Every finding on record at Hospice Care of the Lowcountry

Based on record reviews and interview, the hospice failed to ensure the Interdisciplinary Team (IDT) completed an initial patient comprehensive assessment within 5 days of the patient's signing the Notice of Election (NOE) for 10 of 19 patient charts reviewed. (Patient 1, 3, 6, 7, 8, 9, 12, 13, 15 and 18) --- The findings include: Record review on 09/12/23 at 3:00 PM for Patient 1 revealed the patient was admitted on 04/18/23 for Malignant neoplasm of cecum. Review of the patient's chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 04/19/23 with no initial assessment by the Master Social Worker (MSW) until 05/04/23 and no initial assessment by the Chaplain. During an interview on 09/14/23 at 9:33 AM, the Director of Patient Care Services verified the findings. Record review on 09/12/23 at 10:47 AM for Patient 3 revealed the patient was admitted on 10/20/22 for Intrahepatic bile duct carcinoma. Review of the patient's chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 10/26/22 which was 6 days after the NOE and no initial assessment by the Chaplain. During an interview on 09/14/23 at 10:00 AM, the Director of Patient Care Services verified the findings. Record review on 09/12/23 at 3:44 PM of P 6 revealed P 6 was admitted on 07/10/23 for Senile degeneration of brain. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 07/12/23, with no initial assessment by the MSW until 08/17/23 and no initial assessment by the Chaplain until 07/20/23. During an interview on 09/14/23 at 10:10 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 8:44 AM of P 7 revealed P 7 was admitted on 01/32/23 for Unspecified systolic congestive heart failure. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 02/01/23 and with no initial assessment by the MSW. During an interview on 09/14/23 at 11:00 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 9:35 AM of P 8 revealed P 8 was admitted on 11/16/22 for Traumatic hemorrhage of right cerebrum. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 12/06/22, 21 days after the NOE. During an interview on 09/14/23 at 11:05 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 10:30 AM of P 9 revealed P 9 was admitted on 09/16/22 for Malignant neoplasm of central portion of right breast. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 09/21/22, 5 days after the NOE and no initial assessment by the MSW until 09/23/22 and no initial assessment by the Chaplain until 10/03/22. During an interview on 09/14/23 at 11:12 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 12:45 PM of P 12 revealed P 12 was admitted on 07/11/23 for Malignant neoplasm of hypopharynx. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 07/12/23, 1 day after the NOE and no initial assessment by the MSW until 08/17/23 and no initial assessment by the Chaplain. During an interview on 09/14/23 at 11:20 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 2:15 PM of P 13 revealed P 13 was admitted on 01/17/23 for Malignant neoplasm of upper quad of left breast. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 02/01/23, 15 days after the NOE. During an interview on 09/14/23 at 11:32 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 2:56 PM of P 15 revealed P 15 was admitted on 07/26/23 for Cerebral infarction. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 08/09/23, 14 days after the NOE. During an interview on 09/14/23 at 11:40 AM, the Director of Patient Care Services verified the findings. Record review on 09/12/23 at 9:25 AM of P 18 revealed P 18 was admitted on 08/09/23 for Hypertensive heart disease with heart failure. Review of the chart revealed no IDT comprehensive assessment within 5 days of the notice of election. The first IDT meeting for the patient was on 08/16/23, 7 days after the NOE and no initial assessment by the Chaplain until 08/15/23. During an interview on 09/14/23 at 10:00 AM, the Director of Patient Care Services verified the findings.

