Every finding on record at Harbor Hospice of North Missouri LP

Observed in Record Review. In 1 of 2 patient records reviewed, for live discharge records, it was noted by the nurse surveyor that the patient/patient’s representative was not issued a correctly filled out Notice of Medicare Non-coverage (NOMNC) at least two days prior to discharge as required. For HOSRRDC#1, the signed NOMNC did not include the patient’s name, medical record number, or expected date of discharge as required. Findings were discussed with the Administrator/Volunteer Coordinator, DON, and Director of the Independence Missouri Office.

Observed in Record Review. In 10 of 10 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, “Patient will be able to eat/drink to her satisfaction,” Anxiety /agitation controlled through course of care”, and “Family/caregiver verbalize/demonstrate measures to achieve optimum comfort level.” There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Additionally, time frames for completion were set for the certification cycle and goals were not updated when the patient’s condition changed or goals were met. Finding was discussed with the Administrator/ Volunteer Coordinator, DON, and the Director of the Independence Missouri Office.

Observed in HR File Review. In 2 of 2 HR files reviewed, for Hospice Aides, it was noted by the nurse surveyor that there was no documentation to support that Hospice Aide Staff, HOSRRHR#4 and HOSRRHR#5 had been checked off on the required initial competencies at time of hire. Findings were verified with Finding was verified by the Administrator/ Volunteer Coordinator, DON, and the Administrator of the Independence Office.

Observed in Patient Home. In 3 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. For HOSRRHV#2, the patient has an order for PRN oxygen, however, the hospice aide care plan did not have any information regarding what the hospice aide was supposed to do with the oxygen during the patient’s bath should she have her oxygen on. The patient’s ambulatory status has changed, and the HHA care plan has not been updated to the change in the patient’s mobility. Additionally, there is no instruction to notify the nurse for a change in the patient’s condition. For HOSRRHV#3, as the patient’s condition has declined over the past few months, so has his mobility yet his HHA care plan has not been updated. He is now chair/wheelchair bound with mechanically assisted transfers with the assist of two, His care plan still has ambulate with assistance. Additionally, there is no instruction to notify the nurse for a change in the patient’s condition. For HOSRRNHV#1, the patient was on a ventilator with continuous oxygen, and had a feeding tube, there were no instructions on the aide care plan as to how the hospice aide should handle these devices. Additionally, the patient had developed a pressure ulcer on his ear, and the care plan was not updated to include instructions for the aide. There also were no instructions for the aide to notify the nurse for a change in condition. Findings were verified by the Administrator, DON, and the Administrator of the Independence location.

Observed in Patient Home. In 1 of 2 home visits conducted, for patients with the hospice aide, the nurse surveyor noted that care was not provided according to the hospice aide plan of care. HOSRRHV#3, the Home Health Aide Care Plan indicated that the hospice aide was to provide sit to stand assistance (with two people if necessary). During the home health aide visit, two hospice aides provided the care, and they used a “sit to stand lift” to transfer the patient from his chair to the wheelchair, and then to the shower chair. Findings were verified by the Director of Nursing who was present on the home visit.

Observed in Tracer Activities. It was noted by the nurse surveyor that volunteers did not provide at least 5% of the total patient care hours of all paid hospice employees and contract staff for 2024, 2025, and year to date 2026. Percent of volunteer hours worked were 4.08% for 2024, 1.58% for 2025, and 0.34% for 2026 year to date. Finding was verified by the Administrator/ Volunteer Coordinator, DON, and the Director of the Independence Missouri Office.

Observed in Record Review. In 1 of 2 bereavement records reviewed it was noted that the organization did not ensure all required information was gathered during the comprehensive assessment. For example, a review of medical record for BR#1, revealed that an initial bereavement risk assessment was not completed. This observation was reviewed with the Administrator.

Observed in Record Review. In 1 of 9 patient records reviewed it was noted that the organization did not ensure the plan of care included all required information. For example, a review of the medical record for RR#3, revealed the patient's primary diagnosis was Senile Degeneration of Brain, not elsewhere classified. The comprehensive assessment identified care needs related to Dementia. The plan of care did not include a goal statement to evaluate interventions implemented to address the care needs related to Dementia. This observation was reviewed with the Administrator.

Observed in Record Review. In 2 of 9 patient records reviewed, the organization did not ensure the plan of care included all required information. For example, a review of the medical record for HV#1, revealed that during the patient's 3rd benefit period a transfer to the North Missouri office was completed. There was no documented evidence that an order to transfer the patient from the Harbor Hospice Missouri office to the Harbor Hospice North Missouri office was completed. Example #2: A review of the medical record for RR#7, revealed that during the 3rd week of care, the patient experienced a change in condition related to symptoms of depression. The plan of care was not updated with interventions, and a goal statement to evaluate the effectiveness of interventions related psychosocial needs of depression. This observation was reviewed with the Administrator.