Every finding on record at Essential Hospice and Palliative Services, L.L.C.

It is required that each patient’s individualized written plan of care, includes all services necessary for the palliation and management of the terminal illness, including 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 11 of 19 (58%) clinical records reviewed, the agency did not ensure the individualized plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 2: The patient elected the hospice benefit on 09/11/2023 with a terminal diagnosis of Alzheimer's disease. The initial plan of care dated 09/11/2023 included the problem of "Altered Nutrition" with an associated goal that stated, "Patient will have acceptable level of appetite." The goal on the plan of care was not measurable when it did not include what an acceptable level of appetite would be for the patient. Clinical Record 3: The patient elected the hospice benefit on 06/08/2023 with a terminal diagnosis of corticobasal degeneration. The initial plan of care dated 06/08/2023 included the problem of "Safety Deficit" with an associated goal that stated, Patient will be safe in the home environment. The goal on the plan of care was not measurable when it did not describe what would allow the patient to remain safe in the home environment. Clinical Record 4: The patient elected the hospice benefit on 07/28/2023 with a terminal diagnosis of senile degeneration of the brain. The initial plan of care dated 07/28/2023 included the problem of "Safety Deficit" with an associated goal that stated, Patient will be safe in the home environment. The goal on the plan of care was not measurable when it did not describe what would allow the patient to remain safe in the home environment. Clinical Record 5: The patient elected the hospice benefit on 11/06/2023 with a terminal diagnosis of chronic obstructive pulmonary disease. The initial plan of care dated 11/06/2023 included the problem of "Altered Respiratoty Status" with an associated goal that stated, "Pt [patient] will report an improvement in cough." The goal on the plan of care was not measurable when it did not describe what would be an improvement in the patient cough. Clinical Record 7: The patient elected the hospice benefit on 06/13/2023 with a terminal diagnosis of chronic congestive heart failure. The initial plan of care dated 06/13/2023 included the problem of "Alteration in Cardiovascular Blood Coagulation" with an associated goal that stated, "Pt will have adequate circulation." The goal on the plan of care was not measurable when it did not describe what adequate circulation would be for the patient. Clinical Record 8: The patient elected the hospice benefit on 06/22/2023 with a terminal diagnosis of Parkinson’s disease. The initial plan of care dated 06/22/2023 included the problem of “Alteration Elimination” with an associated goal that stated, "Pt will be free from UTIs [urinary tract infections]." The goal on the plan of care was not measurable when it did not describe how to determine the patient was free from UTIs. Clinical Record 9: The patient elected the hospice benefit on 11/13/2023 with a terminal diagnosis of heart failure. The initial plan of care dated 11/13/2023 included the problem of "Altered Respiratoty Status" with an associated goal that stated, "Pt will report acceptable breathing." The goal on the plan of care was not measurable when it did not describe what acceptable breathing would be for the patient. Clinical Record 10: The patient elected the hospice benefit on 01/31/2023 with a terminal diagnosis of multiple myeloma. The initial plan of care dated 01/31/2023 included the problem of "Altered Respiratoty Status" with an associated goal that stated, "Pt will have less difficulties in breathing." The goal on the plan of care was not measurable when it did not describe what would be less difficulties in breathing for the patient. Clinical Record 15: The patient elected the hospice benefit on 05/03/2022 with a terminal diagnosis of senile degeneration of the brain. The initial plan of care dated 05/03/2022 included the problem of "Altered Thought Process" with an associated goal that stated, "Pt will report improvement." The goal on the plan of care was not measurable when it did not describe how to determine if the patient had improvement in thought process. Clinical Record 14: The patient elected the hospice benefit on 02/07/2024 with a terminal diagnosis of congestive heart failure. The initial plan of care dated 02/07/2024 included the problem of "Alteration in Comfort" with an associated goal that stated, "Pt will require fewer doses of breakthrough pain medication." The goal on the plan of care was not measurable when it did not describe how to measure if the patient received fewer doses of pain medication. Clinical Record 18: The patient elected the hospice benefit on 06/02/2023 with a terminal diagnosis of Alzheimer’s disease. The initial plan of care dated 06/02/2023 included the problem of "Difficulty Swallowing" with an associated goal that stated, "Pt will verbalize understanding of impaired swallowing." The goal on the plan of care was not measurable when it did not describe how or what the patient would describe for understanding of impaired swallowing. During an interview on 02/14/2024, the Alternate Director of Nursing confirmed that the goals for the problems identified during the initial assessments were not measurable. No further information was provided.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 6 of 14 (43%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Registered Nurse (RN) prepared the aide plan of care with specific care instructions for the aide. Clinical Record 2: The aide care plan dated 09/11/2023 completed by the RN assigned the aide to check the patient’s vital signs with a frequency of “as requested." The task frequency on the aide care plan was not specific when it was assigned as requested. Clinical Record 3: The aide care plan dated 06/28/2023 completed by the RN assigned the aide to check the patient’s vital signs with a frequency of “as requested." The task frequency on the aide care plan was not specific when it was assigned as requested. Clinical Record 5: The aide care plan dated 11/06/2023 completed by the RN assigned the aide the task of patient shower on Monday, Wednesday, Friday, and PRN [as needed]. The task frequency on the aide care plan was not specific when it included an as needed frequency. Clinical Record 9: The aide care plan dated 11/13/2023 completed by the RN assigned the aide the task of patient shower two times a week and PRN [as needed]. The task frequency on the aide care plan was not specific when it was assigned as needed. Clinical Record 10: The aide care plan dated 01/31/2024 completed by the RN assigned the aide the tasks of patient shower every visit and bed bath every visit. The task on the aide care plan did not provide specific instructions on when a shower should be provided or when a bed bath should be given. Clinical Record 18: The aide care plan dated 06/02/2023 completed by the RN assigned the aide the task of patient shower PRN [as needed]. The task frequency on the aide care plan was not specific when it was assigned as needed. During an interview on 02/14/2024, the Alternate Director of Nursing confirmed that tasks on the aide plan of care were not specific. No further information was provided.