Based on record reviews, interview, and review of the hospice's policy, the hospice failed to ensure medication reconciliation (MAR) of the actual medications in the patient's home that the patient takes for 2 of 3 home visits. (Patients 16 and 18) --- The findings include: Home observation on 09/11/23 at 3:38 PM to 4:03 PM for Patient 16 revealed Patient 16s home medications of Furosemide 40 mgs (milligrams): take 40 mg oral 1 time a day when compared to the hospice MAR for the patient which reads, Furosemide 20 mgs, take 20 mgs oral 2 times a day. The following listed medications were on the hospice MAR for the patient which Patient 16 was not taking: Dofetilide 250 mcg (micrograms), take 250 mcg once a day; Ondansetron 8 mgs, take 1 tab every 8 hours as needed for nausea; Miralax oral powder, administer 17 gms once a day as needed for constipation; Percocet 325 mg-10 mg, take 1-2 tablets every 4-6 hours as needed for moderate pain; and Hyoscyamine 0.125 mg tablets, take 1-2 tablets every 4 hours as needed for secretions. During an interview on 09/14/23 at 10:12 AM, the Director of Patient Care Services verified the findings. Home observations on 09/12/23 at 11:30 AM to 1:25 PM for Patient 18 revealed home medications of Lasix 40 mg, take 1 tablet once a day; Metoprolol tartrate 50 mg, take 1 tablet every am (morning) while the hospice MAR for the patient showed of Lasix 80 mg, take 1 tablet once a day and Metoprolol tartrate 75 mg, take 1 tablet 2 times a day. The following listed medications were listed on the hospice MAR for the patient which Patient 18 does not take: Plaquenil 200 mg, take 1 tab twice a day and Xtampza ER 9 mg, take 1 capsule every 12 hours as needed for pain. During an interview on 09/14/23 at 10:53 AM, the Director of Patient Care Services verified the findings. Hospice policy, entitled, ";Medications-Profile" revealed, ";A patient-specific medication profile is maintained for each patient and reviewed, at a minimum, every fifteen days...4. The patients medication profile review includes, but is not limited to, a. determining accuracy and completeness of the profile...".

Based on record reviews and interview, the hospice failed to ensure the patient's plan of care (POC) was specific to 4 of 19 patient charts reviewed. (Patient 13, 14, 16, and 18) --- The findings include: Record review on 09/13/23 at 1:19 PM for Patient 13 revealed Patient 13 was admitted on 10/05/22 for senile degeneration of brain. Review of the certification period dated 08/01/23 to 09/29/23 revealed Patient 13 had bilateral hip wounds. Further review of the patient's plan of care revealed there was no documentation of Patient 13s bilateral hip wounds. During an interview on 09/14/23 at 11:29 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 2:15 PM for Patient 14 revealed Patient 14 was admitted on 01/17/23 for malignant neoplasm of upper inner quad left breast. Review of the certification period dated 07/16/23 to 09/13/23 revealed Patient 14 reported signs and symptoms of burning, frequency, and odor with urination. Further review of the patient's plan of care revealed there was no documentation for Patient 14s urinary symptoms. During an interview on 09/14/23 at 11:32 AM, the Director of Patient Care Services verified the findings. Record review on 09/11/23 at 2:15 PM for Patient 16 revealed Patient 16 was admitted on 06/12/23 for malignant neoplasm of appendix. During home observation on 09/11/23 at 3:38 PM to 4:02 PM, Patient 16 was observed with an Oxygen concentrator which was being used at 3 liters via nasal cannula by the patient. Further review of the patient's plan of care revealed there was no documentation of Patient 16s Oxygen. During an interview on 09/14/23 at 10:12 AM, the Director of Patient Care Services verified the findings. Record review on 09/12/23 at 9:25 AM for Patient 18 revealed Patient 18 was admitted for hypertensive heart disease with heart failure. During home observations on 09/12/23 at 11:30 AM to 1:25 PM, Patient 18 was observed with an in-home oxygen concentrator for use as needed for shortness of breath. Further review of the patient's plan of care revealed there was no documentation of Patient 18s Oxygen. During an interview on 09/14/23 at 10:53 AM, the Director of Patient Care Services verified the findings.

