Every finding on record at Dynamic Care Hospice, Inc

Based on record review, interview, and agency policy review, the agency failed to ensure that within 48 hours of a referral for hospice admission for two of 14 patients (Patient (P) P3 and P5) reviewed, the initial assessment was completed by a Registered Nurse (RN). Failure to complete the initial assessment within 48 hours had the potential for new patients to have physical, psychosocial, or financial needs addressed in a timely manner. --- Findings include: Record review revealed P3s referral date was 01/24/24, however the initial RN assessment was not completed until 01/29/24. Record review revealed P5s referral date was 10/02/23, however the initial RN assessment was not completed until 10/06/23. During an interview on 08/01/24 at 2:45 PM, the Administrator confirmed that the initial RN assessment was not completed within 48 hours of the hospice referral for P3 and P5. Review of the undated hospice agency policy titled, "Provision of Care, Treatment and Service" revealed, "...The Hospice RN will complete an initial assessment within 48 hours after the election of hospice care (unless the physician, patient or representative requests that the initial assessment be completed in less than 48 hours)..."

Based on interview, record review, and policy review, the agency failed to ensure a comprehensive assessment was completed in five days after the start of care (SOC) for one of 14 (Patients (P)2) patients sampled. The Social Service assessment was completed 13 days after the SOC. This failure presents a potential for the hospice to be unable to ensure that each hospice patient receives services that may be deemed necessary for psychosocial needs. --- Findings include: Review of the undated hospice agency policy titled, ";Admission Criteria and Process," revealed, ";Purpose: To establish standards and a process by which a patient can be evaluated and accepted for admission. . .17. lf the patient is accepted for hospice care; a comprehensive assessment of the patient will be performed no later than five (5) calendar days after the election of hospice care. A plan of care will be developed by the attending physician, the Medical Director or physician designee and the hospice team. lt will them be submitted to the attending physician for signature. The patient's wishes/desires will be considered and respected in the development. of the plan of care. . ." Review of P2s medical record provided by the facility revealed a SOC date of 03/31/23 with diagnosis of right ear melanoma. Review of P2's initial assessment completed by the Master Social Worker (MSW) dated 04/13/23, revealing an assessment completed 13 days after the SOC. During an interview on 08/01/24 at 11:30 AM, the MSW was asked about the time frame for an initial assessment to be completed. The MSW stated the initial assessment had to be completed in five days after the election of Hospice care. The MSW could not recall why it had taken the 13 days to get the initial psychosocial part of the assessment completed. During an interview on 08/01/24 at 2:00 PM, the Administrator was asked about the initial assessment time frame. The Administrator stated the initial assessment should be completed in five days after the election of Hospice care. The Administrator could not recall why the MSW did not complete the psychosocial portion of the assessment in the five-day time frame. The Administrator stated the expectation was to complete it in the five-day time frame. Findings include: Review of the undated hospice agency policy titled, ";Admission Criteria and Process," revealed, ";Purpose: To establish standards and a process by which a patient can be evaluated and accepted for admission. . .17. lf the patient is accepted for hospice care; a comprehensive assessment of the patient will be performed no later than five (5) calendar days after the election of hospice care. A plan of care will be developed by the attending physician, the Medical Director or physician designee and the hospice team. lt will them be submitted to the attending physician for signature. The patient's wishes/desires will be considered and respected in the development. of the plan of care. . ." Review of P2s medical record provided by the facility revealed a SOC date of 03/31/23 with diagnosis of right ear melanoma. Review of P2's initial assessment completed by the Master Social Worker (MSW) dated 04/13/23, revealing an assessment completed 13 days after the SOC. During an interview on 08/01/24 at 11:30 AM, the MSW was asked about the time frame for an initial assessment to be completed. The MSW stated the initial assessment had to be completed in five days after the election of Hospice care. The MSW could not recall why it had taken the 13 days to get the initial psychosocial part of the assessment completed. During an interview on 08/01/24 at 2:00 PM, the Administrator was asked about the initial assessment time frame. The Administrator stated the initial assessment should be completed in five days after the election of Hospice care. The Administrator could not recall why the MSW did not complete the psychosocial portion of the assessment in the five-day time frame. The Administrator stated the expectation was to complete it in the five-day time frame. Findings include: Review of the undated hospice agency policy titled, ";Admission Criteria and Process," revealed, ";Purpose: To establish standards and a process by which a patient can be evaluated and accepted for admission. . .17. lf the patient is accepted for hospice care; a comprehensive assessment of the patient will be performed no later than five (5) calendar days after the election of hospice care. A plan of care will be developed by the attending physician, the Medical Director or physician designee and the hospice team. lt will them be submitted to the attending physician for signature. The patient's wishes/desires will be considered and respected in the development. of the plan of care. . ." Review of P2s medical record provided by the facility revealed a SOC date of 03/31/23 with diagnosis of right ear melanoma. Review of P2's initial assessment completed by the Master Social Worker (MSW) dated 04/13/23, revealing an assessment completed 13 days after the SOC. During an interview on 08/01/24 at 11:30 AM, the MSW was asked about the time frame for an initial assessment to be completed. The MSW stated the initial assessment had to be completed in five days after the election of Hospice care. The MSW could not recall why it had taken the 13 days to get the initial psychosocial part of the assessment completed. During an interview on 08/01/24 at 2:00 PM, the Administrator was asked about the initial assessment time frame. The Administrator stated the initial assessment should be completed in five days after the election of Hospice care. The Administrator could not recall why the MSW did not complete the psychosocial portion of the assessment in the five-day time frame. The Administrator stated the expectation was to complete it in the five-day time frame.

