Every finding on record at Hospice of Tucson, Inc.

It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 8 (25%) clinical records reviewed revealed that the agency did not ensure that planned interventions were included in the plan of care for all problems identified in the comprehensive assessment. Clinical Record 1: The record revealed an initial nursing assessment dated 02/16/2024 that read in part "Patient used to ambulate with a walker but is now bedbound." The plan of care dated 02/16/2024-04/15/2024 lacked documentation of goals and interventions related to safety and fall risk. The initial nursing assessment dated 02/16/2024 also read in part "Patient has heart failure." The plan of care dated 02/16/2024-04/15/2024 lacked documentation of goals and interventions related to heart failure. Clinical Record 2: The record revealed an initial nursing assessment dated 04/30/2024 that read in part "patient is a fall risk.". The plan of care dated 04/30/2024-06/29/2024 lacked documentation of goals and interventions related to safety and fall risk. In an interview on 06/27/2024, the VP of Hospice Operations reviewed the records and stated, "There are no interventions on these plans of care for fall risk or for heart failure.".

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 8 (25%) clinical records reviewed revealed that the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the plan of care. Clinical Record 3: The record revealed an initial nursing assessment dated 01/30/2024 that read in part "patient uses a walker." The plan of care dated 01/30/2024-03/29/2024 lacked documentation of any medical supplies or appliances. Clinical Record 2: The record revealed an initial nursing assessment dated 04/30/2024 that read in part "patient used to use a cane but now uses a walker." The plan of care dated 04/30/2024-06/29/2024 lacked documentation of any medical supplies or appliances. In an interview on 06/27/2024, the VP of Hospice Operations reviewed the records and stated "The DME is not listed on these plans of care."

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 3 (33%) clinical records with aide services ordered reviewed revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 1: The record revealed a physician's order dated 03/07/2024 that included wound care with wound dressings for a wound to the sacrum. The aide care plan dated 03/07/2024 lacked instructions related to the wound dressings. In an interview on 06/28/2024, the VP of Hospice Operations reviewed the record and stated "There are no instructions for the wound dressing but there should be.".