Based on record reviews and interview, the hospice failed to ensure an individualized plan of care was updated for 1 of 19 patients (Patient 13) with wounds, 1 of 19 patients (Patient 14) with a urinary tract infection (UTI), and for home Oxygen for 2 of 19 patients (Patient 16 and 18) whose charts were reviewed for care and services. --- The findings include: Record review on 09/13/23 at 1:19 PM for Patient 13 revealed Patient 13 was admitted on 10/05/22 for senile degeneration of brain. Review of the certification period dated 08/01/23 to 09/29/23 revealed Patient 13 had bilateral hip wounds. Review of the patient's plan of care revealed there was no documentation for the bilateral hip wounds and/or goals or interventions for treatment. During an interview on 09/14/23 at 11:29 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 2:15 PM for Patient 14 revealed Patient 14 was admitted on 01/17/23 for malignant neoplasm of upper inner quad left breast. Review of the certification period dated 07/16/23 to 09/13/23 revealed Patient 14 reported signs and symptoms of burning, frequency, and odor with urination. Patient 14 was prescribed Cipro and Pyridium as the treatment option. Review of the patient's plan of care revealed no update for the Urinary Tract Infection. During an interview on 09/14/23 at 11:32 AM, the Director of Patient Care Services verified the findings. Record review on 09/11/23 at 2:15 PM for Patient 16 revealed Patient 16 was admitted on 0612/23 for malignant neoplasm of appendix. During home observation on 09/11/23 at 3:38 PM to 4:02 PM, Patient 16 was observed with an Oxygen concentrator which was being used at 3 liters via nasal cannula by the patient. Review of the plan of care revealed there was no documentation of the update for the Oxygen. During an interview on 09/14/23 at 10:12 AM, the Director of Patient Care Services verified the findings. Record review on 09/12/23 at 9:25 AM for Patient 18 revealed Patient 18 was admitted for hypertensive heart disease with heart failure. During home observations on 09/12/23 at 11:30 AM to 1:25 PM, Patient 18 was observed with an Oxygen concentrator not in use at the time by the patient. Review of the patient's plan of care revealed there was no documentation of the update for the Oxygen. During an interview on 09/14/23 at 10:53 AM, the Director of Patient Care Services verified the findings.

Based on record reviews and interview, the hospice failed to ensure the Hospice Aide (HA) and Chaplain completed home visits per the ordered frequency on the patient's plan of care for 4 of 14 patient charts reviewed. (Patient 6, 8, 11 and 18) --- The findings include: Record review on 09/12/23 at 3:44 PM for Patient 6 revealed Patient 6 was admitted on 07/10/23 for Senile degeneration of Brain. Review of the patient's certification period dated 07/10/23 to 10/07/23 revealed HA visit frequency was 1 time a week for 11 weeks. Review of Patient 6s visits revealed 1 missed visit during the week of 07/10/23 to 07/15/23 and 07/16/23 to 07/22/23. During an interview on 09/14/23 at 10:10 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 9:35 AM for Patient 8 revealed Patient 8 was admitted on 11/16/22 for Traumatic hemorrhage of right cerebrum. Review of the patient's certification period dated 07/14/23 to 09/11/23 revealed Chaplain visit frequency was 1-3 times a month. Review of Patient 8s Chaplain visits revealed 1-3 missed visits for the month of July 2023. During an interview on 09/14/23 at 11:05 AM, the Director of Patient Care Services verified the findings. Record review on 09/13/23 at 11:33 AM for Patient 11 revealed Patient 11 was admitted on 03/31/23 for Uterine Cancer. Review of the patient's certification period dated 06/29/23 to 09/26/23 revealed HA visit frequency was 3 times a week for 12 weeks. Review of Patient 11s HA visits revealed 1 missed visit during the week of 06/29/23 to 07/01/23, 3 missed visits during the week of 07/02/23 to 07/08/23, 3 missed visits during the week of 07/09/23 to 07/15/23, 3 missed visits during the week of 07/16/23 to 07/22/23, and 1 missed visit during the week of 07/23/23 to 07/29/23. During an interview on 09/14/23 at 11:15 AM, the Director of Patient Care Services verified the findings. Record review on 09/12/23 at 9:25 AM for Patient 18 revealed Patient 18 was admitted on 08/09/23 for Hypertensive heart disease with heart failure. Review of the patient's certification period dated 08/09/23 to 11/06/23 revealed Chaplain visit frequency was 1-4 times a month. Review of Patient 18s Chaplain visits revealed 1-4 missed visits for August 2023. During an interview on 09/14/23 at 10:53 AM, the Director of Patient Care Services verified the findings.

