Every finding on record at Hospice Preferred Choice, Inc.

Upon client record review, 1 of 19 (Patient #14) did not have evidence that the plan of care included IDG's documentation of the patient's or families level of understanding, involvement and agreement with the plan of care. Patient 14 order on 5/24/24 for SW effective 5/21/24 2m1, 4m1, 5m1, 2m1 (weekly visits). SW visit on 5/24 and a refusal documented on 5/29. A refusal is documented on 6/7, and a note on 6/13 states the patient desires a visit next week and not this week. Missed visit note on 6/20/24 documents no answer to calls and due to previous refusals will change visit frequency. Order entered on 6/20/24 for SW effective 6/1/24 2m1, 1m2. No evidence that the patient requested a change in the visit frequency and no evidence documented within the IDG of communication with the patient or family for involvement in the change in visit frequency.

Upon patient record review, 3 of 19 (Patient #1, 2, 14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1 medication profile includes oxygen at 2LPM NC continuous. Nursing visit on 6/28/24 documents patient using oxygen at 4LPM, nursing visits on 6/29 and 6/30 document patient using oxygen at 3LPM. Patient 2 medication profile includes 2/20/24 for Miralax17g prn constipation mix with 8oz of water drink day 2 no BM, does not include a frequency for how often to take. Medication profile includes Ativan 0.5mg, 2 tabs as directed give 2 tabs 1 hour prior to shower, does not include a frequency for how often it can be given. Patient 14 medication profile includes oxygen 2LPM continuous/prn, does not include a route. Nursing visit on 5/21/24 and initial CTI document oxygen at 3LPM.

Upon patient record review, 1 of 19 (Patient #14) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 14 abdominal incision (previously closed) reopened 6/21/24 with drainage, call to physician. No evidence of an assessment of this draining incision from 6/21/24 to current, documented continued drainage and dressing changes during this timeframe.

Upon patient record review, 5 of 19 (Patient #5, 8, 9, 12, 14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 5 nursing visits throughout June document dysphagia and pureed diet, no evidence of aspiration precautions on care plan. Patient 8 is on Aspirin for stroke prevention, no evidence of bleeding precautions on care plan. Patient 9 initial CTI documents dysphagia with possible aspiration, no evidence of aspiration precautions on care plan. Patient 12 aide care plan has fall precautions and a prn nursing visit was completed on 6/20/24 for a fall. No evidence of fall precautions on the care plan. Patient 14 nursing visits throughout June document the presence of a port, nursing visit on 6/9/24 documents cleaning and applying a dressing to the port. No evidence of a care plan for the port.

Upon patient record review, 3 of 19 (Patient #1, 2, 14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 1 initial plan of care orders oxygen at 2LPM NC continuous. Nursing visit on 6/28/24 documents oxygen at 4LPM, nursing visits on 6/29 and 6/30 document oxygen at 3LPM. Patient 2 order on 2/20/24 for Miralax17g prn constipation mix with 8oz of water drink day 2 no BM, does not include a frequency for how often to take. Order on 6/12/24 for Ativan 0.5mg, 2 tabs as directed give 2 tabs 1 hour prior to shower, does not include a frequency for how often it can be given. Patient 14 initial plan of care includes order for oxygen 2LPM continuous/prn, does not include a route. Nursing visit on 5/21/24 and initial CTI document oxygen at 3LPM, no evidence of an order for oxygen 3LPM.

Upon patient record review, 1 of 19 (Patient #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 5 nursing visit 6/13/24 documents hoyer lift, aide care plan includes the use of hoyer lift and wheelchair, no evidence of an order for hoyer lift and wheelchair on the POC.

Upon client record review, 2 of 19 (Patient #6, 14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 6 order on 2/1/24 for SW frequency of 2m2, 1m1. SW visit completed on 2/1/24, no evidence of a second visit for February. Order on 4/11/24 for SW frequency effective 4/22/24 of 1m1, 2m2, 1m1. No evidence of a SW visit completed after 4/22/24 for April. Patient 14 nursing visit on 6/9/24 documented port site not accessed site cleaned gauze and sure site placed to reduce sheering, no evidence of an order. Nursing visit 6/21/24 documents abdominal incision now draining (previously closed), nursing visit on 6/25 and 6/27 document new dressing to ABD incision. No evidence of an order for dressings or site care.

Upon observation, 1 of 4 (Patient 2) there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 2, RN placed phone on the patient's wheelchair to utilize the stopwatch and did not clean the phone prior to or after use, and did not utilize a barrier.

Upon patient record review, 3 of 19 (Patient #15, 16, 17) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 15 holiday card and memorial letter/invitation, and your not alone mailing due 12/19/23. No evidence these were sent and no coordination note to explain any variances that were needed. Patient 16 holiday card and memorial letter/invitation, and your not alone mailing due 11/12/23. No evidence that the holiday card or memorial mailing were sent, and the your not alone mailing was documented as sent on 1/8/24, no coordination note to explain and variances that were needed. Patient 17 holiday card and memorial letter/invitation, and your not alone mailing due 1/12/24. No evidence these were sent and no coordination note to explain any variances that were needed.

Upon patient record review, 3 of 19 (Patient #3, 5, 8) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 3 is high risk for aspiration per the plan of care and nursing documentation, no evidence of aspiration precautions on the aide care plan. Patient 5 is high risk for falls per the plan of care and nursing documentation, no evidence of fall precautions on the aide care plan. Patient 8 is high risk for seizures and bleeding, no evidence of seizure or bleeding precautions on the aide care plan.

Upon patient record review 1 of 19 (Patient #5) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 5 shampoo is to be performed every visit. Aide visit on 6/28/24 documented no not completed for shampoo.

Upon patient client record review, 6 of 19 (Patient #1, 3, 4, 6, 11, 14) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1 order on 6/16/24 for SN order description stated 6/16 4xweek, week of 6/23 3xweek. The calendar frequency included effective 6/16 8w1, 7w8, 1w1. The frequencies conflicted within the order. Order on 6/28 order description included daily visits starting 6/28, the calendar frequency documented effective 6/23 11w8, 2w1 and these conflicted within the same order. Nursing visit on 5/21 documented patient needed 1 person gait belt transfer and aide care plan documented 1 person transfer without gait belt, unclear which is correct. Patient 4 order on 6/17/24 for aide visit frequency in the order description stated aide 4xweek the week of 6/16 and 5x week starting 6/23, the calendar frequency read effective 6/16 4w1, 3w1, the order was not clear for the frequency. Patient 6 nursing visit on 6/25/24 documented wound care provided as per orders and did not include the detail of the care provided. Patients 3, 11, 14 agency procedure is to write SW visit frequency as a monthly frequency then 2prn visits and 5 phone calls for psychosocial needs, the phone calls are intended to be prn for support per the procedure. No evidence of the calls, unclear on visit frequency and didn't follow the agency procedure, utilized phone visits and not phone calls. Patient 3 on 6/5/24 SW frequency effective 6/15 included 5 prn phone visits Patient 11 on 4/4/24 SW frequency effective 4/1 includes 5 phone visits. Patient 14 on 5/24/24 and 6/20 SW frequency included 5 phone visits.

Upon client record review, 1 of 19 (Patient #8) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 8 order on 4/30/24 for SW frequency effective 4/14/24 of 3m3, 1m1. SW visit completed on 4/23/24 no evidence of a 2nd or 3rd visit for April after 4/14/24.