Every finding on record at Gentle Transitions LLC

Surveyor conducted an entrance conference on 04/23/2024 at 10:02 a.m. with the Administrator, PCM and Office Manager. The agency representatives were informed the purpose of the visit was a Recertification Survey. The census was: Moody (Parent): Hospice- 39 Garland (ADS): Hospice- 5 Surveyor conducted an exit conference on 04/26/2024 at 11:35 a.m. with the Administrator, Office Manager and by telephone with the Quality Operations Specialist. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies." Abbreviations: ADS- Alternate Delivery Site RN- Registered Nurse SN- skilled nurse visit PCM- Patient Care Manager M.D.- medical doctor FM- family member IDT- Interdisciplinary Team Pt- patient --- Review of the agencys policies and procedures revealed a policy titled ";Coordination of Care, PC.110, Reviewed: 100121", which read ";The hospice will provide for and ensure the ongoing sharing of information between disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement, by the hospice or by other providers." Review of the clinical record for Patient #11 revealed a start of care date of 11/01/2023 with a terminal diagnosis of Senile Degeneration of the Brain (decreased brain function). Review of an SN visit note documented by RN- A, dated 12/07/2023 read, ";(FM) called to report pt is declining, not responding, pt has not eaten today. Upon assessment pt is lying in bed asleep, is lethargic and not talking. Pt has rhonchi (gurgling) to bilateral breath sounds, heart murmur with weak thready pulses. Pt decline with CHF (congestive heart failure) which is a decline in the efficiency of the heart". RN- A failed to notify the IDT of the patients change in condition. Review of an SN visit note documented by RN- A dated 12/12/2023 read, ";Upon assessment pt is lying in bed. Pt is disorient(ed). Pt is asleep but does become agitated when RN performs assessment. Pt heart sounds are weak, continues to have a heart murmur. RN educated on sx (symptoms) of end of life." RN- A failed to notify the IDT of the patients continuing decline. Review of a SN visit note documented by RN- A, dated 12/14/2023 read, ";Pt O2 (oxygen) sats (saturation) not detected. Pt has diminished breath sounds. Pt is mouth breathing. Pt sleeping, does not respond to sternal rub, does not arouse to painful stimulus. Upon assessment pt is lying in bed. Pt is unresponsive to verbal and physical stimulus. RN educated on sx of end of life. Pt is imminent. RN daily visit(s)." RN- A failed to notify the IDT that Patient #11s death was imminent. RN- A notified the M.D. that Patient #11 passed away on 12/15/2023. The surveyor conducted an interview on 04/24/2024 at 2:10 p.m. with the Administrator/Alternate Supervising Nurse. The clinical record for Patient #11 was reviewed. The surveyor asked what the agencys policy is regarding notification of changes in a patients condition. The Administrator stated the nurse is supposed to notify the M.D. as well as the rest of the interdisciplinary team of any changes in condition so that all members are aware, especially of the patients physical decline and imminent death. The surveyor conducted a telephone interview on 04/26/2024 at 10:50 a.m. with RN- A. The surveyor reviewed the documentation in the SN visit notes dated 12/07/2023, 12/12/2023 and 12/14/2023 with RN- A. The surveyor asked if she notified the M.D. or any interdisciplinary team members of the changes in the patients condition. RN- A indicated she did not recall the specific notes from December 2023 and stated, ";I thought I did, but if its not documented then I guess I didnt do it."