Every finding on record at Fv Hospice by Friendship Village LLC

It is required that each patient’s individualized written plan of care 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 3 of 14 (21%) clinical records reviewed revealed that the agency did not ensure that all problems identified in the initial and updated comprehensive assessments had planned interventions in the plan of care. Clinical Record 1: The election of hospice benefits was 01/24/2024. The initial nursing assessment was dated 01/24/2024. The initial nursing assessment read in part "The patient has a history of falls and a rib fracture.". The plan of care dated 01/24/2024-04/22/2024 lacked interventions and goals related to the patient being a fall risk. Clinical Record 2: The election of hospice benefits was 03/05/2024. The initial nursing assessment was dated 03/05/2024. The initial nursing assessment read in part "The patient is a fall risk.". The plan of care dated 03/05/2024-06/03/2024 lacked interventions and goals related to the patient being a fall risk. Clinical Record 8: The election of hospice benefits was 03/18/2024. The initial nursing assessment was dated 03/18/2024. The initial nursing assessment read in part "The patient has a history of falls.". The plan of care dated 03/18/2024-06/16/2024 lacked interventions and goals related to the patient being a fall risk. In an interview on 04/03/2024, the Director of Clinical Services reviewed the records and stated, "There are no interventions listed for fall risk on these patients but there should be.".

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 an 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 1 of 13 (8%) clinical records with aide services ordered reviewed revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 9: The record revealed an initial nursing assessment dated 03/12/2024. The initial nursing assessment read in part "The patient has dysphagia and is on a pureed diet with honey thick liquids.". The aide care plan dated 03/12/2024 read in part "Feed regular diet with pureed consistency and honey thick liquids.". The aide care plan lacked instructions related to aspiration precautions. In an interview on 04/03/2024, the Director of Clinical Services reviewed the record and stated, "There are no aspiration precautions listed but since the patient has dysphagia there should be.".

It is required that when controlled medications are first ordered, a copy of the hospice’s written policies and procedures for the management and disposal of controlled medications is provided to the patient or family or patient’s legal representative(s). This standard was not met as evidenced by clinical record review, document review, and interview. In 1 of 5 (20%) deceased clinical records reviewed revealed that the agency did not ensure that disposal of controlled medications was documented. Agency Policy-"Hospice Medication Disposal Policy" reads in part "Controlled drugs, no longer needed by the patient, are disposed of in compliance with state and federal regulations, and disposal instructions and activities are documented. Long-Term Care/Hospital Setting: When the patient resides in long-term care, or in the in-patient hospital setting, hospice staff will follow the policies of the facility. The Medication Disposal form will be completed and placed into patient's clinical record.". Clinical Record 12: The election of hospice benefits was 02/16/2024. The medication profile dated 02/16/2024 read in part "Morphine 20mg/ml, give 0.25ml every 4 hours as needed for pain or dyspnea. Lorazepam 2mg/ml, give 0.25ml every 4 hours as needed for anxiety.". The record revealed a nursing death visit dated 02/20/2024. The record lacked documentation of the disposal of the morphine and lorazepam. In an interview on 04/03/2024, the Director of Clinical Services reviewed the record and stated, "There is no documentation of drug disposal, but the facility nurses typically dispose of the medications when a patient passes away.".