Every finding on record at Day-By-Day Staff Relief, LLC

Based on interview, record review, and facility policy review, it was determined that the facility failed to complete an Interdisciplinary Group (IDG) Plan of Care Update (IDG POCU-a comprehensive plan developed and updated by nurses, social workers, chaplains and medical directors that includes the frequency of staff visits and interventions that guide the staff in providing patient care) to include the patient's current psychosocial needs, goals, and visit frequency for 1 (Patient #4) of 13 patients reviewed. The failure had the potential for the patient to not receive needed assessments and services. --- Findings included: Review of a facility policy titled, "Scope of Services," dated 10/25/2012, showed, "The social worker participates in IDG meetings every 2 weeks and participates in the development, implementation and revision of the plan of care for patients." A review of Patient #4's "Hospice Certification and Plan of Care," dated 10/14/2022, showed the agency admitted Patient #4 on 10/14/2022 with diagnoses that included chronic heart failure, chronic kidney disease, anxiety disorder, and alcohol abuse. Further review showed Patient #4 resided in a skilled nursing facility (SNF). A review of Patient #4's "Client Coordination Note Report (CCNR)," dated 11/10/2022 and completed by Social Worker (SW) #1, showed Patient #4 was annoyed by another resident at the facility, but was able to calm down with support of SW #1, was "emotionally stable at the time of the visit," and had no psychosocial (combined influences that psychological factors and the surrounding social environment have on a patient's physical and mental wellness and their ability to function) concerns. Further review showed SW #1 planned to continue visiting Patient #4 two times per week per Patient #4's POC. A review of Patient #4's "Hospice IDG Comprehensive Assessment and Plan of Care Update (IDG POCU)," dated 11/16/2022, showed Patient #4's IDG POCU was updated by SW #2; however, Patient #4's updated psychosocial concerns were limited to "ongoing education and teach back on end of life and hospice philosophy at each visit by the hospice team care plan." Additionally, the IDG POCU indicated the agency was to provide Patient #4 one social work visit per month. A review of Patient #4's "CCNR," dated 11/22/2022, completed by SW #1, showed Patient #4 was "clearly" agitated by another resident at the SNF, reported feeling anxious and tense, had stopped eating the facility food, and was having auditory hallucinations (hearing sounds and voices that do not exist in reality). Further review showed SW #1 planned to continue visiting Patient #4 two times per week per Patient #4's POC. A review of Patient #4's "CCNR," also dated 11/22/2022, completed by SW #1, showed Patient #4 was drinking alcohol during the visit, had mood changes, was upset as the SNF was threatening to evict the patient, reported auditory hallucinations, and wanted help to stop drinking, and SW #1 would assist the SNF with any referrals for Patient #4's psychosocial needs. Further review showed SW #1 planned to continue visiting Patient #4 two times per week per Patient #4's POC. A review of Patient #4's "IDG POCU," dated 11/30/2022, showed the plan was updated by SW #2; however, Patient #4's updated psychosocial concerns were limited to "ongoing education and teach back on end of life and hospice philosophy at each visit by the hospice team care plan," and the IDG POCU indicated the agency was to provide Patient #4 one social work visit per month. During an interview on 12/09/2022 at 2:30 PM, the Regional Administrator (RA) confirmed Patient #4's updated POC did not contain social work updates that reflected Patient #4's current psychosocial status and needs, did not contain updated SW visit frequencies, and acknowledged that the facility was not following its policy.

