Every finding on record at Crown Hospice of St. Louis, Inc.

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 1 of 5 (20%) clinical records reviewed it was revealed that the agency did not ensure that all problems identified in the initial and updated comprehensive assessments were included in the plan of care. Clinical Record 2: The election of hospice benefits was dated 02/28/2024. The initial nursing assessment dated 02/28/2024 revealed that the patient's primary diagnosis was Congestive Heart Failure and read in part "Patient has 2-3+ pitting edema to all extremities and dyspnea with minimal exertion". The plan of care dated 02/28/2024-05/27/2024 lacked interventions and goals related to Congestive Heart Failure. In an interview on 03/26/2024, the Administrator reviewed the record and stated, "There should have been interventions on the plan of care related to the heart failure.".

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 medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed it was revealed that the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the plan of care. Clinical Record 5: The election of hospice benefits was dated 03/05/2024. The initial nursing assessment dated 03/05/2024 read in part "Patient has a shower chair, over the bed table, hospital bed and wheelchair". The plan of care dated 03/05/2024-06/02/2024 did not include any medical supplies or appliances. In an interview on 03/26/2024, the Administrator reviewed the record and stated "The DME should have been included in the plan of care.".

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed of patients receiving aide services revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 2: Physician's orders on 03/11/2024 included wound care for a wound to the sacrum. The aide care plan dated 03/11/2024 did not include instructions to the aide related to the sacral wound when providing care. In an interview on 03/26/2024, the Administrator reviewed the record and stated "There are no instructions related to the wound. I did not think about that since our nurses are providing aide care right now.".