. The hospice plan of care did not include Jevity 1.2 calorie 8 cans per day via a pump. This was verified with the family that the patient has been getting since discharge from the hospital. Clinical Record 22/Home Visit 5: During the home visit on 12/18/2024 with the Medical Social Worker (MSW) [Personnel Record 6], the hospice plan of care dated 10/04/2024 - 01/01/2025 was compared to the facility plan of care dated 09/06/2024. The facility plan of care included Cymbalta 30mg 1 cap by mouth twice a day. The hospice plan of care listed Cymbalta 30mg 1 cap daily. During a joint record review and interview on 12/20/2024, the Clinical Director agreed with the finding and stated, the nurses are relying more on verbal confirmation rather than physically looking, more education is needed.