Every finding on record at Diamond Hospice Services, Inc

Observed in Tracer Activities. Example #2: The organization did not ensure the patient's right to choose an attending provider was implemented. For example, during a review of the consent in the medical record for RRBR#1, the Line titled Physician Name was blank. This observation was reviewed with the RN/QAPI Coordinator. Observed in Tracer Activities. Example #3: The organization did not ensure the patient’s right to choose an attending provider was implemented. For example, during a review of the Patient Consent for Primary Care Physician form in the medical record for RRHV#1, the Line titled Physician Name did not include the first name of the provider. This observation was reviewed with the RN/QAPI Coordinator. Observed in Tracer Activities. In 14 of 14 patient records reviewed, it was noted that the organization did not ensure that the Informed Consent and Treatment Authorization Form(s) were completed as required. For example, a review of the Informed Consent and Treatment Authorization Form revealed that patients were not informed of their financial responsibility prior to beginning care, treatment, or services or during the initial evaluation visit before beginning care, treatment, or services. During a review of the Informed Consent and Treatment Authorization Form in the medical record for RRHV#1, RRHV#2, RRHV#3, RRBR#1, and RRBR#2; RRDC#1, RRDC#2, RRNHV#1, RRNHV#2 and RRNHV#3; RRNHV#4, RRNHV#5, RRNHV#6, and RRNHV#7, there was no documented evidence that the patient received information about the services covered under the hospice benefit. The consent states “1. Payment responsibilities. It is understood that for Hospice patients, the agency assumes financial responsibility for medications and/or durable medical equipment and medical supplies related to the terminal illness. The Patient and/or Patient’s representative assumes financial responsibility for all other charges not authorized by the hospice.” However, this document did not indicate the amount of financial responsibility and was signed by the patient or the patient's caregiver. This observation was reviewed with the RN/QAPI Coordinator.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the organization did not ensure plan of care goals included outcome measures for specific care activities. For example, a review of initial and ongoing assessments for RRHV#3, revealed that the comprehensive assessment(s) identified multiple areas of skin impairment concerns [dry skin at heels, open areas at surgical incision site, redness at sacral area]. The plan of care did not include interventions related to maintenance of skin integrity and a goal statement to evaluate the response to care, treatment, and services related to skin care interventions. This observation was reviewed with the RN/QAPI Coordinator.

Observed in Record Review. Example #2: A review of the medical record for RRNHV#3 revealed, the Hospice Aide visit frequency was ordered 3 times per week. There was no documented evidence that a Hospice Aide visit was provided during week 1 and week 3 of services. During week 2 of services the Hospice Aide provided 1 visit. During week 4 and week 6 of services the Hospice Aide provided 2 visits. During week 5 of services the Hospice Aide provided 1 visit. This observation was reviewed with the RN/QAPI Coordinator. Observed in Record Review. In 2 of 10 patient records reviewed, for patient's receiving Hospice Aide services, it was noted that the Hospice Aide did not provide care as ordered in the plan of care. For example, a review of the medical record for RRNHV#1, revealed the Hospice Aide visit frequency was ordered 3 times per week. The Hospice Aide provided visits 2 times per week. This observation was reviewed with the RN/QAPI Coordinator.

Observed in Tracer Activities. During the Data Management session it was noted that the organization did not ensure that data related to non-clinical operations was included in the design of the QAPI program during the year(s) 2022 and 2023. This observation was reviewed with the RN/QAPI Coordinator.

Observed in Tracer Visit. In 1 of 3 Individual Tracers, the organization did not ensure that standard precautions were implemented during patient care activities. For example, during RRHV#1, it was noted that the clinician removed gloves after performing physical assessment activities and did not perform hand hygiene prior to applying new gloves. This observation was reviewed with the RN/QAPI Coordinator.

Observed in Record Review. Example #2: A review of the certification of terminal illness statement for RRNHV#4, revealed that the section titled Certifying Physician Summary was blank. This observation was reviewed with the RN/QAPI Coordinator. Observed in Record Review. Example #3: A review of the certification of terminal illness statement for RRNHV#5, revealed that the section titled Certifying Physician Summary was blank. This observation was reviewed with the RN/QAPI Coordinator. Observed in Record Review. In 3 of 14 patient records reviewed, it was noted that the organization did not ensure the written certification statement included all required information. For example, a review of the certification of terminal illness statement for RRNHV#1, revealed that the section titled Certifying Physician Summary was blank. This observation was reviewed with the RN/QAPI Coordinator.

Observed in Patient Home. In 1 of 1 home visits conducted, the organization had not assessed all of the elements required for supervision of the hospice aide. For example, during the home visit for HOS 1 the RN was observed assessing the hospice aide services and asked the patient if he was satisfied with the services provided by the hospice aide however did not inquire of or assess; completing the tasks in the plan of care as assigned by the registered nurse, demonstrating competence with assigned tasks, complying with infection control policies and procedures and reporting changes in the patient’s condition. This was discussed with and validated by the DPCS.