Every finding on record at Heart of Hospice, LLC - Delta

Based on staff interview, medical record document review, document review of investigation findings, and policy/procedure review the facility failed to Update the Plan of Care with care planning and medication changes; and further failed to have specific documentation of coordination of care between Skilled Nursing facility and the Hospice Care Team for one (1) of one (1) patient; Patient #1. --- An interview with the Executive Director on 09/13/2023 at 2:10 p.m., confirmed the lack of documentation in Patient #1s medical record to support the communication of specific needs/orders/changes to the plan of care to the hospice team and the Skilled Nursing Facility (SNF) on each nursing visit. An interview with Registered Nurse (RN) #1 on 09/13/2023 at 3:30 p.m., confirmed the SNF moved Patient #1 from a secure environment within the nursing facility and placed Patient #1 in a room on the floor with a roommate, unknown when this occurred. Patient #1 was placed on isolation precautions on 08/17/2023 due to exposure to COVID-19 after roommate tested positive for COVID-19. RN #1 confirmed Patient #1 no longer had one on one (1:1) sitters, as ordered by the plan of care and further confirmed when RN #1 questioned the SNF staff at the nursing desk concerning the lack of sitters for Patient #1, the SNF staff responded ";...they will be watching the patient." No documented evidence in Patient #1s medical record of SNF discontinuing 1:1 sitter, communication with the SNF staff, or with the Hospice Medical Director (MD) or the Nurse Practitioner (NP) regarding the change in care. An interview with the Medical Social Worker (MSW) on 09/13/2023 at 5:05 p.m., confirmed patient #1 never expressed suicidal ideations during any of MSW visits. MSW further confirmed sitter was present with Patient #1 until the patient was exposed to the COVID virus. An interview with the Nurse Practitioner (NP) on 09/13/2023 at 4:50 p.m., confirmed the NP gave a verbal order to RN #1 to discontinue Patient #1s scheduled Morphine and Ativan and add oxycodone, but the order failed to be recorded and signed in the Patient #1s hospice medical record. An interview with the State Agencys Long-Term Care (LTC) surveyor on 09/14/2023 at 2:05 p.m. who investigated the same complaint at the Skilled Nursing Facility, confirmed documented evidence from the SNF of 1:1 sitters in the patients room from 08/08/2023-08/17/2023, and further confirmed at the SNF Behavioral meeting on 08/17/2023 at 9:30 a.m. the SNF MSW reported an improvement in Patient #1s mood and behavior and the SNF Behavioral team determined the patient no longer needed 1:1 sitters in room and would be placed on hourly observation by facility staff until Patient #1 expired on 08/19/2023. No documented evidence the SNF communicated the change with the hospice facility. Review of Patient #1s medical record documents titled, ";Visit Note reports" dated 08/10/2023, 08/14/2023, 08/15/2023, 08/16/2023, 08/17/2023, revealed ";... Skilled Nurse (SN) reviewed suicidal/ideation plan with agency staff..." no evidence in the medical record of specific communication with whom or what was communicated with Skilled Nursing Facility staff. Review of Patient #1s medical record document titled, ";Medical Social Worker Psycho-social assessment" on 08/10/2023 documented under assessment revealed no relevant psychosocial history, but a late entry on 8/13/2023 documented by the Medical Social Worker in her narrative reveals ";...Patient has a sitter with him due to suicidal thoughts...". Review of Patient #1s medical record document titled, ";Medical Social Worker Hospice Visit" on 08/17/2023 documented under emotional assessment ";...no problems identified..." then further documentation dated 08/19/2023 and last updated 08/21/2023 as addendum to visit on 08/17/2023 revealed ";...The patients roommate tested positive for COVID 19. Patient reports that he is upset about the medication change. MSW notified hospice nurses of complaints. Patient refuse to talk about suicidal ideation during visit..." Review of Patient #1s medical record document titled; ";Visit Note Report" dated 08/16/2023 revealed new order received per Nurse Practitioner ";...oxycodone 5/324 milligrams (mg) every five (5)-six (6) hours as needed for moderate pain..." no documented evidence in Patient #1s medical record of a written order for Oxycodone. Review of Patient #1s medical record document titled, ";Discharge-Transfer Summary report" dated 08/19/2023 revealed no evidence that Oxycodone was added to the medication list. Review of facility document titled ";Root Cause Analysis and Action Plan in response to a Sentinel Event," file # 1323188, no date, documented by the Executive Director, reveals ";...other factors having directly influenced this event...Lack of care coordination between the nursing facility and the Hospice Care Team...what steps were contributed to the event...Medications changes, the patient resided in a secured environment within the nursing facility from which he was removed and placed in a room on the floor. The date of this move is unknown to the Hospice staff. The sitter was present and then removed from the room and hospice unknown date of removal...sitter was not present...Agency staff documentation not comprehensive...clinical notes for services the patient received were not complete and synced within 24 hours from end of visit time...equipment factors...hospital bed remote control cord was not – identified as a risk factor and was not removed from the room...what other areas of service are impacted...verbal orders received from NP were documented in a nursing coordination note but were not written in the orders...". Review of the facilitys Policy and Procedure # 3.046, effective date: 07/01/2010, titled ";Hospice Care in the Nursing Home/Skilled Nursing Facility Setting" reveals ";...Nursing Home/Skilled Nursing Facility and the Hospice will communicate with each other and document such communications to ensure that the needs of patients are addressed and met 24 hours a day...The Hospice Agency will establish a specific member of the Interdisciplinary Group who will be responsible for overall coordination of patient care, including the determination to change the level of services provided. This responsibility for the management of the hospice patient is clearly communicated to the Nursing Home/Skilled Nursing Facility...". Review of the facilitys Policy number 9.001 effective date 07/12/96 titled ";Hospice Medical Record" reveals ";...q. Legible, complete, and individualized diagnostic and therapeutic orders authenticated within the time frame defined by the organization or according to law and regulation...r. Identity of other individuals and organizations known to be involved in the patients care...s. Plan of care developed/revised by the interdisciplinary group based on comprehensive assessments and desired outcomes...aa. Care/coordination of care provided in other setting...4. Clinical notes for all services the patient has received shall be...for point of care users, synchronization will occur within 24 hours from visit.... days of incorporation into the medical record from date of service...Mississippi written on day of service..." During the exit conference on 09/14/2023 at 2:30 p.m. with the Executive Director, survey findings were discussed, and no further documentation was submitted for review.

