Every finding on record at Elite Hospice LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 5 (20%) clinical records reviewed it was revealed that the agency did not ensure that all current medications were included in the patient's drug profile. Document 1: Agency Policy 8.20.1 titled, "Medication Reconciliation" dated 06/2019 read in part, "Hospice will reconcile patient's medications at time of admission and on an ongoing basis. At time of initial assessment, the RN will create and document a complete list of medications that patient is taking, including dose, route and frequency. Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication." Clinical Record 5: A physician's order dated 12/21/2023 read in part, "Oxygen at 2 liters per nasal cannula continuously." The medication profile dated 12/21/2023 did not include oxygen. In an interview on 07/24/2024, the Assistant Director of Clinical Services reviewed the record and stated, "The oxygen is not on the medication profile."

It is required that each patient’s individualized written plan of care reflects patient and family goals, identifies planned interventions based on problems identified in the initial and updated comprehensive assessments and includes all services necessary for the palliation and management of the terminal illness, including intervention to manage pain and symptoms, and measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 5 (60%) clinical records reviewed it was revealed that the agency did not ensure that all problems identified in the initial and updated comprehensive assessments had planned interventions and goals documented in the patient's individualized plan of care. Clinical Record 2: The initial nursing assessment dated 06/25/2024 read in part, "Patient is a fall risk." The plan of care dated 06/25/2024-09/22/2024 lacked interventions and goals related to the fall risk. Clinical Record 3: The initial nursing assessment dated 06/25/2024 read in part, "Patient is a fall risk." The plan of care dated 06/25/2024-09/22/2024 lacked interventions and goals related to the fall risk. Clinical Record 5: The initial nursing assessment dated 12/21/2023 read in part, "Patient is a fall risk." The plan of care dated 12/21/2023-02/18/2024 lacked interventions and goals related to the fall risk. In an interview on 07/24/2024, the Assistant Director of Clinical Services reviewed the records and stated, "There are no interventions in the plan of care for fall risk for these patients."

It is required that each patient’s individualized written plan of care includes medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed it was revealed that the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the plan of care. Clinical Record 1: The initial nursing assessment dated 06/27/2024 read in part, "Patient uses a walker for ambulation." The plan of care dated 06/27/2024-09/24/2024 did not include documentation of the walker. On 07/24/2024, the Assistant Director of Clinical Services reviewed the record and confirmed the finding.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation, and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 3 of 5 (60%) clinical records reviewed of patients that received aide services, it was revealed that the agency did not ensure that aide services were provided as ordered in the patient's plan of care. Clinical Record 1: The plan of care dated 06/27/2024-09/24/2024 read in part, "Hospice aide 3x/week starting 06/27/2024." The record revealed documentation of one aide visit dated 06/28/2024 for the week of 06/23/2024-06/29/2024, leaving two (2) outstanding aide visits. Clinical Record 4: The plan of care dated 06/27/2024-09/24/2024 read in part, "Hospice aide 6x/week starting 06/27/2024." The record lacked documentation of any aide visits completed for the week of 06/23/2024-06/29/2024. Clinical Record 5: The plan of care dated 12/21/2023-02/18/2024 read in part "Hospice aide 2x/week starting 12/21/2023." The record lacked documentation of any aide visits completed for the week of 12/17/2023-12/23/2023. In an interview on 07/24/2024, the Assistant Director of Clinical Services confirmed the findings, and stated, "There are no missed visit notes documented for these missed aide visits."

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed of patients that were provided with aide services, it was revealed that the agency did not ensure that aide supervisory visits were completed no less frequently than every 14 days. Clinical Record 5: An aide supervisory visit was dated 01/09/2024 with the next supervisory visit dated 01/30/2024, seven (7) days outstanding. The record also revealed an aide supervisory visit dated 02/06/2024 with the next supervisory visit dated 02/29/2024, nine (9) days outstanding. In an interview on 07/24/2024, the Assistant Director of Clinical Services reviewed the record, confirmed the findings and stated, "There should have been supervisory visits every 14 days."

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 5 (40%) clinical records reviewed it was revealed that the agency did not ensure that all physician's orders were included in the patient's clinical record. Clinical Record 2: The plan of care dated 06/25/2024-09/22/2024 read in part "Oxygen at 2 liters per nasal cannula". The record revealed a nursing visit note dated 07/01/2024 that read in part "The patient is on 3 liters of oxygen". The record lacked a physician's orders for oxygen at 3 liters. Clinical Record 4: The patient's discharge date was 07/12/2024. The record revealed a nursing discharge visit note dated 07/12/2024 along with a discharge summary. The record lacked a physician's order for discharge from the agency. In an interview on 07/24/2024, the Assistant Director of Clinical Services reviewed the records and stated "There is not an order in the record to increase the oxygen. We also did not document an order from our Medical Director for the live discharge".