Based on record reviews, interviews, and review of the hospice policy and procedure, the hospice failed to ensure the Quality Assessment Performance Improvement (QAPI) minutes contained measurable outcomes with indicators related to palliative outcomes and hospice services. --- The findings include: Record review on 09/14/23 at 3:44 PM of QAPI minutes from June 2023 to September 2023 revealed there was no documentation of measurable outcomes for quality indicators for the hospice. During an interview on 09/14/23 4:23 PM, the Executive Director stated, ";We recognized that it (QAPI) was looking like a check box".

Based on review of the hospice's Quality Assurance Process Improvement (QAPI) data and interview, the hospice had no documentation that the hospice measured, analyzed, and/or tracked adverse patient events, and other aspects of performance that enable the hospice to assess processes of care, hospice services, and operations. --- The findings include: Review of the hospices QAPI data on 09/14/23 at 3:44 PM from June 2023 to September 2023 revealed there was no documentation that the hospice tracked, analyzed, and/or investigated adverse patient events to assess the care, services, and operations of the hospice. During an interview on 09/14/23 at 4:23 PM, the Executive Director verified the findings.

Based on record reviews, interviews, and review of hospice policy and procedure, the hospice failed to ensure the Quality Assessment Performance Improvement (QAPI) minutes contained documentation of data collection related to all areas of the hospice program. --- The findings include: Record review of the hospice Quality minutes from June 2023 to September 2023 on 09/14/23 at 3:44 PM revealed there was no documentation of data collected related to all areas of the hospice program. During an interview on 09/14/23 at 4:23 PM, the Executive Director verified the findings. Hospice policy, entitled, ";QAPI-Program Scope and Activities", revealed, ";3. Selected quality indicators related to adverse events and other aspects of performance are measured, analyzed, and tracked to assess processes of care, hospice services, and operations...".

Based on record review, interview, and review of hospice policy and procedure, the hospice failed to perform an analysis of adverse events with documentation noted within the Quality Assessment Performance Improvement (QAPI) minutes. --- The findings include: Record review on 09/14/23 at 3:47 PM of the hospice's QAPI minutes from June 2023 to September 2023 revealed there was no documentation of analysis of adverse events within the QAPI minutes. During an interview on 09/14/23 at 4:30 PM, the Executive Director stated, ";We have identified measures and improvements for what needs to be done."

Based on record reviews, interviews, and hospice policy and procedure, the hospice failed to ensure the hospice followed the patient's bereavement plan of care for up to a year for 2 of 2 bereavement patient charts reviewed. (Patient 3 and 5) --- The findings include: Record review on 09/12/23 at 10:47 AM for Patient 3 revealed Patient 3 was admitted on 10/20/22 for intrahepatic bile duct carcinoma and expired on 12/11/22. Review of Patient 3s chart revealed the patient's bereavement plan of care was not followed after Patient 3s death. Documentation revealed one 9-month bereavement letter was sent to the caregiver after Patient 3s death on 09/05/23. During an interview on 09/14/23 at 12:15 PM, the Director of Social Services stated, ";There is no additional information for the patient." Record review on 09/12/23 at 3:21 PM for Patient 5 revealed Patient 5 was admitted on 03/21/23 for malignant neoplasm of prostate and expired on 03/28/23. Review of Patient 5s chart revealed the patient's bereavement plan of care was not followed after Patient 5s death. Documentation revealed one 6-month bereavement letter was sent to the caregiver after Patient 5s death on 09/05/23. During an interview on 09/14/23 at 12:18 PM, the Director of Social Services verified the findings. Hospice policy, entitled, ";Bereavement -Mailings", revealed, ";Bereavement mailings are sent to identified family members, and significant others of deceased hospice patients. These mailings are sent at regular intervals during the thirteen months following the patients death. The mailings include an individualized letter and standardized bereavement literature appropriate to the needs of the bereaved person...".

