Every finding on record at Green River Hospice

Upon observation, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient's Rights and Responsibilities in a language and manner that the patient understands. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence of the appropriate documentation for release of confidential information. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient record review 1 of 14 (Patient # 10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #10: Patient was admitted on 05/02/23, the initial comprehensive psychosocial assessment was completed on 05/23/23.

Upon patient record review 1 of 14 (Patient #11) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #11: Patient was admitted 06/04/23, spiritual care services were declined, but the patient did not receive a spiritual care assessment by the RN or MSW within 5 days or by date of discharge.

Upon patient record review, 3 of 14 (Patient # 2, 5, 9) 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 #2:During the initial comprehensive assessment on 08/31/22, it was identified that the patient is incontinent of bowel and bladder. Incontinent supplies are not listed in the plan of care. Corrected on site. Patient #5:During the initial comprehensive assessment on 07/17/23, it was identified that the patient utilizes a walker for ambulation, this is not included in the plan of care. Corrected on site. Patient #9.During the initial comprehensive assessment on 07/17/23, it was identified that the patient was incontinent of bowel and bladder. Incontinent supplies are not listed in the plan of care. Corrected on site.

Upon patient record review, 2 of 14 (Patient # 5, 6) 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 #5:The hospice aide task assignment initiated on 10/26/23 does not specify the frequency for performing shower, hair care, and nail care. Corrected on site. Patient #6:The hospice aide task assignment initiated on 03/17/23 does not specify the frequency for performing shower, hair care, shaving, and nail care. The record indicates the patient was on Eliquis 2.5mg every 12 hours. There was no evidence that the hospice aide task assignment included bleeding precautions. Corrected on site.

Upon patient record review 2 of 14 (Patient #3,9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient # 3: Hospice aide visits are ordered for 3 times per week, last documented visit in the medical record is 10/31/23. Patient#9: The record indicates the hospice aide started care on 08/07/23. The MD order was not obtain until 09/04/23.

Upon patient record review 1 of 14 (Patient # 6) 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#6: The patient receives hospice aide services, there are no supervisory visits in the record between 10/09/23 and 10/30/23.

Upon patient client record review, 1 of 14 (Patient #8) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon patient client record review, 1 of 14 (Patient #8) did not have evidence that each patient record contains Advance Directives. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.

Upon client record review, 1 of 14 (Patient #8) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient # 8: Patient admitted on 08/13/22 with a comorbidity of vascular dementia and senile degeneration of the brain with noted evidence of confusion and behavior disturbances. Patient signed her election of benefit, consent for service and POLST.