Every finding on record at Dignita Hospice Inc.

It is required that each patient’s individualized written plan of care reflects patient, and family goals and 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 3 of 14 (21%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The initial nursing assessment dated 03/23/2024 stated the patient had bowel incontinence. The POC dated 03/23/2024 lacked evidence of a goal and intervention(s) for bowel incontinence. Clinical Record 5: The initial nursing assessment dated 10/16/2023 stated the patient had "Psychotic agitation". The POC dated 10/16/2023 lacked evidence of a goal and intervention(s) for agitation. Clinical Record 9: The initial nursing assessment dated 01/21/2024 stated the patient had "Chronic episodes of SOB well managed with rest and oxygen inhalation". The POC dated 01/21/2024 lacked evidence of a goal and intervention(s) for Respiratory. The Owner and Alternate Director of Patient Care Services stated in an interview while performing joint clinical record review on 10/10/2024 that the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments.

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered, and the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical records reviewed for patients discharged due to death revealed the agency did not ensure a post-death bereavement assessment and plan of care (POC) was completed. Clinical Record 10: The patient expired on 09/01/2024. The record lacked evidence of a completed post-death bereavement assessment and POC. There was evidence of phone contact to the family post-death offering bereavement services. The Owner and Alternate Director of Patient Care Services stated in an interview on 10/10/2024 that the agency did not ensure a post-death bereavement assessment and plan of care (POC) was completed.