Based on record review, review of agency policy and staff interview, the hospice agency failed to ensure the facility interdisciplinary group (IDG) meetings for seven patient (Patient (P1, P3, P5, P6, P8, P9, and P10) records reviewed from a total sample of 14 patients included at a minimum the physician, Registered Nurse (RN), social worker (SW) and chaplain in attendance. Failure to include multiple IDG members in the meetings presents a potential inability to accurately evaluate the patients progress in meeting goals of care. This had the potential to affect the 21 patients who were currently receiving hospice services and all future hospice patients/patient family units. --- Findings include: Review of the undated hospice agency policy titled "Interdisciplinary Group Meeting," revealed, "...The meeting will be facilitated by the hospice Clinical Supervisor or designee. The hospice Medical Director and all hospice interdisciplinary group members will be present, including but not limited to medical director, attending physician, director of nursing, case managers, visiting nurses, medical social worker, home health aide, chaplain, bereavement coordinator, volunteers..." Record review revealed P1 was admitted to the hospice agency on 02/13/24. During review of the IDG meetings, located in the electronic medical record (EMR), it was noted the IDG meetings for 05/02/24 and 07/11/24 consisted of the RN and SW. Record review revealed P3 was admitted to the hospice agency on 01/29/24. During review of the IDG meetings, located in the EMR, it was noted the IDG meetings for 03/07/24 and 03/21/24 consisted of the Medical Director, RN, and SW. Record review revealed P5 was admitted to the hospice agency on 10/06/23. During review of the IDG meetings, located in the EMR, it was noted that the IDG meetings for 01/25/24 consisted of the Medical Director, SW, and chaplain and the 06/13/24 meeting consisted of the RN and SW. Record review revealed P6 was admitted to the hospice agency on 09/25/23. During review of the IDG meetings, located in the EMR, it was noted that the IDG meeting for 04/18/24 consisted of the Medical Director, RN, and SW. Record review revealed P8 was admitted to the hospice agency on 07/11/23. During review of the IDG meetings, located in the EMR, it was noted that the IDG meeting for 07/25/24 consisted of the Medical Director and RN. Record review revealed P9 was admitted to the hospice agency on 02/25/24. During review of the IDG meetings, located in the EMR, it was noted that the IDG meetings for 03/07/24 and 04/18/24 consisted of the Medical Director, RN, and SW. The 07/25/24 meeting consisted of the Medical Director and RN. Record review revealed P10 was admitted to the hospice agency on 01/28/24. During review of the IDG meetings, located in the EMR, it was noted that the IDG meetings for 03/21/24, 04/18/24, 05/30/24 and 07/24/24 consisted of the Medical Director, RN, and SW. Record review revealed P11 was admitted to the hospice agency on 01/28/24. During review of the IDG meetings, located in the EMR, it was noted that the IDG meetings for 03/21/24 consisted of the Medical Director, RN, and SW. During an interview on 10/19/22 at 2:45 PM, with the Hospice Administrator, he stated the agency expectation for staff IDG meetings was to include ";...the Medical Director, RN, SW and chaplain..." and the agency Administrator and Volunteer Coordinator to attend as needed.

Based on interview, record review, and agency policy review, the hospice agency failed to ensure one patient of 14 (Patient(P)4) had the physicians signature on the "Physician Orders for Life-Sustaining Treatment (POLST)" document. This deficient practice had the potential to allow the patient's request to be carried through because the physician had not signed the order. --- Findings include: Review of the undated hospice policy titled, ";Verification of Physician Orders," revealed, ";Purpose: To ensure that accurate physician (or other authorized licensed independent practitioner) orders and prescriptions are obtained in accordance with state and federal law and regulation. . . Procedure. . . 9. The original order will be delivered to the physician (or other authorized licensed independent practitioner) for his/her signature." Review of P4s ";Patient Intake" provided by the agency revealed a start of care (SOC) date on 05/12/23 with diagnoses of atherosclerotic heart disease (ASHD), and right sided breast cancer. Further review revealed a "POLST" document provided by the facility dated 05/12/23 with no physicians signature. P4 was discharged on 05/14/24, a year after SOC. During an interview on 08/01/24 at 2:00 PM, the Administrator was asked about the POLST document did not have the physician's signature. The Administrator stated he did not know why it was not signed and why it had not been noticed.

