Every finding on record at Diamond Hospice LLC

Upon observation, there was not evidence of a written contract/agreement with an other Facility/Agency/Hospice to receive the patients of Devotion Hospice in the event that Devotion Hospice cannot provide care to their patients during a Natural Disaster/Emergency.

Upon patient record review, 2 of 19 (Patients #2 and 4) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions; specifically: A detailed statement of both the scope and frequency of services necessary to meet the specific patient and family needs. Patient #2: The IDG POC dated 10/05/23 included a visit frequency for ARNP of 20 prn visits over the next year, without a baseline visit frequency listed. Also, a Chaplain visit frequency of 10 prn without a baseline visit frequency. Patient #4:The IDG POC dated 10/05/23 included a visit frequency for ARNP of 4 prn visits without a baseline visit frequency listed.

Upon patient record review, 2 of 19 (Patient #7 and 11) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 7 SN visit was made on 10/10/23 which documented, "Small red open area on bottom. Family applying Zinc ointment." As of 10/12/23 no Physician order had been obtained to update the Hospice Plan of Care. Patient 11 The POC dated 10/11/23 included, "Nurse will change supra-pubic catheter and irrigate per MD orders. Flush catheter with 30ml Acidic Acid every 3 days for sediment and to prevent clogging." This is an incomplete order, as it does not include an ordered frequency for the changing of such catheter, the catheter/balloon size, any applicable site dressings, site maintenance, etc... Nor does it identify 'who' in the patient's home will be responsible for this potential every 3-day intervention.

Upon patient record review, 2 of 19 (Patients #1 and 2) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, to include equipment and supply needs: Patient #1: The POC dated 10/05/23 listed DME of hospital bed. During the Surveyor-attended home visit on 10/11/23 it was confirmed that this patient did not have a hospital bed. Patient #2: The POC dated 10/05/23 listed DME of: 1) hospital bed; 2) overbed table; and 3) commode. During the Surveyor-attended home visit on 10/11/23 it was confirmed that the patient did not have any of these DME.

Upon patient record review, 1 of 19 (Patients #8) did not contain evidence that a revised Plan of Care included information from the patient's updated comprehensive assessment(s): Patient #8: A verbal order was obtained on 09/14/23 for, "Cleanse left buttocks Stage II with wound cleanser or normal saline, apply thin layer zinc-based barrier cream, QD and prn soiling. Caregiver may provide such intervention". The nurse documented on 09/19/23 and 09/26/23 visits that this Stage II wound was still present. However, this wound care problem and intervention had not yet been updated onto the Hospice IDG POC dated 09/27/23.

Upon patient record review, 2 of 19 (Patients #4 and 12) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #4: The POC dated 10/05/23 listed a Music Therapy visit frequency (effective 01/01/23) of "2x every 4 weeks." In July, August, and September 2023 there was only one Music Therapy visit made per every 4 weeks. An SN visit was made on 10/09/23 which documented wound care as follows: 1) Cleansed with wound cleanser, pat dry, applied Triple ATB to 4x4, then opti-foam, to right forearm and left elbow area; and 2) Skin tear to left upper arm. Cleansed with soap/water, pat dry, applied Lanolin, then covered with island dressing. There were no Physician orders located for these two wound care interventions. Patient #12:The SN visit note dated 10/06/23 noted, "Excoriation to left groin. Moisture Barrier Cream applied to both groin and buttocks region. There was no order located for this intervention.

Upon patient record review, 3 of 19 (Patients #17, 18, and 19) did not contain evidence that the Hospice had provided bereavement counseling that included: Ensuring that the bereavement services provided reflected the needs of the bereaved, as established on the Bereavement Plan of Care. For each of these bereaved records, the Hospice was not able to provide a documented tracking record of the Hospice having followed the Bereavement Plan of Care; specifically no evidence of having sent the required Sympathy Card(s), nor the 1-month and 3-month bereavement letters.

Upon patient record review, 1 of 19 (Patient #3) did not contain evidence that Hospice Aide assignments and duties indicated what tasks were to be done by the Aide, and the frequency of such tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable. The Aide POC dated 08/16/23 assigned, "Change linen weekly and as needed", without an indication for such as needed intervention.

Upon patient record review 5 of 19 (Patients #1, 6, 7, 9, and 12) did not contain documented evidence that a Hospice Aide had provided services that were: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1: During the Surveyor-attended home visit on 10/11/23 the Aide reported having routinely applied Gold Bond Powder underneath this patient's breasts, and then laying paper towels under the breasts, to assist in decreasing the moisture build-up. This intervention was not on the current Aide POC. Patient #6: An order was obtained 09/03/23 increasing the Aide visit frequency from 2x per week to 5x per week. The week beginning 09/03/23 had only two Aide visits. The week beginning 09/10/23 had only one Aide visits. The week beginning 09/17/23 had only two Aide visits. The week beginning 09/24/23 had only two Aide visits. Patient #7: The Physician ordered Aide visit frequency was for 3x per week, effective 09/17/23. The week beginning 09/17/23 only evidenced x2 visits/refusals, the week beginning 09/24/23 only evidenced x2 visits, and the week beginning 10/01/23 evidenced x2 visits. Patient #9: An order was obtained 08/15/23 for an Aide visit frequency of 3x per week. There were only 2 Aide visits made the week of 08/13/23. An order was obtained 08/27/23 for an Aide visit frequency of 2x per week. The weeks beginning 09/03/23, 09/10/23 and 09/17/23 had no Aide visits. The week beginning 09/24/23 had x3 Aide visits. Patient #12: Effective 09/10/23 Aide visits were ordered at a frequency of 3x per week. The weeks beginning 09/10/23 and 09/17/23 had only x2 Aide visits each.

Upon patient record review, 1 of 19 (Patient #6) did not contain evidence that each patient record contained signed/dated clinical progress notes. As of 08/27/23 the SN visit frequency was ordered for 1x per week. During record review activity, the last SN visit/clinical note documented within the record was dated 08/28/23. The nurse reported having made all ordered home visits, but documentation was not present/filed in the EMR. Texas regulation §558.301 Client Records., requires (D) Clinical and progress notes. Such notes must be written the day service is rendered and incorporated into the client record within 14 working days. The Administrator reports that this is their policy.

Upon patient record review, 1 of 19 (Patient #8) did not contain evidence that the Hospice had forwarded a Transfer Summary, and a copy of the patient record if requested, to a facility when transferring the patient to that facility. Patient #8 was transferred to the ER/Hospital on 09/08/23 for chest and leg pain, with the Hospice being aware of such transfer on same date. There was no evidence of the Hospice having forwarded a Transfer Summary to the receiving hospital.