Every finding on record at Elite Hospice & Palliative Care LLC

Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to respect the patient's right to participate in decisions about their care, treatment, or services. For example: on review of RRNHV#5 the patient elected to receive the patient notification of non-covered items, services, and drugs on admission. At the time of survey nearly 2 weeks post start of care there was no documentation that the notification had been supplied to the patient/family. In RRNHV#7 the patient elected notification of non-covered items yet there was no documentation that the document was presented within the 5 days after start of care. Similar lack of documentation of the notice delivered within 5 days of admission was noted in RRNHV#10. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to conduct and document a patient-specific comprehensive assessment and reassessment that identified the patient's need for hospice care and services. For example: on review of RRNHV#9 the documentation noted wounds to the ankle and sacrum however there was not consistent wound assessment to include all elements as required by the organization documented in the patient record. This observation was reviewed with the Director of Nursing.

Observed in Record Review. In 7 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRNHV#5 there was documentation that the patient was a high fall risk with multiple past falls yet fall safety was not reflected in the plan of care. In review of RRHV#3, RRNHV#6, RRNHV#7, RRNHV#8 the patient was being seen by the Medical Social Worker yet there were no psychosocial care plans to guide the care. In RRNHV#6 the patient was admitted with protein calorie malnutrition with nutrition being a focus of the care yet there was no nutrition care plan open. In RRNHV#9 there was documentation of an ankle, and sacral wound but no care plan to address skin integrity. In RRHV#2 the documentation and discussion in the home observation revealed many psychosocial issues surrounding family conflict yet there was no psychosocial care plan to guide the care. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to ensure the plan of care include all drugs and treatments needed for the palliation and management of the terminal illness and related conditions. On review of RRNHV#9 there was documentation of a stage3 sacral wound that required treatment yet there was no physicians order noted on the plan of care for the wound. In RRHV#3 there was documentation of a skin tear to the left calf with wound treatment yet no physicians order for treatment noted as part of the plan of care. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. In review of RRNHV#5 the hospice aide was ordered per the plan of care 2 times a week, yet there were no visits documented provided the week following admission. In RRNHV#6 and RRNHV#8 the plan of care ordered the chaplain monthly yet per documentation the chaplain was available to the patient as needed and monthly visits were not being made. In RRNHV#9 the chaplain was ordered monthly but there was no visits documented in July or August. These observations were reviewed with the Director of Nursing.

Observed in Data Session. The organization failed to document what performance improvement projects were being conducted the reasons for conducting the projects and measurable progress achieved on the project, as this documentation was unavailable at the time of survey. This observation was reviewed with the Director of Nursing Designee who was name as QAPI coordinator.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to ensure the written patient care instructions for a hospice aide was prepared by the registered nurse. In review of RRNHV#5 the hospice aide was scheduled to provide care 2 times a week yet at the time of survey there was no aide assignment/plan of care noted in the record. This observation was reviewed with the Director of Nursing.

Observed in Patient Home. In 1 of 10 patient records reviewed, the organization failed to ensure the patient record contain information that reflects the patient's care, treatment, and services. For example: on review of RRHV#1 during the home observation of the medication reconciliation it was noted the medications metoprolol, Eliquis, and Ocuvite supplement were being given to the patient as part of the facility medication profile yet were not part of the hospice medication profile. In discussion with the Director of Nursing the medications had been discontinued months prior on the hospice profile. This observation was reviewed with the Director of Nursing.

Observed in Record Review. In 1 of 2 patient records reviewed, for live discharge, the organization failed to ensure the discharge summary include all required elements. In review of RRDC#2 the patient revoked hospice services yet the discharge summary only noted that the patient/family revoked seeking aggressive treatment yet did not include a summary of the patient’s stay, including treatments, symptoms, and pain management - The patient’s current plan of care - The patient’s latest physician orders - Any other documentation that will assist in post discharge continuity of care or that is requested by the attending physician or receiving provider as required. This observation was reviewed with the Director of Nursing.

Observed in Competency Session. In 1 of 4 contracts reviewed, The organization failed to ensure the written agreement with an outside agency providing contracted services provide a stipulation that the outside agency will complete criminal background checks on contracted employees that provide patient care or have access to patient records. In review of the contract for pharmacy there was no stipulation for background checks as required. This observation was reviewed with the Marketer who oversees HR.

Observed in Record Review. In 1 of 5 patient records reviewed, the agency failed to assess duplicate medications. In RR#2 acetaminophen was ordered every 6 hours routine and hydrocodone with acetaminophen ordered every 6 hours as needed for pain. There was no documentation of screening for or instructing the patient/family on management of duplicate acetaminophen orders or of notification to the physician.

Observed in Record Review. In 5 of 5 patient records reviewed, the patient record did not include a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs. In HV#1 the presence of a ureterostomy was not addressed in the POC. In HV#2 the presence of port a cath and orders for routine flushing were not included in the plan of care. In HV#3 the patient was assessed to be a fall risk but the prevention of falls was not addressed on the plan of care. In addition there is no visit frequency documented and ordered for social work and spiritual care in all five charts reviewed. This was validated with the quality coordinator.

Observed in Record Review. In 5 of 5 patient records reviewed, the agency failed to document a spiritual assessment that included concerns or needs identified by the patient or family, such as despair, suffering, guilt, and forgiveness. In all five records reviewed the spiritual care assessment documented the patient/family connection to faith and church but the assessment section of the evaluation was left blank. There was no assessment of despair/depression, suffering, guilt or forgiveness even if other disciplines had noted issues such as depression or fear of dying. This was validated with the quality coordinator.

Observed in Record Review. In 4 of 4 patient records reviewed, there was no documentation of education on the use of oxygen specific to the findings of an oxygen safety assessment. In HV#1, HV#3, RR#1 and RR#2 there was no documented oxygen safety assessment. Since there was no documentation of assessed risks there was no opportunity to educate on the risks identified. This was validated with the quality coordinator.

Observed in Record Review. In 2 of 3 contracts reviewed, the contract did not stipulate that the contractor would obtain criminal background checks on all employees who have direct patient contact or access to patient records. This stipulation was missing in Contract#1 for a DME and Contract #3 for a pharmacy. This was validated with the quality coordinator.