Every finding on record at Direct Hospice Care, Inc.

Observed in Record Review. In 3 of 10 patient records reviewed, the hospice’s interdisciplinary group failed to complete the comprehensive assessment no later than five calendar days after the election of hospice care. In review of the medical record for RRNHV #4 the psychosocial assessment by the medical social worker had not been completed until 27 days following the election of the hospice benefit. Additionally, in review of the medical record for RRNHV #6 the spiritual assessment had not been completed until 38 days following the election of the hospice benefit. Also, in review of the medical record for RRNHV #7 the spiritual assessment and bereavement risk assessment had not been completed until 6 days following the election of the hospice benefit and the psychosocial assessment had not been completed until 14 days following the election of the hospice benefit.

Observed in Record Review. In 10 of 10 patient records reviewed, the bereavement assessment was not completed by the social worker, as required by policy no. 2-010.1 Bereavement Services which states a bereavement risk assessment will be completed by the hospice social worker at the time of admission to hospice. In all medical records reviewed the Hospice Spiritual Counselor had completed the bereavement risk assessment. This was validated with the Quality Director.

Observed in Record Review. In 10 of 10 patient records reviewed, the written plan of care failed to include measurable goals, time frames and interventions required to meet goals. In review of the medical record for RRHV #1 the plan of care included a problem for skin integrity and documented that the patient had three open areas including the coccyx and right and left buttock however failed to include objective measurements of the open areas. The plan of care included goals that wounds will heal to maximum potential however measurable outcomes were not identified for example, reduce wound size by 25% in two weeks. This was also observed in review of the plan of care for RRHV #2 which included a problem for skin integrity and documented that the patient had bruises on the upper extremity but the goals documented were skin will heal to maximum potential and did not include measurable outcomes and interventions to meet outcomes. This was also noted in review of the medical record for RRHV #3 and seven additional medical records that were reviewed without home visits. This was validated with the Quality Director.

Observed in Record Review. In 10 of 10 patient records reviewed, there was no evidence that the organization had revised the plan of care and documented the patient's progress toward goals and outcomes. In review of the medical record for RRHV #1 who was admitted to hospice three months ago, the plan of care at the start of care included a problem for skin integrity with documented open areas on the coccyx and right and left buttock. In review of the visit notes for nursing staff the wounds on the right and left buttock had healed two weeks ago however there was no evidence of documentation of progress towards goals in the care plan updates including wound measurements or changes in orders since the start of care. The plan of care had not been updated with changes since the start of care. This was also observed in review of the medical records for RRHV #2, RRHV #3 and seven medical records without home visits that were reviewed. This was validated with the Quality Director.

Observed in Record Review. In 1 of 2 patient records reviewed, for bereavement the organization failed to provide the patient with care, treatment, or services according to the patient's individualized plan of care. In review of the medical record for RRBR #2 where the primary bereaved daughter was assessed to be at high risk the bereavement care plan included a referral to therapist or other mental health professional, however there was no evidence that a referral had been made. The documentation showed that the Bereavement Coordinator suggested to the primary bereaved daughter that she receive outside counseling and that she - the daughter, reach out to a therapist to work through her complex grief. There was no evidence that referral was made by Bereavement Coordinator.

Observed in Patient Home. In 2 of 3 home visits conducted, staff failed to perform hand hygiene consistent with the organizational policy 9-009.1 Hand Hygiene which requires hand decontamination using an alcohol based hand rub before having direct contact with patients. For RRHV #1, the Spiritual Care Counselor failed to perform hand hygiene upon entering the patient's residence and before or after having contact with the hospice patient. Additionally, for RRHV #2 the RN failed to perform hand hygiene prior to having contact with the patient. This was validated with the Administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, for bereavement, the hospice did not develop a bereavement plan of care that specifies the type of bereavement services to be offered and the frequency of service delivery. In review of the medical record for RRBR #1 the record was missing documentation of a bereavement plan of care.

Observed in Leadership Session. Leaders did not provide for a sufficient number and mix of individuals to support safe, quality care, treatment and services as evidenced by the absence of the appointed Director of Patient Care Services (DPCS) and the DPCS Designee who were both out of the country, therefore the organization did not have an RN in place that had been designated to coordinate patient care and supervise staff. This was validated by the Administrator.