Based on interview, and policy review, the agency failed to ensure volunteers one of two volunteers (Volunteer(V)1) had an identified position and hours spent with a cost estimate of what the volunteer saved the agency. This deficient practice had the potential to affect all 21 patients seen by the agency to not use the volunteers in the correct capacity or cost saving manner. --- Findings include: Review of the undated hospice agency policy titled, ";Volunteer Services," revealed, ";Purpose: To ensure qualified volunteers provide appropriate services in accordance with the interdisciplinary plan of care and hospice program needs. . . Procedure: In order to verify volunteer visits and to facilitate communication between the volunteer and other team members, the volunteer must document each contact made with the patient, family or hospice staff. This documentation is completed on the Volunteer Documentation Form and is submitted to the Volunteer Coordinator on a weekly basis. A separate documentation form is completed for each patient/family assigned to the volunteer. This documentation is also utilized in determining the volunteer cost savings & activity level. . ." During an interview on 08/01/24 at 1:30 PM, the Administrator was asked for a list of volunteers. The Administrator provided a volunteer list that included three names (Volunteer Coordinator, V1and the name of a third volunteer that would start next month.) The Administrator was asked for documentation of the services the volunteers performed. The Administrator brought a document that showed the hours for the Volunteer Coordinator. The Administrator stated, ";The Volunteer Coordinator called patients to see if they were satisfied with services staff provided." The Administrator stated they had been working hard to get volunteers and that they had one volunteer (V1) to help. The Administrator was asked about the Volunteer Coordinator calling patients could not count because he was a paid employee. The Administrator stated the Volunteer Coordinator made the calls during his own time. There was no documentation to indicate V1 had volunteered. During an interview on 08/01/24 at 1:55 PM, V1 was asked if he had volunteered any time with the hospice. V1 stated he started June 2024. V1 stated he had done office work and had driven his car for errands. V1 was asked if he had documented his hours anywhere and he stated he had not.

Based on interview, record review and policy review, the agency failed to ensure the volunteer services of two of two volunteers (Volunteer Coordinator and Volunteer (V)1) accurately documented a cost savings of at least five percent (5%) of total patient care hours. This failed deficiency had the potential to affect all 21 patients seen by the hospice agency and allow the agency to not use volunteers in an effective position for cost savings. --- Findings include: Review of the undated hospice agency policy titled, ";Volunteer Services," revealed, ";Purpose: To ensure qualified volunteers provide appropriate services in accordance with the interdisciplinary plan of care and hospice program needs. . . Procedure: 4. The volunteer coordinator will track the use of volunteers' cost savings achieved, and that hours of volunteer services exceed 5% of the total patient care hours of paid and contracted hospice personnel. . . Volunteers will document their activities on volunteer activity/ clinical notes. . . 4. All volunteer hours documented are added up for the month and used to determine the Volunteer Cost Savings ratio and percentage." Review of the ";Volunteer Cost Saving" report, provided by the facility, dated from 02/01/24 to 07/29/24 revealed, ";Total Direct Care Hours (excluding volunteer hours) 847.95 hours and 55.08 hours for Administrative." The section ";Volunteer Direct Support for patients and Volunteer Support" had no hours recorded. The section ";Total volunteer hours/total Direct patient care hours (excluding volunteer hours) times 100" Indicated the figure used was a total of 6.6%. During an interview on 08/01/24 at 1:30 PM, the Administrator was asked for documentation of the volunteer hours to show how the agency produced the 6.6% total. The Administrator brought a document that showed the hours for the Volunteer Coordinator and stated, ";The Volunteer Coordinator called patients to see if they were satisfied with services staff provided. The Administrator stated they had been working hard to get volunteers and that they had one volunteer (V1) to help. The Administrator was asked about the Volunteer Coordinator calling patients could not count because he was a paid employee. The Administrator stated the Volunteer Coordinator made the calls in his own time. The Administrator was shown the report that indicated there were no volunteer hours recorded to get the figure of 6.6%. The Administrator stated, ";This is all we have" referring to the document that had the Volunteer Coordinators paid time. During an interview on 08/01/24 at 1:55 PM, V1 was asked if he had volunteered any time with the hospice. V1 stated he started June 2024. V1 stated he had done office work and had driven his car for errands. V1 was asked if he had documented his hours anywhere and he stated he had not.