Based on interviews, record reviews, and facility policy review, it was determined that the facility failed to provide services as ordered in the Interdisciplinary Group Plan of Care Update (IDG POCU-a comprehensive plan developed by nurses, social workers, chaplains and medical directors that includes the frequency of staff visits and interventions that guide the staff in providing patient care) for 3 (Patients #3, #5, and #7) of 13 patients reviewed. The failure resulted in these three patients not receiving necessary assessments and services. --- Findings included: Review of a facility policy titled, "Scope of Services," dated 10/25/2012, showed, "The Agency provides skilled nursing services by or under the supervision of a registered nurse and in accordance with the IDG plan of care and established policies and procedures." Further review showed, "The Agency provides medical social services by a qualified social worker or by a qualified social work assistant under the supervision of a qualified social worker in accordance with the IDG plan of care and established policies and procedures." 1. A review of Patient #3's IDG POCU," dated 11/02/2022, showed the agency admitted Patient #3 on 04/16/2021, with diagnoses that included sarcopenia (an age related, involuntary loss of skeletal muscle mass and strength), muscle weakness, and dysphagia (difficulty swallowing). Further review showed the agency was to provide Patient #3 three nursing visits during the week of 10/30/2022 and two nursing visits during the week of 11/06/2022. A review of Patient #3's entire clinical record revealed no evidence that the agency provided three nursing visits to Patient #3 during the week of 10/30/2022 and two nursing visits during the week of 11/06/2022. The agency did not provide any additional documentation of nursing visits during these weeks. 2. A review of Patient #5's "IDG POCU," dated 10/26/2022, showed the agency admitted Patient #5 on 12/16/2021 with diagnoses that included atherosclerotic heart disease (ASHD-a thickening and hardening of the walls of the heart arteries) and dementia. Further review showed Patient #5 needed a social work visit one time per month to provide Patient #5 support with self-care and coping with dying. A review of Patient #5's IDG POCU, dated 11/09/2022, showed the agency social worker determined that Patient #5 had continued needs for a social work visit one time per month to provide Patient #5 support with self-care and coping with dying. A review of Patient #5's IDG POCU, dated 11/23/2022, showed the agency social worker determined that Patient #5 had continued needs for a social work visit one time per month to support Patient #5 with self-care and coping with dying. A review of Patient #5's entire clinical record revealed no evidence to indicate the agency provided a social work visit to Patient #5 during the month of November 2022. The agency did not provide additional documentation that showed the agency provided a social work visit to Patient #5 in November 2022. 3. A review of Patient #8's IDG POCU, dated 10/26/2022, showed the agency admitted Patient #8 on 10/17/2022 with diagnoses that included senile degeneration of the brain (dementia), anxiety, and insomnia (difficulty falling or staying asleep). Further review showed Patient #8 needed a social work visit one time per month to support Patient #8 with addressing personal business, handling grief, health changes that could affect life quality, and coping with dying. A review of Patient #8's IDG POCU, dated 11/09/2022, showed the agency social worker determined that Patient #8 had continued needs for a social work visit one time per month to support Patient #8 with addressing personal business, handling grief, health changes that could affect life quality, and coping with dying. A review of Patient #8's IDG POCU, dated 11/23/2022, showed the agency social worker determined that Patient #8 had continued needs for a social work visit one time per month to support Patient #8 with addressing personal business, handling grief, health changes that could affect life quality, and coping with dying. A review of Patient #8's entire clinical record revealed no evidence the agency provided a social work visit to Patient #8 during the month of November 2022. The agency did not provide additional documentation that showed the agency provided a social work visit to Patient #8 in November of 2022. During an interview on 12/08/2022 at 3:25 PM, the Regional Administrator (RA) stated visit frequencies shown on patients' IDG POCUs were considered visit orders because the patients' physicians signed the patients' IDG POCUs. The RA confirmed that Patient #5's IDG POCUs showed the agency was to provide Patient #5 with one social worker visit in November of 2022, and the agency did not provide Patient #5's social worker visit during that month. The RA also confirmed that Patient #8's IDG POCUs showed the agency was to provide Patient #8 with one social worker visit in November of 2022, and the agency did not provide Patient #8's social worker visit during that month. The RA acknowledged that the agency was not following its policy. During a follow-up interview on 12/09/2022 at 12:20 PM, the RA confirmed that the agency was to provide Patient #3 a total of three nursing visits during the week of 10/30/2022 and two nursing visits during the week of 11/06/2022 but had provided only two nursing visits during the week of 10/30/2022 and only one nursing visit during the week of 11/06/2022. The RA again acknowledged the facility was not following its policy.