Every finding on record at Eutopia Hospice and Palliative Care, Inc.

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed revealed that the agency did not ensure the hospice Interdisciplinary Group (IDG) completed an initial comprehensive assessment within five (5) calendar days of the patient electing hospice services. Clinical Record 1: The patient elected hospice care effective 09/20/2023, and the initial nursing assessment was completed on 09/20/2023, followed by the completion of the spiritual assessment by the chaplain on 09/25/2023. Although the Medical Social Worker (MSW) documented attempts to contact the patient on 09/21/2023 and 09/25/2023, a documented psychosocial and emotional comprehensive assessment was not completed until 09/27/2023 (seven (7) days after the hospice election). The clinical record did not contain documented evidence to support that the Interdisciplinary Group completed an initial comprehensive assessment within five (5) calendar days of the patient electing hospice care or documentation to support the psychosocial and emotional aspects of the comprehensive assessment were addressed within the completed nursing and chaplain assessments. Clinical Record 2: The patient elected hospice care effective 10/20/2023, and the initial nursing assessment was completed on 10/20/2023. The Chaplain documented a completed comprehensive spiritual assessment on 10/26/2023 (six (6) days after the hospice election). Although the Medical Social Worker (MSW) documented attempts to contact the patient on 10/23/2023, 10/24/2023, and 10/25/2023 and documented a telephonic assessment on 10/25/2023, the documentation was limited to, "family and pt (patient) not responsive to assessment, SW (social worker) denied until further notice." The clinical record did not contain documented evidence to support that the Interdisciplinary Group completed an initial comprehensive assessment within five (5) calendar days of the patient electing hospice care or documentation to support the psychosocial and emotional aspects of the comprehensive assessment were addressed within the completed nursing and chaplain assessments. Clinical Record 3: The patient elected hospice care effective 12/23/2023, and the initial nursing assessment was completed on 12/23/2023. The Chaplain documented a completed comprehensive spiritual assessment on 01/05/2024 (13 days after the hospice election), and the Medical Social Worker (MSW) documented a completed psychosocial and emotional comprehensive assessment on 01/07/2024 (15 days after the hospice election). Although there was documentation to support attempts made by the chaplain on 12/24/2023 and the MSW on 12/27/2023 stating the caregiver requested visits from these disciplines after 01/01/2024, the comprehensive nursing assessment on 12/23/2023 did not contain documentation to support the psychosocial, emotional, or spiritual aspects of the comprehensive assessment were addressed. The clinical record did not contain documented evidence to support that the Interdisciplinary Group completed an initial comprehensive assessment within five (5) calendar days of the patient electing hospice care. On 03/13/2024 and 03/14/2024 joint clinical record reviews and interviews were conducted with the Administrator, Nursing Supervisor, and CEO, who confirmed that the clinical records identified did not contain evidence to support initial comprehensive assessments were completed by the IDG within five (5) calendar days of the patient's election of the hospice benefit and care. The Administrator and CEO stated they had been instructed by previous surveyors, accreditation organizations, hospice experts, and through the Centers for Medicare and Medicaid (CMS) website, that documented evidence of the attempts made by the MSW and Chaplain to schedule their initial visits replaced the required standard of completing the comprehensive assessment within five (5) calendar days of the patient electing hospice care. The leaders also argued that the patients and families had the right to refuse MSW and Chaplain services, which would also prevent the initial comprehensive assessment from being completed in the required time frame.

It is required that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the patient’s terminal illness that are addressed to promote the patient’s well-being, comfort, and dignity throughout the dying process. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 14 (14%) clinical records reviewed revealed that the agency did not ensure the comprehensive assessment identified psychosocial and emotional needs related to the patient's terminal illness to promote the patient's well-being, comfort, and dignity. Clinical Record 1/Home Visit 1: The psychosocial assessment completed by the Medical Social Worker (MSW) on 09/27/2023 documented that the patient was "asleep" at the time of the visit. Within the assessment document sections titled, "Psychosocial" and "Primary Care Giver's Evaluation," the MSW documented, "una (unable to assess) - needs investigation...," and the assessment sub-sections, "History" and "Financial and Legal Information" were not addressed. The clinical record did not contain documented evidence to support a completed initial psychosocial comprehensive assessment, identifying a history of psychosocial, emotional, financial, or legal needs that could affect the patient's well-being, comfort, and dignity or evidence to support a conversation in which the patient refused MSW services. On 03/13/2024 a home visit (Home Visit 1) and interview were conducted with the Nursing Supervisor (Personnel Record 1), who reported that the patient has a history of homelessness and substance abuse; however, this historical and relevant information was not documented in the initial nursing and spiritual comprehensive assessments. Clinical Record 2: A telephonic psychosocial assessment was completed by the Medical Social Worker (MSW) on 10/25/2023. Within the assessment document sections titled, "Psychosocial" and "Primary Care Giver's Evaluation," the MSW documented, "family and pt (patient) not responsive to assessment, SW (social worker) denied until further notice." The assessment sub-sections, "History" and "Financial and Legal Information" were not addressed. The clinical record did not contain documented evidence to support a completed initial psychosocial comprehensive assessment, identifying a history of psychosocial, emotional, financial, or legal needs that could affect the patient's well-being, comfort, and dignity, or evidence to support a conversation in which the caregiver refused MSW services. On 03/13/2024 Home Visit 3 with the hospice aide (Personnel Record 2), an interview were conducted with the caregiver, who reported feeling overwhelmed with the care required by the patient as well as personal health issues and the need for assistance in applying for Medicaid, obtaining additional help in the home, and Inpatient Respite care. The caregiver stated she was open to any services offered by the hospice. On 03/13/2024 and 03/14/2024 joint clinical record reviews and interviews were conducted with the Administrator, Nursing Supervisor, and CEO, who confirmed that the clinical records identified did not contain evidence of a completed psychosocial assessment by the MSW that addressed all aspects needed to identify possible psychosocial, emotional, financial, and legal needs that could affect the patient's well-being, comfort, and dignity. The leaders also confirmed that the psychosocial, emotional, financial, and legal aspects of the initial comprehensive assessment were not documented in the initial assessments completed by the Registered Nurse and Chaplain.

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 1 of 14 (7%) clinical record reviews revealed that the agency did not ensure the written plan of care included specific goals and interventions based on the problems identified in the comprehensive assessments. Clinical Record 1: The initial nursing assessment completed on 09/20/2023 documented a medication profile that included opioids (hydrocodone) and a laxative/stool softener (Senna Plus), and the hospice plan of care (POC) effective 09/20/2023 included an order to perform digital disimpaction if the patient was constipated. The Hospice Medical Director's Certification of Terminal Illness narrative written for the benefit period 01/18/2024 through 03/17/2024 documented a comorbid condition of chronic constipation. The POC effective 09/20/2023 was reviewed and updated every 14 days to the current date; however, the POC did not include problems, goals, and interventions related to identified bowel needs. On 03/13/2024 a joint record review and interviews were conducted with the Administrator and Supervising Nurse who confirmed that the clinical record identified the initial and updated plans of care did not include problems, goals, and interventions to address identified bowel needs, and they confirmed the patient continued to take scheduled opioids and Senna Plus as well as had a decrease in mobility affecting the patient’s bowel routines.