Every finding on record at Doctors Choice Hospice LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by record review and interview. 2 of 11 (18%) clinical records revealed the agency did not ensure the Spiritual Assessment component of the Initial Comprehensive Assessment was completed within 5 days of admission to hospice. Record #68987: The patient was admitted to hospice on 7/1/2021. The Initial Spiritual Assessment was not documented in the clinical record until 7/9/2021. No contact with the family or note indicating family refused visit within 5 days was present in the record. Record #57407: The patient was admitted to hospice on 4/8/2021. No MSW comprehensive visit was documented as completed within 5 days of admission in the clinical record or note indicating patient/family refused visit. An interview was conducted on 6/22/22 with the Director of Nursing, (Staff ID #91533) who stated after review, that there was no documentation explaining the reason for the late comprehensive assessments.

It is required that Hospice care and services provided to patients and families follow the individualized plan of care established by: The hospice IDG in collaboration with the attending physician (if any); the patient or patient representative; and the primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by clinical record review and interview. 6 of 11 (54%) clinical records revealed visits were not documented as completed in accordance with the visit frequency orders written on patient plans of care established by the IDG. Record #23212 (election of benefit 8/29/2021) The plan of care order effective August 29, 2021, for the following disciplines was not met: MSW order for 1 visit every 15 days - there were no documented visits on 6/28/2021, 7/13/2021, 7/28/2021; Spiritual Care (SCC) order for 1 visit every 15 days - there were no documented visits on 6/28/2021 and 7/27/2021; and RN order for 1 visit per week - no visit documented on 7/1/2021. Record #30388 (election of benefits 5/11/2022): The plan of care order effective May 11, 2022, included an MSW order for 1 visit every 15 days. There was no visit documented on 6/5/2022. Record #23499 (election of benefit 7/1/2021): The plan of care order effective July 1, 2021, included an MSW order for 1 visit every 15 days. There was no visit documented on 7/21/2021. Also, SCC visit order was present for 1 visit every 15 days and there was no visit documented on 7/25/2021. Record #23003 (election of benefit 6/2/2021): The plan of care order effective June 2, 2021, included an MSW order for 1 visit every 15 days and there was no visit documented on 6/18/2021 and 7/3/2021. Also, a SCC order was present for 1 visit every 15 days and there was no visit documented on 7/3/2021. Record #23447 (election of benefit 7/1/2021): The plan of care order effective July 1, 2021, included an MSW order for 1 visit every 15 days and there was no documented visit on 7/16/2021. Record #16044 (election of benefit 3/30/2021): The plan of care order effective March 30, 2021, included an MSW order for 1 visit every 15 days and there was no documented visit on 10/14/2021. Also, a SCC order was present for 1 visit every 15 days and there was no documented visit on 10/12/2021. During an interview with the Director of Clinical Services (Staff ID: #43046) and Administrator (Staff ID: #90233) on 6/22/2022, they acknowledged the visits were missed and stated the EMR is set up to require a visit frequency every 15 days and creates confusion with scheduling.

It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group; and Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. 3 of 10 (30%) applicable records in which the hospice aide was accepted, revealed the agency did not ensure the hospice aide provided all services as ordered on the hospice plan of care. Record #55634 (election of benefit 5/11/2021): The Hospice aide plan of care was ordered effective 5/11/2021, and the first aide visit was on 5/18/2021. Documentation on the aide visit notes stated the patient was shaved on 5/20/2021, 5/25/2021, 5/27/2021 and 6/1/2021. Shaving the patient was not assigned on the aide plan of care. Record #65197 (election of benefit 6/2/2021): The Hospice aide plan of care assigned the aide to provide the patient with a shower. Documentation on the aide visit note dated 6/10/2021 stated that a partial bath was given, and the visit note dated 7/1/2021 stated a sponge bath was given, as the patient refused the shower. There was no documentation present that described contact with the RN to revise the type of bath to be given. Also, documentation that the patient was shaved was present on aide visit notes dated 7/5/2021, 7/8/2021, 7/12/2015, 7/15/2021 and 7/20/2021, Shaving was not assigned on plan of care. Record #57407 (election of benefit 4/8/2021): The Hospice aide plan of care dated 4/8/2021 did not assign the aide to shave the patient, and the aide visit note dated 4/8/2021 stated the patient was shaved. An interview with the Director of Nursing (Staff ID: #90233) acknowledged that the aide did not provide all services as ordered on the plan of care.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid/MediCal-certified facility, the hospice forwards to the receiving facility a copy of: The hospice discharge summary. This standard was not met as evidenced by clinical record and policy review, and interview. 3 of 3 (100%) applicable clinical records of patients who were transferred revealed the hospice did not send a copy of the transfer/discharge summary to the receiving facility, as described in agency policy, “Transfer/Referral Criteria 9.27.1”. Record #68987: The patient was admitted to hospice on 7/1/2021 and was transferred to another hospice on 7/26/2021. There was no evidence that a written transfer/discharge summary was sent to the receiving hospice per policy, “Transfer/Referral Criteria 9.27.1”. Record #71604: The patient was admitted to hospice on 6/8/2021 and was transferred to another hospice on 9/17/2021. There was no evidence that a written transfer/discharge summary was sent to the receiving hospice per policy, “Transfer/Referral Criteria 9.27.1”. Record #97033: The patient was admitted to hospice on 6/18/2021 and was transferred to another hospice on 6/26/2021. There was no evidence that a written transfer/discharge summary was sent to the receiving hospice per policy, “Transfer/Referral Criteria 9.27.1”. An interview was conducted on 6/22/2022 with the Director of Nursing (Staff ID #91533) and Administrator (Staff ID #90233) who stated after review, there was no documentation that a copy of the transfer/discharge summary was forwarded to the receiving hospice.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: A copy of the hospice discharge summary This standard was not met as evidenced by clinical record and policy review, and interview. 2 of 2 (100%) applicable clinical records of discharged patients revealed the agency did not ensure the patient’s attending physician received a copy of the hospice discharge summary. Record #61264: The patient was admitted to hospice on 7/1/2021 and was discharged from hospice on 7/21/2021. There was no evidence that a discharge summary was provided to the patient’s primary care practitioner or other health care professional per agency policy, “Discharge Summary, 9.29.1”. Record #38924: The patient was admitted to hospice on 3/30/2021 and was discharged on 10/31/2021 due to their extended prognosis. There was no evidence that a discharge summary was provided to the patient’s primary care practitioner or other health care professional per policy, “Discharge Summary, 9.29.1”. An interview was conducted on 6/22/2022 with the Director of Nursing (Staff ID #91533) and Administrator (Staff ID #90233) who stated after review, there was no documentation the physician was notified of hospice discharge or revocations.