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 5 of 14 (36%) clinical records reviewed with hospice aide services provided, the agency did not ensure the aide provided services as ordered in the plan of care. Clinical Record 4: The patient elected the hospice benefit on 07/28/2023 with a terminal diagnosis of senile degeneration of the brain. The aide care plan dated 07/28/2023 assigned the aide the task of “Shower the patient on Monday, Wednesday, and Friday." The aide visit note dated 08/08/2023, a Tuesday, included documentation that the aide provided a shower to the patient. The aide did not follow the aide assignment when a shower was provided on a Tuesday and the clinical record contained no documented evidence that the Registered Nurse was notified. Clinical Record 5: The patient elected the hospice benefit on 11/06/2023 with a terminal diagnosis of chronic obstructive pulmonary disease. The aide care plan dated 11/06/2023 assigned the aide the task of “Shower the patient on Monday, Wednesday, and Friday." The aide visit note dated 11/07/2023, a Tuesday, included documentation that the aide provided a shower to the patient. The aide did not follow the aide assignment when a shower was provided on a Tuesday and the clinical record contained no documented evidence that the Registered Nurse was notified. Clinical Record 10: The patient elected the hospice benefit on 01/31/2023 with a terminal diagnosis of multiple myeloma. The aide care plan dated 01/31/2023 assigned the aide the task of “shower every visit.” On the aide visit noted dated 02/02/2023 the aide documented "patient declined care.” The clinical record contained no documented evidence that the Registered Nurse was notified that the patient declined the shower. Clinical Record 11: The patient elected the hospice benefit on 02/02/2024 with a terminal diagnosis of protein calorie malnutrition. The aide care plan dated 02/02/2024 assigned the aide the task of “bed bath 3 times a week.” On the aide visit noted dated 02/02/2023 the aide documented "facility already provided care.” The clinical record contained no documented evidence that the Registered Nurse was notified that the bed bath was not provided. Clinical Record 12: The patient elected the hospice benefit on 01/13/2023 with a terminal diagnosis of malignant neoplasm lung with metastasis to the bone. The aide care plan dated 01/13/2023 assigned the aide the task of “shower every visit.” On the aide visit noted dated 01/16/2023 the aide documented "patient declined care.” The clinical record contained no documented evidence that the Registered Nurse was notified that the patient declined the shower. During an interview on 02/14/2024, the Alternate Director of Nursing confirmed the finding and stated the aide had not followed the plan of care. No further information was provided.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I; and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed of patients transferred to an acute care facility, the agency did not ensure that the discharge summary was forwarded to the receiving facility. Clinical Record 18: The patient elected the hospice benefit on 06/02/2023. The patient revoked the hospice benefit and was discharged on 01/24/2024 to seek aggressive treatment at a hospital. The clinical record contained no documented evidence that the hospice discharge summary was sent to the hospital where the patient was transferred for treatment. Clinical Record 19: The patient elected the hospice benefit on 01/09/2024. The patient revoked the hospice benefit and was discharged on 01/24/2024 to seek aggressive treatment at a hospital. The clinical record contained no documented evidence that the hospice discharge summary was sent to the hospital where the patient was transferred for treatment. During an interview on 02/14/2024, the Alternate Director of Nursing confirmed that the discharge summaries were completed but the clinical records did not include evidence that the discharge summaries were sent to the hospital where the patients was transferred for treatment.