Every finding on record at Heart to Heart Hospice of Dallas, LLC

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care; ensure continuous assessment of each patient’s and family’s needs; ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any); the patient or patient representative; [and] the primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (21%) clinical records reviewed, the hospice did not ensure that hospice care and services provided to patients followed the plan of care (POC). Clinical Record 9: The patient elected hospice care on 7/13/23. The plan of care ordered a Spiritual Counselor once every two weeks. A review of the clinical record revealed documentation of one Spiritual Counselor visit completed in July 2023; the actual frequency was one time a month. There was no evidence of a documented missed visit or communication with the physician. Clinical Record 12: The patient elected hospice care on 6/22/22. The plan of care ordered Skilled Nursing visits two times a week and Spiritual Counselor visits one time per month. A clinical record review revealed documentation of one nursing visit completed the week of 1/1/23. Additionally, a clinical record review revealed no evidence of a Spiritual Counselor visit completed for December 2022. There was no evidence of documented missed visits or communication with the physician. Clinical Record 16: The patient elected hospice care on 6/2/23. The plan of care ordered a Spiritual Counselor one time a week. A clinical record review revealed no evidence of a Spiritual Counselor visit completed the week of 7/12/23. There was no evidence of a documented missed visit or communication with the physician. During the interview on 8/24/23, the Area Clinical Manager confirmed the missing visit notes. During interview 8/24/23, the Area Clinical Manager confirmed the missing and extra visit notes.

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. Bereavement counseling extends to residents of a SNF/NF (skilled nursing facility/nursing facility) or ICF/IDF (intermediate care facility/intellectual disability facility) when appropriate and identified in the bereavement plan of care. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered; [and] the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. Agency policy, "Bereavement" (revised 1/1/2020), stated in part, "After the death of the patient, the Bereavement Coordinator will complete a follow-up assessment and develop a plan of care for bereavement services...A bereavement file will be maintained on each family/caregiver and will contain all bereavement assessments, all bereavement plans of care, all bereavement clinical notes and documentation of letters and/or resources sent to the bereaved, and all bereavement contacts, declinations of bereavement assistance, inability to contact and referrals will be documented in the patient's clinical record." In 3 of 7 (43%) clinical records reviewed where the hospice provided bereavement services to the bereaved, the hospice did not ensure that the post-death bereavement assessment was completed after the death of the patient, and the bereavement file included documentation of all bereavement contacts. Clinical Record 11: The patient elected hospice care on 10/12/22 and expired on 11/3/22. A clinical record review revealed that the six-month bereavement phone call assigned to the bereavement plan of care was not completed. During an interview on 8/23/23, the Bereavement Coordinator stated, "At six months, I send out a letter and do not do the six-month phone call." No further documentation was provided as of the exit conference on 8/24/23. Clinical Record 17: The patient elected hospice care on 8/3/23 and expired on 8/9/23. A clinical record review revealed the after-death bereavement assessment was not completed per the policy as of 8/24/23. Clinical Record 18: The patient elected hospice care on 7/22/23 and expired on 7/27/23. A clinical record review revealed the after-death bereavement assessment was not completed per the policy as of 8/24/23. During an interview and a joint clinical record review on 8/24/23, the Area Clinical Manager confirmed with the Bereavement Coordinator that the after-death bereavement assessments were not documented and the six-month bereavement phone call assigned on the care plan was not completed. Policy, "Bereavement", Policy number (State).26, revised 1/1/2020, included in part, "After the death of the patient, the Bereavement Coordinator will complete a follow-up assessment and develop a plan of care for bereavement services", and "A bereavement file will be maintained on each family/caregiver and will contain all bereavement assessments, all bereavement plans of care, all bereavement clinical notes and documentation of letters and/or resources sent to the bereaved, and all bereavement contacts, declinations of bereavement assistance, inability to contact and referrals will be documented in the patient's clinical record". During interview 8/24/23, the Area Clinical Manager reviewed the clinical record and confirmed with the Bereavement Coordinator that the after death bereavement assessments were not documented and the six month bereavement phone call that was assigned on the plan of care was not completed. Additionally during interview 8/23/23, the Bereavement Coordinator stated, "At six months, I send out a letter and do not do the six month phone call".

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 17 (6%) clinical records of patients receiving hospice aide services, the hospice did not ensure the hospice aide completed visits as assigned in the plan of care. Clinical Record 10: The patient elected hospice care on 1/6/23. The plan of care ordered hospice aide services three times a week. A clinical record review revealed two extra hospice aide visits during the weeks of 2/12/23 and 2/19/23 and one extra visit during the week of 2/25/23. There was no evidence of communication with the physician to change the hospice aide visit frequency. During the interview on 8/24/23, the Area Clinical Manager confirmed the extra Hospice Aide visits. During interview 8/24/23, the Area Clinical Manager confirmed the extra Hospice Aide visits.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the hospice did not ensure the physician's orders were completed. Clinical Record 13: The patient elected hospice services on 4/19/23 and expired on 7/28/23. Orders were documented on 5/3/23 for "Jevity 120 ml every 8 hours." The SN visit note dated 7/25/23 documented, "Jevity 1.2 BID was discontinued." A clinical record review revealed no orders for twice-a-day (BID) tube feedings and no orders to discontinue the tube feedings. During an interview on 8/24/23, the Area Clinical Manager stated they checked the clinical record and verified the missing physician's order. During interview 8/24/23, the Area Clinical Manager stated she checked the clinical record and verified the missing physician's orders.