Every finding on record at Cross Stone Hospice, LLC

Upon patient record review 1 of 5 (Patient # 3) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. #3: The SOC was 10/27/20. There was no evidence of a psychosocial assessment completed as part of the comprehensive assessment. The agency was not able to provide evidence that the assessment was completed.

Upon patient record review, 1 of 5 (Patient # 3) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring #3-In 9/30/21 RN note, the RN makes reference that Colace is effective in treatment for constipation. Colace was not on medication profile.

Upon patient record review, 1 of 5 (Patient #2) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. #2: The SOC was 4/5/21. The initial bereavement assessment was 4/15/21.

Upon patient record review, 5 of 5 (Patient #1, 2, 3, 4, 5) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Client Records #1, 2, 3, 4, 5: MSW frequency was ordered as PRN as needed for crisis management and SC frequency was order PRN as needed for spiritual support. There was no standing frequencies.

Upon personnel record review, 1 of 1 applicable (Personnel # 5) did not have evidence in the personnel file that the following competency assessment performed by the aide with a patient or pseudo-patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care #5: There was no evidence of a skills competency that included all CMS requirements. The above items were not on the competency assessment.

Upon patient record review, 3 of 5 (Patient #1, 2, 3) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient Records #1, 2, 3: The aide care plans included narrative instructions to assist with feedings. There was no frequency provided. There was no documentation by the aide whether or not the task was completed during visits,

Upon contract review, 1 of 4 (Heritage) did not have evidence the agreement to furnish any services under arrangement included that the hospice must retain administrative and financial management, and oversight of staff and services for all arranged services, to ensure the provision of quality care. Arranged care/services are supported by written contract/agreement that requires all care/services are: • Authorized by the hospice • Furnished in a safe and effective manner by qualified personnel • Delivered in accordance with the patient's plan of care

Upon personnel record review, 12 of 12 (Personnel # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy.

Upon personnel record review, 10 of 10 applicable (Personnel #1, 2, 3, 6, 7, 8, 9, 10, 11, 12) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. #1 The self assessment was completed and the preceptor had signed it, but individual skills observations were not noted as being competent by the preceptor. This was corrected on site. # 2, 3, 6, 7, 8, 9, 10, 11, 12 had no competency skills evidenced in the personnel record.

Upon patient client record review, 5 of 5 (Patient #1, 2, 3, 4, 5) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. The medical director was not identified as the medical director, throughout records. The physician's credentials were corrected in the hospice software program before end of survey.

Upon client record review, 2 of 5 (Patient #3, 4) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #3: In 9/30/21 RN note, the RN notes that Colace is effective in treatment for constipation. It was noted that there was no order obtained for Colace. Volunteer services were provided 9/2, 9/6, 9/8, 9/28, 9/30/21. There was no order for volunteer services. Patient #4: There was no order or coordination for PICC line care in the hospice POC. The PICC site was assessed as clean and dry each visit until it was removed 10/31, apparently by facility staff.

Upon client record review, 1 of 5 (Patient #4) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #4: Upon admission, patient was found to have multiple wounds, a PICC line not in use, and order for dialysis. The record was updated to include wound care tx orders, but there was no clear designation of who would perform the M-W-F wound care, the hospice or the facility nurse.

Upon observation, there was no evidence the hospice provides orientation to personnel of a SNF/NF or ICF/IID regarding the policies and procedures of the provision of care/service including: • Hospice policies and procedures regarding methods of comfort, pain control, symptom management • Principles about death and dying • Individual responses to death • Patient rights • Appropriate forms • Record keeping requirements