Every finding on record at Grs Hospice Inc.

Upon observation, there was no evidence the Emergency Plan communication plan includes all of the following: • Names and contact information for the following: • Hospice employees • Entities providing services under arrangement • Patients' physicians The agency did not have employee and service provider phone numbers included in their emergency communication plan. Corrected on site.

Upon observation, there was no evidence the Emergency Plan communication plan must includes a primary and alternate means for communicating with hospice's employees and Federal, state, tribal, regional, and local emergency management agencies.

Upon patient record review 1 of 14 (Patient #5) 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 5: The medical record contained a comprehensive spiritual assessment completed 4/9/24 with a start of care 4/1/24.

Upon patient record review 1 of 14 (Patient #3) 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 3: There was no evidence of a comprehensive spiritual assessment.

Upon patient record review, 7 of 14 (Patients #2,#3,#4,#5,#6,#7,#9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 2: The medical record contained nursing documentation identifying patient having oxygen in the home. There was no evidence of oxygen included on the medication profile. Corrected on site. Patient 3: The medication profile contained Miralax oral powder with no instructions to mix with a diluent. Corrected on site. Patient 4: The medication profile contained Septra DS ordered for 7 days on 7/18/24 that was still listed as a current medication. Corrected on site. Patient 5: The medication profile contained Metamucil oral powder with no instructions to mix with a diluent. The profile also contained cipro ordered 7/11/24 for 7 days and bactrim ordered 9/11/24 for 7 days that were still listed as current medications. Corrected on site. Patient 6: The medication profile contained Septra DS ordered 10/5/24 for 10 days and cipro ordered 10/28/24 for 5 days that were still listed as current medications. Corrected on site. Patient 7: Upon medication reconciliation with the home visit, the facility medication profile did not contain acetaminophen scheduled dose before noon and had 7.5mg morphine tablet dose every 6 hours as needed instead of liquid 5mg every 4 hours as needed. Patient 9: Upon medication reconciliation with the home visit, the facility medication profile contained a lidocaine patch that was not on the hospice profile. The hospice medication profile also contained cipro ordered 10/21/24 for 7 days still listed as a current medication, corrected on site.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 6: There was no evidence of an initial bereavement assessment. Corrected on site.

Upon patient record review, 4 of 14 (Patients #1,#3,#4,#13) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 1: There was no evidence of a comprehensive physical assessment completed by an RN between 9/23/24 and 10/16/24. Patient 3: There was no evidence of a comprehensive physical assessment completed by an RN between 9/19/24 and 10/21/24. Patient 4: There was no evidence of a comprehensive physical assessment completed by an RN between 9/2/24 and 9/27/24. Patient 13: There was no evidence of a comprehensive physical assessment completed by an RN after 4/23/24. Patient was discharged 5/10/24 due to extended prognosis.

Upon patient record review, 3 of 14 (Patients #1,#2,#9) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 1: The medical record contained nursing documentation upon admission identifying patient is a high risk for falls and ordered spiritual care visits. There was no evidence of problems, goals, and interventions related to fall safety and spiritual needs. Corrected on site. Patient 2: The medical record contained nursing documentation upon admission identifying patient wounds and ordered social work and spiritual care visits. There was no evidence of problems, goals, and interventions related to skin impairment, psychosocial, and spiritual needs. Corrected on site. Patient 9: The medical record contained nursing documentation upon admission identifying patient issues with dysphagia, high risk for falls, and ordered social work and spiritual care visits. There was no evidence of problems, goals, and interventions related to dysphagia, fall safety, psychosocial, and spiritual needs. Corrected on site.

Upon patient record review, 5 of 14 (Patients #2,#3,#5,#8,#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 medications and treatments. Patient 2: The medical record contained nursing documentation identifying patient having oxygen in the home. There was no evidence of an order for oxygen rate, frequency, and delivery method. Corrected on site. Patient 3: The medical record also contained an order for Miralax oral powder with no instructions to mix with a diluent. Corrected on site. Patient 5: The medical record contained an order for Metamucil oral powder with no instructions to mix with a diluent. Corrected on site. Patient 8: The medical record contained nursing documentation 10/2/24 identifying patient's diet advanced to requiring nectar thick liquids. There was no evidence of an order for the diet modification. Corrected on site. Patient 9: The medical record contained nursing documentation 10/21/24 identifying patient's diet advanced to requiring thickened liquids. There was no evidence of an order for the diet modification. Corrected on site.

Upon patient record review, 4 of 14 (Patients #2,#4,#7,#8) 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: The medical record contained nursing documentation upon admission identifying patient use of a Hoyer lift for transfers. There was no evidence of an order for the lift included in the plan of care. Corrected on site. Patient 4: The medical record contained an order for a DuoNeb. There was no evidence of an order for a nebulizer included in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair. There was no evidence of an order for the wheelchair included in the plan of care. Corrected on site. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair, walker, and colostomy supplies. There was no evidence of orders for the DME and supplies included in the plan of care. Corrected on site.

Upon patient record review, 1 of 14 (Patient #13) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 13: There was no evidence the plan of care was updated with the plan to discharge the patient due to extended prognosis.

Upon client record review, 6 of 14 (Patients #2,#3,#4,#5,#7,#10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: The medical record contained nursing documentation 10/28/24 and 10/31/24 identifying nurse was completing wound care. There was no evidence of an order for wound care. Patient 3: The medical record contained documentation of social work visits completed monthly since admission. The current order received 8/6/24 stated patient declined social work services. Patient 4: The medical record contained an order for spiritual care visits once monthly. There was no evidence of any spiritual care visits completed since admission. Patient 5: The medical record contained an order for spiritual care visits once monthly. There was evidence of two spiritual care visits completed in July, August, and October. Patient 7: The medical record also contained an order for spiritual care visits once monthly and evidence of two scheduled visits completed in September. Patient 10: The medical record contained an order for spiritual care visits once monthly. There was no evidence of a visit completed in October.

Upon observation, there was no evidence licensed professionals participate in the hospice's QAPI program.

Upon patient record review, 2 of 14 (Patients #11,#12) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients 11, 12: There was no evidence of bereavement plans of care developed to reflect the needs of the bereaved, the services to be offered, and the frequency of service delivery.

Upon patient record review 2 of 14 (Patients #1,#4) 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 1: The medical record contained an order for aide visits twice weekly. There was no evidence of a second visit the week of 10/13/24. Patient 4: The medical record contained an order for aide visits twice weekly. There was three visits completed the weeks of 10/20/24 and 10/27/24.

Upon patient record review 4 of 14 (Patients #1,#4,#8,#10) 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 1: There was no evidence of a supervisory visit made by the RN until 10/16/24 with aide services started 10/1/24. Patient 4: There was no evidence of a supervisory visit made by the RN between 9/2/24 and 9/27/24. Patient 8: There was no evidence of a supervisory visit made by the RN between 7/30/24 and 10/1/24; and 10/1/24 to current with chart reviewed 11/5/24. Patient 10: There was no evidence of a supervisory visit made by the RN between 9/16/24 and 10/11/24; and 10/11/24 to current with chart reviewed 11/5/24.

Upon patient client record review, 1 of 14 (Patient #1) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1: The aide documentation 10/22/24, 10/24/24, 10/29/24, and 10/31/24 contained conflicting documentation with tasks for personal cares marked as completed and entry stating patient declined care.