Every finding on record at Envoy Hospice Care Inc

Upon patient record review, 1 of 14 (Patient #3) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 3: SN frequency on Plan of Care indicates a routinely scheduled frequency "and PRN" with no evidence of limits, parameters, or indications for PRN visits.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 1: Initial aide instructions completed upon admission (9/9/23) indicate patient is ambulatory with use of a walker. SN visit note dated 12/06/23 indicates patient is bedbound. There was no evidence of hospice aide instructions update at that time. 1/26/24: SN indicated patient is ambulatory with use of walker in visit documentation with no evidence of update to hospice aide instructions. SN documentation 3/7/24 and 3/14/24 indicates PPS score of 30 (Totally bed bound) and a FAST score of 7D (Cannot sit without assistance) documentation further reveals ambulatory with use of walker selected in the mobility section of visit note and a free text note stating, "Patient needs extensive assist with transfer needs due to generalized weakness. OOB, up in WC daily as tolerated". No evidence of update to aide instructions noted.

Upon patient client record review, 3 of 14 (Patient #1, 8, & 9) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1: Initial aide instructions completed upon admission (9/9/23) indicate patient is ambulatory with use of a walker. SN visit note dated 12/06/23 indicates patient is bedbound. There was no evidence of hospice aide instructions update at that time. 1/26/24: SN indicated patient is ambulatory with use of walker in visit documentation with no evidence of update to hospice aide instructions. SN documentation 3/7/24 and 3/14/24 indicates PPS score of 30 (Totally bed bound) and a FAST score of 7D (Cannot sit without assistance) documentation further reveals ambulatory with use of walker selected in the mobility section of visit note and a free text note stating, "Patient needs extensive assist with transfer needs due to generalized weakness. OOB, up in WC daily as tolerated". No evidence of update to aide instructions noted. Documentation is unclear as to true mobility state of patient and subsequent safety needs. Patients 8 & 9: Documentation in discharge summary related to patient death states, "discharge from Reliable Hospice Services due to death". this agency is Envoy Hospice. Verified with agency there has not been a name change at any point.