Every finding on record at Hc Health Care, LLC

It is required that each patient’s individualized written plan of care a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. This standard was not met as evidenced by clinical record review and interview. 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the plan of care included the scope and frequency of services necessary to meet the patient's specific needs. Clinical Record 2: The patient elected hospice care on 10/28/22. The plan of care (POC) dated 6/25/2023 through 8/23/23 ordered Skilled Nursing (SN), Medical Social Worker (SW), and Chaplain (CH) services. The POC did not include the frequency and duration of SN, SW, and CH visits. During an interview on 7/26/2023, the Director of Clinical Services stated, "I don't know how that happened...The software should not allow it, but it is not there." 1 of 19 (5%) of records reviewed revealed that the agency did not ensure that the plan of care included a detailed statement of the scope and frequency of services necessary to meet the patient specific needs.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. 2 of 2 (100%) clinical records reviewed of patients transferred to the hospital, the agency did not ensure that the hospital received a copy of the hospice discharge summary. Clinical Record 6: The patient elected hospice care on 6/22/23. The patient was discharged from hospice on 6/28/2023 after the family called 911 and requested that the patient be admitted to the hospital. A clinical record review revealed no evidence that the hospice discharge summary was forwarded to the receiving facility, the hospital. Clinical Record 7: The patient elected hospice care on 5/6/23. The patient was admitted to the hospital and discharged from hospice on 6/14/2023. A clinical record review revealed no evidence that the hospice discharge summary was forwarded to the receiving facility, the hospital. During an interview on 7/24/2023, the Director of Clinical Services stated, "We gave them verbal report but we never give them a written summary." 2 of 2 (100%) of records reviewed with a discharge to the hospital the agency did not ensure that the receiving facility received a copy of the hospice discharge summary.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. 2 of 2 (100%) clinical records reviewed of patients that revoked the election of hospice care; the agency did not ensure the discharge summary was forwarded to the primary physician. Clinical Record 6: The patient elected hospice care on 6/22/23. The patient was discharged from hospice on 6/28/2023 after the family called 911 and requested that the patient be admitted to the hospital. A clinical record review revealed no evidence that a discharge summary was forwarded to the physician. Clinical Record 7: The patient elected hospice care on 5/6/23. The patient was admitted to the hospital and discharged from hospice on 6/14/2023. A clinical record review revealed no evidence that a discharge summary was forwarded to the physician. During an interview on 7/24/2023, the Director of Clinical Services stated we would have given a verbal report but not in writing. 2 of 2 (100%) of clinical records reviewed with revocations revealed that the agency did not ensure that a discharge summary was forwarded to the primary physician.

It is required that when controlled medications are first ordered, a copy of the hospice’s written policies and procedures for the management and disposal of controlled medications is provided to the patient or family or patient’s legal representative(s). Ensures that the safe use and disposal of controlled drugs is understood. This standard was not met as evidenced by document review and interview. Agency policy (dated 5/10/2021) stated in part, "Procedure: Drug Disposal. Hospice Nurses provide instruction to the family regarding disposal options for patient -controlled medications that are no longer needed by the home care patient. Hospice nurses are responsible to perform the destruction of the medication...When it is determined that the medication is no longer used by the patient, or at death of the patient... Put pills, capsules, tablets, and liquid medication in a quart size zipper baggie with undesirable substance for destruction...The hospice nurse will sign the Medication Disposal Record as the individual performing the disposal and request that the family sign as a witness...The hospice nurse will add enough water to cause the substance to clump together and then seal and place in patient's home trash for disposal." 2 of 3 (66%) clinical records reviewed of patients with a death at home, the agency did not ensure that the agency drug disposal policy was followed. Clinical Record 8: The patient expired at home on 2/6/2023. The Registered Nurse (RN) documented in the electronic medical record on 2/6/2023, "Medications... 2 meds disposed of...Indicate the... 1st medication disposed...See Form...Indicate the method of disposal of 1st medication...Flushed down the toilet...Indicate the method for the 2nd medication disposed...Flushed down the toilet." The RN did not follow the policy for the disposal of the medications, which included morphine. During an interview on 7/24/2023, the Director of Clinical Services stated, "Oh, she knows better! We never should flush meds. I think she clicked the wrong thing twice." Clinical Record 10: The patient expired at home on 3/20/23. A clinical record review revealed that four (4) medications, including morphine, were disposed of in kitty litter. There was no evidence that the agency form "Medication Disposal Record" was completed per agency policy. There was no documented evidence of a witness to the drug disposal. The RN did not follow agency policy for the disposal of the medications. During an interview, the Director of Clinical Services stated, "We have looked everywhere. It just doesn't exist." 2 of 3 (66%) of records reviewed with a death at home revealed that the agency did not ensure that the agency drug disposal policy was followed.

It is required that the hospice obtains a criminal background check on all hospice employees who have direct patient contact or access to patient records. Hospice contracts require that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. This standard was not met as evidenced by document review and interview. The agency did not ensure that the Medical Director contract included language requiring that contracted employees with direct patient contact or access to patient records obtain a criminal background check. Personnel Record 10/Contract 1: The Medical Director contract was effective October 1, 2016. A personnel record review revealed no evidence of a criminal background check completed at the time of hire. During an interview on 7/27/2023, the Director of Clinical Services confirmed that the Medical Director contract did not include language related to criminal background checks. The agency did not ensure that the Medical Director contract included language requiring the contracted Medical Director to obtain a background check.