Every finding on record at Hospice Longview, Inc.

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 13 (8%) records reviewed revealed the agency did not ensure the initial comprehensive assessment was completed within five calendar days after the election of hospice care. . Record #13 was reviewed and identified the patient elected hospice care on 10/7/2021. A review of the clinical record revealed that the initial spiritual assessment was completed on 10/26/2021. There was no communication note or phone call noted to document the family's request or denial of spiritual services prior to the 10/26/2021 chaplain visit. During an interview conducted on 9/13/22, the director of nursing confirmed there was no evidence of a spiritual assessment completed within 5 days of hospice election.

It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient's family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and considered in the bereavement plan of care. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 13 (8%) records reviewed revealed the agency did not ensure the initial comprehensive assessment included a bereavement risk assessment.. Record #13 was reviewed and identified the patient elected hospice care on 10/7/2021. A review of the clinical record revealed that the initial bereavement risk assessment was completed on 10/26/2021. The initial assessments completed by the RN and the Social Worker were missing documentation regarding the assessment of bereavement needs. There was no communication note or phone call note to document any request to delay bereavement assessment prior to the 10/26/2021 chaplain visit. During an interview conducted on 9/13/22, the director of nursing confirmed there was no evidence a timely initial bereavement assessment was completed, and confirmed that if the Chaplain was not seeing the patient within the five days that the nurse or social worker should have completed it.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene, use of gloves, safe handling of soiled items in the patient’s care environment, and other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by a review of document reviews, interviews, and observations. 1 of 3 (33%) home visits revealed that the agency did not ensure staff followed standard precautions as defined by applicable state law and regulation. Home Visit #2: During the home visit conducted on 9/13/2022, the Registered Nurse (RN) (staff #7) was observed providing wound care. The RN did not change gloves after removing the soiled dressing, prior to applying the new dressing. The state's health services infectious disease contact precaution guideline stated in part, "In addition to wearing gloves as outlined under Standard Precautions...change gloves after having contact with infective material that may contain high concentrations of microorganisms (fecal material and wound drainage)." During an interview conducted on 9/13/22, the RN confirmed that the gloves were not changed after removing the old (dirty) dressing prior to placing on the new dressing and said that she knows she should have.