Based on staff interviews, medical record review, document review of investigative findings and policy/procedure review the facility failed to update the comprehensive assessments with specific services necessary to include all services for the management of the terminal illness and related conditions for one (1) of one (1) patient; Patient #1 --- Cross refer to L-536/418.56 for the facilitys failure to update the Plan of Care of medication changes/hospital bed remote control cord not identified as a risk factor and not removed from the room. During the exit conference on 09/14/2023 at 2:30 p.m. with the Executive Director, survey findings were discussed, and no further documentation was submitted for review.

Based on staff interviews, medical record review, document review of investigative findings and policy/procedure review the facility failed to ensure coordination of services between Skilled Nursing Facility and Hospice Care Team on for one (1) of one (1) patient; Patient #1. --- Cross refer to L-536/418.56 for the facilitys failure to ensure the coordination between the Skilled Nursing Facility and the Hospice Care Team. During the exit conference on 09/14/2023 at 2:30 p.m. with the Executive Director, survey findings were discussed, and no further documentation was submitted for review.

Based on staff interviews, medical record review, document review of investigative findings and policy/procedure review the facility failed to ensure that the care and services provided are based on all assessments of the patients needs for one (1) of one (1) patient; Patient #1. --- Cross refer to L-536/418.56 for the facilitys failure of the lack of coordination between the Skilled Nursing Facility and the Hospice Care Team and updating the Plan of care when changes occurred. During the exit conference on 09/14/2023 at 2:30 p.m. with the Executive Director, survey findings were discussed, and no further documentation was submitted for review.

Based on staff interview, medical record review, document review of investigative findings and policy/procedure review the facility failed to ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement for one (1) of one (1) patient; Patient #1. --- Cross refer to L-536/418.56 for the facilitys failure to document the specific coordination of care between the Skilled Nursing Facility and the Hospice Care Team. During the exit conference on 09/14/2023 at 2:30 p.m. with the Executive Director, survey findings were discussed, and no further documentation was submitted for review.