Every finding on record at Eden Hospice, LLC

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 7 (43%) clinical records reviewed revealed that the agency did not ensure the patient's individualized written plan of care reflected the patient's and family's goals and planned interventions associated with problems identified during the initial and updated comprehensive assessments. Clinical Record 1: The initial nursing assessment completed on 04/08/2024 documented the patient was bedbound, required two (2) persons to transfer using a Hoyer lift, and scored seven (7) out of ten (10) on fall risk assessment, indicating the patient was at risk for falls. The initial nursing assessment also included a drug profile that included scheduled and as-needed opioids for pain (Fentanyl 25MCG, MS Contin 30MG, and Morphine concentrate 20MG/1ML), and various laxatives and stool softeners for the management and prevention of constipation (Bisacodyl 5MG tablets, Bisacodyl 10MG suppository, Colace 100MG, Gavilax 17GM, Lactulose 10GM/15ML and laxative stool softener with Senna 8.6MG-50MG). The clinical record did not contain evidence that the written plan of care, effective 04/08/2024 through 07/06/2024, contained goals and interventions associated with the patient's identified fall risk and constipation. Clinical Record 2: The initial nursing assessment completed on 03/25/2024 documented the patient exhibited anxiety, rated six (6) out of ten (10), and treatment was initiated to include Lorazepam intensol. The nursing assessment completed on 04/29/2024 documented that facility staff had reported the patient continued to have restlessness and anxiety at night. The clinical record did not contain evidence that the written plan of care, effective 03/25/2024 through 06/22/2024, contained goals and interventions associated with the patient’s identified anxiety or that the plan of care was updated to include goals and interventions related to the patient’s restlessness and anxiety. Clinical Record 7: The initial nursing assessment completed on 04/15/2024 documented the patient had a fall risk score of five (5) out of ten (10), which indicated the patient was at risk for falls, and reported an anxiety rating of five (5) out of ten (10). The clinical record did not contain evidence that the plan of care, effective 04/15/2024 through death on 04/19/2024, included identified goals and interventions associated with the patient's fall risk and anxiety. The initial assessment completed by the Medical Social Worker (MSW) on 04/17/2024 documented that the patient was unresponsive, restless, tossing, turning, and clutching a pillow. The plan of care order was updated by the MSW on 04/17/2024; however, it did not reflect evidence of goals and interventions associated with the patient's identified anxiety and restlessness or a frequency of visits for the accepted MSW services. On 05/02/2024 joint clinical record reviews and interviews were conducted with the Director of Patient Care Services/Administrator and Chief Executive Officer who confirmed that the clinical records identified did not include goals and interventions associated with identified problems that included fall risks, constipation, anxiety, and restlessness.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IDF representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed, in which the patient resided in a skilled nursing facility (SNF), revealed that the agency did not ensure the plan of care specified which provider would be responsible for performing functions agreed upon and included in the plan of care. Clinical Record 4: The registered nurse obtained and documented physician orders on 03/24/2024, 04/01/2024, and 04/07/2024 for the patient/resident of a skilled nursing facility to apply skin prep to the right posterior distal calf, apply skin prep to right lateral ankle DTI (deep tissue injury), and apply skin prep to left heel DTI two (2) times per day and offload heels. The physician orders, used to update the plan of care, did not specify which provider was responsible for performing the skin prep application and heel offload. On 05/02/2024 joint clinical record reviews and interviews were conducted with the Director of Patient Care Services/Administrator and Chief Executive Officer who confirmed that the plan of care, for the clinical record identified, did not specify the provider responsible for performing the skin prep application and heel offload.