It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and document review. In 3 of 4 (75%) clinical records reviewed for patients that elected aide services revealed the agency did not ensure the hospice aide provided services included in the plan of care. Clinical Record 1: The aide care plan dated 03/23/2024 ordered the tasks: "Meal prep - Breakfast, Lunch, Dinner, Snack", "Feeding instructions - Aspiration precaution (every visit), and Feeding assistance". The aide visit note dated 08/02/2024 showed each box associated with the above tasks ordered were not checked (A box would be checked by the aide once the assigned task was completed). The record lacked supportive documentation as to the reason the tasks were not completed as ordered on the aide care plan. Clinical Record 3: The aide care plan dated 07/27/2024 ordered the tasks: "Ambulatory - Geri chair every visit". The aide visit note dated 07/27/2024 showed the box associated with the above task ordered was not checked (A box would be checked by the aide once the assigned task was completed). The record lacked supportive documentation as to the reason the tasks were not completed as ordered on the aide care plan. Clinical Record 11: The aide care plan dated 05/26/2024 ordered the tasks: "Meal prep - Breakfast, Lunch, Dinner, Snack", and "Feeding instructions - Aspiration precaution (every visit)". The aide visit note dated 07/04/2024 showed each box associated with the above tasks ordered were not checked (A box would be checked by the aide once the assigned task was completed. The record lacked supportive documentation as to the reason the tasks were not completed as ordered on the aide care plan. The Owner and Alternate Director of Patient Care Services stated in an interview on 10/10/2024 that the agency did not ensure that the aide provided services included on the aide care plan.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 3 of 3 (100%) records reviewed for the patients that elected hospice aide services and had a change in status requiring the aide to report changes to an RN revealed the agency did not ensure the hospice aide reported changes in the patient's medical needs to the registered nurse (RN) as the changes related to the plan of care (POC). Clinical Record 1: The aide care plan dated 03/23/2024 ordered the tasks: "Meal prep - Breakfast, Lunch, Dinner, Snack", "Feeding instructions - Aspiration precaution (every visit), and Feeding assistance". The aide visit note dated 08/02/2024 showed each box associated with the above tasks ordered were not checked (A box would be checked by the aide once the assigned task was completed). The record lacked supportive documentation as to the reason the tasks were not completed as ordered on the aide care plan. The record also lacked evidence that the aide notified the RN of the changes in the patient's medical needs as related to the aide care plan. Clinical Record 3: The aide care plan dated 07/27/2024 ordered the tasks: "Ambulatory - Geri chair every visit". The aide visit note dated 07/27/2024 showed the box associated with the above task ordered was not checked (A box would be checked by the aide once the assigned task was completed). The record lacked supportive documentation as to the reason the tasks were not completed as ordered on the aide care plan. The record also lacked evidence that the aide notified the RN of the changes in the patient's medical needs as related to the aide care plan. Clinical Record 11: The aide care plan dated 05/26/2024 ordered the tasks: "Meal prep - Breakfast, Lunch, Dinner, Snack", and "Feeding instructions - Aspiration precaution (every visit)". The aide visit note dated 07/04/2024 showed each box associated with the above tasks ordered were not checked (A box would be checked by the aide once the assigned task was completed). The record lacked supportive documentation as to the reason the tasks were not completed as ordered on the aide care plan. The record also lacked evidence that the aide notified the RN of the changes in the patient's medical needs as related to the aide care plan. The Owner and Alternate Director of Patient Care Services stated in an interview on 10/10/2024 that the agency did not ensure the hospice aide reported changes in the patient's medical needs to the RN as the changes related to the aide care plan.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The review of the "Volunteer Savings Report" revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. Document 1: The review of the 2024 "Volunteer Saving Report" revealed the volunteer percentage of hours worked for January 2024 thru September 2024 was 0%. The Owner and Alternate Director of Patient Care Services stated in an interview on 10/10/2024 that they had offered volunteers, but the patients had refused. She acknowledged the 5% was not achieved. The review of the "Volunteer Savings Report" revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 3 of 3 (100%) clinical records reviewed for patients that were transferred to the hospital to pursue aggressive treatment thereby having revoked further hospice services revealed the agency did not ensure the discharge summary was forwarded to the receiving facility. Clinical Record 11: The patient elected the hospice benefit on 05/26/2024. The patient elected to transfer to the hospital to pursue aggressive treatment thereby having revoked further hospice services on 07/09/2024. In a clinical discharge note dated 07/09/2024, there was evidence that the registered nurse (RN) documented "The discharge summary was sent to the receiving hospital". However, the record lacked evidence of confirmation that this information was forwarded. Clinical Record 12: The patient elected the hospice benefit on 12/14/2023. The patient elected to transfer to the hospital to pursue aggressive treatment thereby having revoked further hospice services on 07/02/2024. In a clinical discharge note dated 07/02/2024, there was evidence that the RN documented "The discharge summary was sent to the receiving hospital". However, the record lacked evidence of confirmation that this information was forwarded. Clinical Record 13: The patient elected the hospice benefit on 04/10/2024. The patient elected to transfer to the hospital to pursue aggressive treatment thereby having revoked further hospice services on 06/11/2024. In a clinical discharge note dated 06/11/2024, there was evidence that the RN documented "The discharge summary was sent to the receiving hospital". However, the record lacked evidence of confirmation that this information was forwarded. The Owner and Alternate Director of Patient Care Services stated in an interview on 10/10/2024 that the agency did not ensure the discharge summary was forwarded to the receiving hospitals.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation, the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary and the patient's record, if requested. This standard was not met as evidenced by clinical record review and document review. In 3 of 3 (100%) clinical records reviewed for patients that were transferred to the hospital to pursue aggressive treatment thereby having revoked further hospice services revealed the agency did not ensure the discharge summary was forwarded to the patient's attending physician. Clinical Record 11: The patient elected the hospice benefit on 05/06/2024. The patient elected to transfer to the hospital to pursue aggressive treatment. The patient revoked further hospice services on 07/09/2024. The record lacked evidence that a discharge summary was forwarded to the patient's attending physician. Clinical Record 12: The patient elected the hospice benefit on 12/14/2023. The patient elected to transfer to the hospital to pursue aggressive treatment. The patient revoked further hospice services on 07/02/2024. The record lacked evidence that a discharge summary was forwarded to the patient's attending physician. Clinical Record 13: The patient elected the hospice benefit on 04/10/2024. The patient elected to transfer to the hospital to pursue aggressive treatment. The patient revoked further hospice services on 06/11/2024. The record lacked evidence that a discharge summary was forwarded to the patient's attending physician. The Owner and Alternate Director of Patient Care Services stated in an interview on 10/10/2024 that the agency did not ensure the discharge summary was forwarded to the patient's attending physician.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not reduce the risk of infections associated with medical equipment, devices, and supplies by implementing the cleaning and disinfection of medical equipment according to accepted standards of practice. During HV#2 and HV#3, the clinician cleaned the digital blood pressure monitor and cuff with a chemical-based wet wipe/cloth. This cleaning/disinfection was not according to the outlined product recommendations. This was reveiwed and confirmed with the CEO.

Observed in Record Review. In 1 of 2 live discharge records reveiwed, the organization did not give the receiving facility information about the care, treatment, or services provided to the patient upon hospice discharge/transfer. In RR#2, it was noted the spouse called 911 to have the patient transported to the hospital for treatment of shortness of breath, with revocation of hospice. Although it was documented the Discharge Summary was faxed to the primary physician, there was no documentation that the Hospice Discharge Summary was provided to the receiving facility/hospital. This was reveiwed and confirmed with the CEO.