Every finding on record at Harvard Group for Hospice & Palliative Care, 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, document review, interview and observation. In 4 of 5 (80%) clinical records reviewed, it was revealed that the hospice did not ensure that issues identified in the initial and updated assessments were included in the patients' planned interventions in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 1/26/2023. In the comprehensive assessment note dated 1/26/2023, the nurse stated under topics discussed that the caregiver and patient were educated that if there were no Do Not Resuscitate (DNR) order/signed form for the patient, 911 would need to be called if there was an emergency or change of condition. The initial Plan of Care dated 1/26/2023, documented that the Social Worker would need to assist with advance directives. The Interdisciplinary Group (IDG) updates dated: 1/26/2023 – 2/2/2023, 2/3/2023- 2/16/2023, 2/17/2023 - 3/2/2023, and 3/3/2023 - 3/17/2023 documented “Of note the DNR is not signed yet and there is some fear that the caregiver displays regarding to signing". The patient's plan of care, effective 1/26/2023 to the time of the site visit, did not include any interventions to address the ongoing discussion about advance directives. Clinical Record 2: The patient elected the hospice benefit on 1/20/2023. In the comprehensive assessment note dated 1/20/2023, the nurse stated under topics discussed that the caregiver and patient were educated that if there was no DNR, that 911 would need to be called if there was an emergency or change of condition. In the initial Plan of Care dated 1/20/2023, it was noted that the Social Worker would need to assist with advance directives. Interdisciplinary Group (IDG) updates: 1/26/2023 – 2/2/2023, 2/3/2023- 2/16/2023, 2/17/2023 - 3/2/2023, and 3/3/2023 - 3/17/2023, documented, “Of note the DNR is not signed yet and there is some fear that the caregiver displays regarding to signing.” The patient's plan of care, effective 1/20/2023 to the time of the site visit, did not include any interventions to address the ongoing discussion about advance directives. Clinical Record 3: The patient elected the hospice benefit on 3/2/2023. In the comprehensive assessment dated 3/2/2023, the nurse stated under topics discussed that the caregiver and patient were educated that if there was no DNR, that 911 would need to be called if there was an emergency or change of condition. The initial Plan of Care dated 3/2/2023, noted that the Social Worker would need to assist with advance directives. The Interdisciplinary Group (IDG) update 3/3/2023 - 3/17/2023, included a narrative stateing: “Of note the DNR is not signed yet and there is some fear that the caregiver displays regarding to signing.” The patient's plan of care, effective 3/2/2023 to the time of the site visit, did not include any interventions to address the ongoing discussion about advance directives. Clinical Record 4: The patient elected the hospice benefit on 3/7/2023. In the comprehensive assessment dated 3/7/2023, the nurse documented that the primary language for the patient was Spanish. During the home visit on 3/29/2023 with staff (#5), the patient was home with the patient's youngest daughter. It was observed that no one in the home at that time spoke English. In the patient's plan of care effective 3/7/2023 to the time of the site visit, there was no intervention to address the need for a Spanish-language interpreter to assist with appropriate communication with the patient and family. Document 1: The agency's policy "Plan of Care," dated 1/31/2015, reads in part, "The written plan of care will include the following: problems identified; interventions to assist with end-of-life care; the interdisciplinary group's documentation of the patient's or representative's ability to learn and understand teaching...". Additionally, the policy states the interdisciplinary group's documentation will include the patient's or representative's, "...level of understanding, involvement, and agreement with the plan of care ...education and training ....". Interview: In an interview with the Director of Nursing (DON) on 3/30/2023, it was confirmed that there were no interventions in the patients' plans of care to address the patients' full-code status or the need for a translator with the Spanish-speaking patient and family.