Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 1 of 19 (Patient #8) did not have evidence that the hospice had 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 #8: SOC 06/28/24.The RN visit report dated 07/02/2024 reflected that the patient had a "port in the right jugular and subclavian vein, that is not accessed and open to air." This port was present at time of admission. However was not present on the most recent IDG plan of care.

Upon client record review, 2 of 19 (Patient #4,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: A volunteer evaluation was conducted on 06/25/24, and a subsequent volunteer visit was made. However the plan of care did not include a scope for the planned volunteer interventions. Patient #14: Patient was currently receiving volunteer services at time of survey. However, there was no documented scope or frequency for such volunteer services on the most recent IDG plan of care for this discipline.

Upon patient record review 1 of 19 (Patient #9) did not contain documented evidence that a Registered Nurse had made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs: Patient #9: An aide supervisory visit was conducted on 06/11/24. The next supervisory visit was not conducted until 06/28/24.

Upon observation, there was not documented evidence that the Hospice's use of Volunteers, providing day to day administrative and/or direct patient care services, is an amount that at a minimum, equals 5 percent of the total patient care hours of all paid Hospice employees and contract personnel: The Administrator provided their 2023 calendar-year Volunteer report, which totaled 0.01%. A PIP was reviewed/revised 04/30/2024. The Volunteer percentages for calendar-year 2024 so far are: 1) January 0.49%; 2) February 0.31%; 3) March 0.41%; 4) April 0.28%; and 5) May 045%. The Hospice continues to hold biweekly meetings to include the Regional Volunteer Coordinator and Director or OPs related to ongoing Volunteer recruitment and utilization needs.

Upon patient record review, 1 of 19 (Patient #16) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, that the hospice must forward to the patient's attending physician: A copy of the hospice discharge summary. Patient #16: Patient was discharged on 03/21/24. There was no documented evidence of a discharge summary having been completed.

Based on record review and interview, the hospice failed to include all medications necessary to meet the needs of the patient on the plan of care in 1 of 1 patient that resided in a skilled nursing facility (Patient #5). Findings include: --- A revised policy dated 06/14/2023, titled, ";Medication Management Policy," indicated medication reconciliation would be done at admission, recertification, and when a new medication was ordered. A revised policy dated 06/30/2023, titled, ";Hospice Plan of Care," indicated the plan of care would include drugs including the dose for medication, frequency and duration. A Visit Note Report dated 06/21/2024, for Patient #5 indicated the Patient had a lidocaine patch (pain reliever) to the right knee for complaints of pain. An Updated Plan of Care dated for the benefit period 06/07/2024 – 09/04/2024 failed to include the use of the lidocaine patch. During an interview on 07/17/2024, beginning at 12:50 PM, the Administrator indicated if a new medication was noted, the hospice nurse should have reconciled medications with the nursing facility, notified the hospice physician and updated the plan of care but the lidocaine patch was not on the plan of care medication list.

Based on record review and interview, the hospice failed to ensure physician orders were included in the clinical record for 2 of 2 clinical records reviewed with a foley catheter (tube into bladder to drain bladder) (Patient #1, #5). Findings include: --- 1. The policy titled ";Hospice Plan of Care" with revised date 06/30/2023, indicated the plan of care would include the treatments necessary to meet the needs of the patient. 2. The clinical record for Patient #1, included an Updated Plan of Care for the benefit period 04/11/2024 – 07/09/2024, that indicated the skilled nurse was to perform insertion and maintenance of a 16 French Foley catheter and change every month and as needed. A. A nurse visit note dated 07/09/2024, indicated the nurse patients foley was changed and placed an 18 French coude catheter. B. A clinical record review failed to include an order for the change in the foley, catheter size and type of catheter. C. During an interview on 07/17/2024, beginning at 12:18 PM, Registered Nurse (RN) 1 indicated the order for the change of the Foley catheter type and size should have been written and updated to the plan of care and he/she did not write the physician order. 3. The clinical record for Patient #5 included an Updated Plan of Care for the benefit period 06/07/2024 – 09/04/2024, which indicated the skilled nurse was to insert/maintain patients catheter. A. A Visit Note Report dated 06/18/2024 indicated the Patient had a foley catheter. B. The clinical record failed to include an order for a foley catheter, size, and the frequency of change required. C. During an interview on 07/17/2024, beginning at 12:18 PM, RN 1 indicated the plan of care should include orders for a foley catheter type and size.

Based on record review and interview, the hospice failed to ensure the plan of care delineated the care and services to be provided, specifically which provider was responsible for performing each function in 1 of 1 clinical record reviewed that resided in a skilled nursing facility (Patient #5). Findings include: --- The policy titled ";Hospice Plan of Care," last revision date 6/030/2023, indicated the plan of care would include education for the patient and primary caregiver to their responsibility for the care and services identified in the plan of care. A Visit Note Report dated 03/09/2024, for Patient #5 indicated the Patient resided at entity 6, a skilled nursing facility, and was dependent for all activities of daily living. The Plan of Care for the benefit period 6/07/2024 to 9/04/2024, with last Interdisciplinary Team Plan of Care update, dated on 7/10/2024, failed to evidence the specific delineation of care between the skilled nursing facility and the hospice staff. During an interview on 07/17/2024, beginning at 12:50 PM, the Administrator indicated the delineation of care between the skilled nursing facility and the hospice was not on the plan of care.