Every finding on record at Family First Hospice, Inc.

Observed in Record Review. In 2 of 5 patient records reviewed, the organization failed to maintain a complete and accurate patient record. During record review for HOSRRHV#1 and HOSRRHV#3, the Hospice Nurse Surveyor observed some discrepancies in the patient record. For example in both records, the nurse documentation at SOC did not mention the patient had previously been on hospice and there were no notations in IDG that the patient had previously been on hospice. The EMR generated a hospice recertification at 60 days, which was completed. There was still no mention that the patient was now in the 3rd benefit period. Also noted on both patients, the certification of terminal illness at SOC from current episodes stated I have reviewed the clinical information prior to recertification and pt is still considered terminally ill but both patients were being brought back onto hospice after revoking several years earlier. This was discussed and reviewed with the Admin/ DPCS.

Observed in Record Review. In 3 of 3 patient records reviewed, the organization failed to plan the patient's care. During record review for HOSRRHV#1, HOSRRHV#2, and HOSRRHV#3, the Hospice Nurse Surveyor observed the patients plan of care and documentation did not contain progress towards goals. For example in HOSRRHV#1, the patient had a goal of In 2 weeks and while in hospice care, patient will have no unusual bleeding or bruising from anticoagulant therapy. This goal was placed at SOC 4 months prior to survey and there was no documentation of progression of the goal. In HOSRRHV#2, the patient had a goal of in 2 weeks and while on hospice care, the patient/PCG/ Family will be able to cope with the disease/ dying process in anticipation of grief. This goal was placed at SOC 4 months prior to survey and not updated and there was no progress towards the goal. In HOSRRHV#3, the patient had a goal of in 2 weeks and while on hospice care, patient will have skin comfort with no exacerbation as evidenced by relieved dry skin r/t eczema. This was placed on all previous episodes and there was no progress towards this goal documented. This was discussed and reviewed with the Administrator/ DPCS.

Observed in Tracer Activities. During the Volunteer Program session with the Volunteer Coordinator, the organization did not show evidence its volunteer program had provided day-to-day administrative or direct patient care in an amount that equaled 5% of the total patient care hours of all paid hospice employees and contract staff. The organization had an overall percentage of 2.9%. This was discussed and verified with the Administrator/ DPCS.

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to reassess its patient's. During record review for HOSRRHV#3, the Hospice Nurse Surveyor observed the patient began a new benefit period the same day as survey began but he did not have a certification of terminal illness in place for that benefit period. This was discussed and reviewed with the Administrator/ DPCS.

Observed in Record Review. In 1 of 2 patient records reviewed, where the patient was discharged for extended prognosis, the organization failed to ensure documentation that the patient received the Medicare Notice of Non-Coverage at lease two days prior to the discharge from hospice as required. Upon review of RR#11 it was noted that the Medicare Notice of Non-Coverage was signed by the patient only one day prior to patient discharge. This observation was reviewed with the Administrator/DPCS, COO/Care Coordinator, and LVN.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization did not ensure that scope and frequency of services necessary to meet the specific patient and family needs was met. For example: on review of RR#10 the RN frequency was ordered for every other week however there was no RN visit documented from week 11 to week 14. This observation was reviewed with the Administrator/DPCS, COO/Care Coordinator, and LVN.

Observed in Record Review. In 4 of 11 patient records reviewed, the organization failed to ensure that the plan of care included all services necessary for the palliation and management of the terminal illness as related to instructions for the drugs and treatments necessary to meet the needs of patient. For example: On review of RR#3 it was noted that the patient's medication profile included the medication for pain of Tylenol, morphine, tramadol, and Norco. The Tylenol and morphine included indication/instructions for when to use, however for the tramadol and Norco there was no indication beyond as needed for pain to guide the patient as to which pain medication to use related to the type or severity of pain experienced. In RR#4 the patient had Docusate and Milk of Magnesia on the medication profile for constipation. Both medications were ordered as needed yet there was no indication to guide the patient when to take which medication for constipation. Further, the med profile had Fleets enema with an indication to use if Dulcolax was ineffective, yet there was no Dulcolax on the med profile. In RR#7 the patient had orders for Morphine and Oxycodone as needed for pain but no indication as to when to take which medication. Similar findings were noted in RR#11 where the patient was ordered the pain medications Tramadol, Norco, Morphine, and Tylenol. There was no specific instructions to guide the patient as to when to take the Tramadol as opposed to the other pain medications. These observations were reviewed with the Administrator/DPCS, COO/Care Coordinator, and LVN.

Observed in Record Review. In 7 of 11 patient records reviewed, the organization failed to ensure that the plan of care revisions were based on information from the patient's comprehensive assessment and address the patient's progress toward goals and outcomes. For example: On review of the care plans from HV#1 it was noted that many of the goals contained time parameters such as in 2 weeks patient will verbalize comfort as evidenced by absence/decreased dizziness, pain, or tightness of chest, general body weakness and fatigue with physical activity or at rest with non-pharmacological interventions and in 2 weeks HR will be with his range at 60-100 BPM. However, these goals remained unchanged or unresolved from the time they were established to the time of survey showing no progress toward goals or outcomes. In review of RR#8 the goal established noted in 3-5 days patient will have decreased episodes of dyspnea at rest or on exertion with continuous O2 therapy or repositioning and In 3-5 days patient will have decrease/absence of abnormal lung sounds. The care plans showed no progress toward goals or outcomes as the goals remained the same throughout the patients stay on hospice spanning 4 weeks. Similar findings of lack of documenting progress toward established goals can be seen in HV#2, RR#4, RR#7, RR#10, and RR#11. These observations were reviewed with the Administrator/DPCS, COO/Care Coordinator, and LVN.