Every finding on record at First Choice Hospice Care, Inc.

Upon patient record review, 13 of 14 (Patients # 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients # 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14: The patient's initial comprehensive assessment did not contain evidence of the evaluation of the imminence of death.

Upon patient record review, 1 of 14 (Patient # 2) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient # 2: Patient's medication list/plan of care listed, a) Benadryl Allergy 25 mg, (1) tab oral, twice a day as needed for allergies/pruritis and, b) Triamcinolone Acetate 0.025% topical cream, 1 gram topical, as needed every four hours for rash. Upon review of the patient's medications in the home the patient did not have these medications available for use. The home assistant stated the patient was out of both medications.

Upon patient record review, 8 of 14 (Patients # 1, 2, 3, 6, 7, 9, 11, 12) 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. Patients # 1, 2, 3: The current plan of care contained order for 3 PRN nursing visits without a scope. Patient # 6: The current plan of care contained orders for spiritual care upon request and MSW as needed without a frequency or scope. Patient # 7: The current plan of care contained orders for 1 PRN nursing visit without a scope and chaplain as needed without a frequency or scope. Patient # 9, 11: The current plan of care contained orders for chaplain as needed without a frequency or scope. Patient # 12: The current plan of care contained orders for 3 PRN nursing and MSW visits without a scope.

Upon patient record review, 3 of 14 (Patients # 1, 2, 3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient # 1: Patient's plan of care did not contain supplies. Upon home visit, it was noted that patient was using gloves, chux and adult briefs. Patient plan of care listed the patient's oxygen concentrator, although did not list the wheelchair, hospital bed or hoyer lift the patient and caregivers are currently using for his care. Patient # 2: Patient's plan of care did not contain supplies. Upon home visit, it was noted that patient was using gloves, chux and adult briefs. Patient # 3: Upon home visit, it was noted that patient was using gloves, chux and adult briefs, and heel protectors. These items were not listed on the patient's plan of care.

Upon observation and home visit, 1 of 3 (Patient #3) there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient # 3: While preparing to leave the patient's room the nurse removed equipment bag from barrier covering the surface of a table, and set the bag on a chair without a barrier.

Upon personnel record review, 1 of 12 (Personnel # 9) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel # 9: Employee's file did not contain evidence of competencies for, a) communication skills including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff, and b) shampoo, sink, tub, and bed.

Upon patient record review, 13 of 14 (Patients # 1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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: The current hospice aide plan of care contain orders for, a) turn and reposition and, b) record bowel movements. The tasks did not contain a frequency. Patients # 2, 3, 4, 7, 8, 9, 11, 12, 14: The current hospice aide plan of care contain orders for, a) turn and reposition and, b) change linens. The tasks did not contain a frequency. Patients # 6, 10: The hospice aide plan of care contains orders to change bed linens. The task did not contain a frequency. Patient # 13: The hospice aide plan of care contains order to empty urine collection bag and change linens. The tasks did not have a frequency.

Upon patient record review 3 of 14 (Patients # 4, 9, 12) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient # 4: Patient record did not contain evidence of an RN supervisory for the hospice aide occurring between 7/16/23 and 8/11/23. The aide frequency was two times per week. Patient # 9: Patient record did not contain evidence of an RN supervisory for the hospice aide occurring between 4/18/23 and 5/11/23. The aide frequency was two times per week. Patient # 12: Patient record did not contain evidence of an RN supervisory for the hospice aide occurring between 2/9/23 and 5/9/23. The aide frequency was two times per week.

Observed in Record Review. In 2 of 5 patient records reviewed, the Surveyor noted the patient Plan of Care (POC) had not addressed patient specific needs related to diagnosis and/or identified problems. For example, in HV #2 the patient had a terminal diagnosis of End Stage Cardiovascular Disease (CAD); however, the POC had no interventions or goals related to CAD. In RR #5, the patient had dysphagia and been identified as a high aspiration risk; however, there had been not interventions on the POC to address the issues associated with dysphagia and aspiration. This was validated with the Nursing Supervisor.

Observed in HR File Review. In 8 of 8 HR files reviewed, the initial competency for employees had not been accurately validated. The initial competency form for employee files HR #1, HR #2, HR #3, HR #4, HR #5, HR #6, HR #7 AND HR #8 had been reviewed and the documents had one date and initials, and then a line down the entire page. It had also been difficult to ascertain the method (Verbal, Observed, or Demonstrated) utilized to evaluate the competency. This was validated with the Clinical Supervisor during the HR file review.

Observed in Record Review. In 1 of 5 patient records reviewed, the Surveyor noted in RR #5, the clinical intervention summary documentation for 2 consecutive nursing visits had been duplicate.

Observed in Record Review. In 5 of 5 patient records reviewed, the Surveyor noted a time had been hand written in on multiple patient documents after they had been completed, each with the same time of '17:00'. This was evident in HV #1, HV #2, HV #3, RR #4 and RR #5 on the patient on the Certificate of Terminal Illness, the Election of Hospice Benefits, and faxed (to MD) medication profile that required a signature. The documents had been faxed to the organization, signed and dated by the Medical Director; however, there was a hand written time of 17:00 added to each one. The same time had also been added to other documents in the patient record including the Interdisciplinary Group Meetings. When discussed with the organization, they could not speak to why this was done. They validated that it had been done by the Director of Patient Care Services who was not present during the survey. The Agency was educated on this finding including the rules against altering an MD signed and dated document. The Agency was also educated regarding the timing of MD orders is not a requirement for Hospice at this time. This finding was validated with the CEO and Nursing Supervisor.