Every finding on record at Heart of Texas Hospice - Hill Country, LLC

Observed in Emergency Management Session. The organization's Emergency Operations Plan did not have a written order of succession plan that identified who is authorized to assume leadership or management roles when those individuals are unable to fulfill their functions or perform their duties. This was reviewed and validated with the Administrator.

Observed in Emergency Management Session. The organization's Emergency Operations plan did not include how they would inform state and local officials of any on-duty staff or patients that they are unable to contact in an emergency, This was reviewed and validated with the Administrator/Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted with skilled nurses, the hospice did not conduct a patient-specific reassessment that identifies the patients' need for hospice care and services. Observed in RRHV#1, MRN 3144, the Registered Nurse (RN) did not conduct a thorough skin assessment, instead assessing only the areas of the patient's body that were in view, his upper and lower extremities, but failing to assess the patient's torso and posterior. Observed in RRHV#3, MRN 2269, the Licensed Vocational Nurse identified new onset of pustules (boils) in the patient's left groin area, and reassessed the patient's chest where there had previously been a documented rash, but did not complete a thorough skin assessment of the patient's posterior. This was reviewed and validated with the Administrator/Director of Nursing.

Observed in Record Review. In 3 of 12 active patient records reviewed the organization did not ensure that the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions. For example, in the review of RRHV#3, MRN 2269 it was identified in the initial psychosocial assessment that the patient did not have funeral/burial arrangements, yet this need was not included on the plan of care despite six (6) additional visits completed by the Medical Social Worker. Identified in the review of RRHV#4, MRN 3200, the patient had a comorbidity of unspecified severe protein calorie malnutrition. At the time of the hospice admission, it was noted in the referring documents that she had a recent nine (9) lb. weight loss, and a decrease in dietary intake of 30 percent over the prior month, yet Nutrition was not listed as a problem on the plan of care. In the review of the record for RRNHV#6, MRN 3028, it was identified in the initial psychosocial assessment that the patient did not have funeral/burial arrangements, yet this need was not included in the plan of care despite five (5) additional visits completed by the Medical Social Worker. This was reviewed and validated with the Director of Nursing.

Observed in Record Review. In 1 of 12 active patient records reviewed the organization did not ensure that plan of care revisions were based on information from updates to the patient's comprehensive assessment and address the patient's progress toward goals and outcomes in accordance with Organizational Policy PC.40 V. For example, in the record review for RRNHV#2, MRN 2230, it was identified in the initial psychosocial assessment approximately nine (9) months prior to the survey date, that the patient did not have funeral/burial arrangements. The plan of care included the goal Patient will make after death arrangements. There has been no update to the plan of care reflecting progress toward the goal despite seven (7) subsequent visits by the Medical Social Worker. This was reviewed and validated with the Administrator/Director of Nursing.

Observed in HR File Review. In 2 of 2 Hospice Aide Personnel Records Reviewed, there was no evidence that an annual on-site hospice aide competency visit was conducted. In the review of RRHR#8 Hospice Aide 1, and RRHR#9 Hospice Aide 2, there was no competency assessment visits documented during the past three years. This was reviewed and validated with the Administrator/DON who shared that the organization completes only an initial on-site skills competency.

Observed in HR File Review. In 5 of 13 Personnel Records reviewed there was no evidence that staff competence was assessed and documented during the last three (3) years. It was identified in the following HR charts that there were no staff competencies reassessed or documented during the past three years: HR#3 LVN, HR#5 LVN/RN, HR#7 Chaplain, HR#12 Associate Medical Director, HR#13 Medical Director. This was reviewed and validated with the Administrator/DON who shared that the organization completes only an initial on-site skills competency. Observed in HR File Review. In 1 of 13 Personnel Records reviewed the organization failed to perform and document a competency assessment as part of orientation. In HR#5, the Registered Nurse, was employed with the organization as a Licensed Practical Nurse beginning in 2018. Upon becoming a Registered nurse in 2022, the organization failed to perform and document a competency assessment for the role of Registered Nurse. This was validated with the Administrator/DON.

Observed in Record Review. In 1 of 2 Live Discharge records reviewed, there was no evidence that the organization created, provided, or informed the patient's attending physician of the availability of a discharge summary in accordance with Organizational Policy PE.20, VIII. Identified in the record for RRLiveDC#1, there was no evidence of a discharge summary following the patient's discharge from hospice services for no longer being terminal, and there was no documentation of communication with the patient' primary care provider, or health care professionals who would be responsible for providing care and services to the patient. This was reviewed and validated with the Administrator/Director of Nursing.