Every finding on record at Five Star Home Hospice, Inc.

Observed in Patient Home. In 2 of 2 home visits conducted, with skilled nurses it was noted that the hospice nurse failed to conduct a medication assessment. For example, during RRHV#1 the RN asked if any changes had been made to medications, however she did not complete an assessment or reconciliation of the patient's medications. During visit RRHV#2 the LVN completed an assessment of the medications in the 'Comfort Kit' but did not assess or reconcile the patient's daily medications. This was confirmed and discussed with the Administrator who was present.

Observed in Record Review. In 1 of 2 patient records reviewed, post death it was noted that the comprehensive assessment was not updated. For example, in record RRBR#2 the last update to the comprehensive assessment was the day prior to the patient death. This was confirmed and discussed with the Administrator and DPCS present.

Observed in Record Review. In 1 of 2 patient records reviewed, for live discharge patients it was noted that the plan of care did not include all services needed. For example, in record RRDC#2 the plan of care did not include an order or indication of the patient's move out of area with a transfer to another hospice. This was confirmed and discussed with the Administrator, DPCS and Asst DPCS.

Observed in Record Review. In 4 of 13 patient records reviewed, the organization failed to assess the patient and patient's condition according to defined time frames. During record review for HV#2, RR#6, RR#7 , and RR#8 the hospice nurse surveyor observed the psychosocial assessment was not completed within the 5 days due to declining a visit from the SW but there was no documentation that the RN attempted the psychosocial assessment. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 4 of 13 patient records reviewed, the organization failed to plan the patient's care. During record review for RR#5, RR#8, RR#9 and RR#10, the hospice nurse surveyor observed the LPN visit note stated a change in condition but nothing was added to the POC for interventions related to the change in condition or pending death. This was discussed and reviewed with the Administrator.