Based on observations and interview, the hospice failed to ensure 1 of 2 observed hospice aides (HA 1) followed the aide plan of care for patient care. (Patient 18) --- The findings include: Record review on 09/12/23 at 9:25 AM for Patient 18s ";Interdisciplinary Care Plan" (IDT) revealed HA 1s plan of care interventions were: ";Ambulate with assistance at each visit, assist with dressing at each visit, complete shower using shower chair at each visit, provide oral care at each visit, provide perineal care at each visit, provide skin care at each visit, provide standard precautions at each visit". Observations on 09/12/23 at 12:53 PM after Patient 18s shower revealed HA 1 obtained wound cleanser, a piece of toilet tissue, and wiped Patient 18s closed sacral decubitus area x (times)1. HA 1 applied barrier cream to the sacral decubitus area and covered the area with a heart-shaped foam dressing. During an interview on 09/12/23 at 1:27 PM, HA 1 stated, ";The nurses will ask us to put the dressings on for them in certain circumstances, so we will do it." During an interview on 09/14/23 at 10:51 AM, the Director of Patient Care Services stated, ";The aide is not to change the patient dressings."

Based on record review and interview, the hospice failed to ensure physical therapy services were provided for 1 of 1 patient charts reviewed. (Patient 18) --- The findings include: Record review on 09/12/23 at 9:25 AM for Patient 18 revealed Patient 18 was admitted on 08/09/23 for hypertensive heart disease with heart failure. Review of a skilled nursing visit note dated 08/14/23 revealed nursing documentation that Patient 18 inquired about physical therapy for strengthening. Further review of the patient's chart revealed there was no documentation of a Physical Therapy (PT) evaluation and/or treatment. During an interview on 09/12/23 at 11:30 AM to 12:07 PM in the patient's home, the patient stated, ";No PT has been out to see me, and I would still like to have one." During an interview on 09/14/23 at 10:41 AM, the Director of Patient Care Services stated, ";When requested, we can put in for an eval (evaluation) from PT."

Based on observations, interview, and review of the hospice's policy and procedure, the hospice failed to ensure expired supplies were removed from the patient supply room. --- The findings include: Observations on 09/11/23 at 11:35 AM in the hospice supply room revealed the following expired items: (60) Relia-Med lubricating jelly 0.3 g(gram) expired 12/16, (12) E-Z lubricating jelly 0.1 oz (ounce) expired 10/2015, (3) 20 gauge 2 inch IV (intravenous) catheter needle unit expired 04/01, (1) Surgical lubricant sterile bacteriostatic 4 ¼ oz tube expired 01/31/22, (100) BD safety glide needle 27 g x(by) 5/8 expired 05/18, (5) 20 g x 1.0 in Huber needle set expired 12/28/22, (2) Micro Clave neutral connector expired 06/2020, (2) Heparin flush 500 units/5 ml (milliliter) expired 08/31/21, (72) adhesive tape remover pads expired 04/21, (12) Povidone iodine 3 pack swabs expired 08/2022, (9) dressing change trays with Chlora prep expired 05/31/19. During an interview on 09/11/23, the Hospice Coordinator verified the findings. Hospice policy, entitled, ";Medical Supplies", revealed, ";6. Expiration dates (if applicable) are checked prior to use and are checked periodically by the hospices administrative support staff. Outdated medical supplies are discarded...".