Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 1 of 19 (Patient #11) did not contain evidence that the Comprehensive Assessment included a Bereavement component, which includes 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 is considered in the Bereavement Plan of Care: Patient #11: SOC was 09/20/24. The Bereavement Risk Assessment was not conducted until 09/30/24.

Upon patient record review, 3 of 19 (Patients #1, 5, and 13) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: During the Surveyor-attended ALF home visit on 10/30/24, it was noted that the patient was being transferred with a Gait Belt, by both Facility staff and the Hospice Aides. This Gait Belt was not on the Hospice POC. Patient #5: The RN SOC assessment reflected that the patient had a hospital bed, and used a Hoyer Lift. These DME were not on the current POC. Patient #13: The Physician CTI reflected that the patient used a Hoyer Lift. This DME is not on the Hospice POC.

Upon patient record review, 2 of 19 (Patients #3 and 6) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #3: The Hospice POC dated 09/15-11/13/2024 ordered Chaplain visits at a frequency of "Effective 09/15/24, 1x per month x1 month." There were no documented Chaplain visits made in September 2024. Patient #6: A verbal order was obtained 10/13/24, "Volunteer 3x per week during inpatient Respite stay" (10/10-10/15/24). Three Volunteer visits were made during those five Respite days. However, an additional three Volunteer visits were made during the following week of 10/20-10/26/2024.

Upon patient record review 3 of 19 (Patients #5, 13 and 14) did not contain evidence that a Hospice Aide had provided services that were: • 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: The Aide POC assigned, "Report Patient Pain Every Visit." The Aide(s) documented this assigned intervention by documenting a "Y" after this assigned task. There was no documented evidence that the Aide(s) had reported the patient's pain on every home visit report.. Patient #13: The Aide POC assigned, "Report Patient Pain Every Visit." The Aide(s) documented this assigned intervention by documenting a "Y" after this assigned task. There was no documented evidence that the Aide(s) had reported the patient's pain on every home visit report. Patient #14: The Aide POC assigned, "Report Patient Pain Every Visit." The Aide(s) documented this assigned intervention by documenting a "Y" after this assigned task. There was no documented evidence that the Aide(s) had reported the patient's pain on every home visit report.

Upon patient record review 2 of 19 (Patients #3 and 10) did not contain documented evidence that a Registered Nurse had made an on-site visit to these patients' homes 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 #3: An Aide Supervisory visit was made on 10/07/24, and then not again until 10/28/24. Patient #10: An Aide Supervisory visit was made on 10/03/24, and then not again until 10/21/24.

Upon observation, there was not evidence that the annual report documented the use of Volunteers, providing day to day administrative and/or direct patient care services, in an amount that at a minimum equals 5 percent of the total patient care hours of all paid Hospice employees and contract personnel. The Hospice documented a 3.76% rate for calendar year 2023.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. This standard was not met as evidenced by a joint clinical record review and interview. 2 of 13 (15%) clinical records reviewed revealed the agency failed the ensure the plan of care included the individualized interventions to meet the safety needs of the patient. Record #92487: (start of care: 1/13/22, diagnosis: chronic respiratory failure with hypoxia): Medication order (effective 1/13/22): Dilaudid 1mg/ml (milligram/milliliter) orally, every 2 hours as needed for pain or shortness of breath. RN clinical note from the IDT (interdisciplinary team) meeting (dated 2/1/22) stated: “patient is much more alert since locking up the Dilaudid.” The note also revealed that the RN prefilled the syringes (for Dilaudid administration) and provided additional education to the husband on administering the medication and documenting the Dilaudid doses given. The current hospice plan of care, effective 1/13/2022, listed a NDP (nursing diagnosis problem) that stated, “Need for medication management and instruction- hospice.” Relevant interventions included: “Prefilled medi-planner device” and “Instructed regarding the importance of medication compliance to achieve maximum benefit and symptom control.” There was no update to the Interdisciplinary plan of care to reflect a new intervention to initiate a locked medication box. In an interview with the Administrator (on 2/23/22), she acknowledged that the clinical documentation indicated the nurse had implemented the use of a lockbox as well as specific instructions for the husband to follow and that these interventions should have been included in the written plan of care. Record #51843: (Start of Care: 9/23/21, Election date: 9/23/21, Diagnosis: Senile degeneration of brain): Nursing clinical note dated 12/27/21 stated, “since the mattress with bolsters was put in place, the patient has not had any more falls,” it also noted that patient was transferred using two (2) assist and a Hoyer lift. A review of the occurrence report revealed the patient last fell on 12/13/21. Effective 12/22/21, the current care plan does not list any fall or safety problems. An interview with the Administrator was conducted on 2/23/22; she reviewed the clinical documentation and concurred that the patient should have had a care plan problem indicating the patient was at risk of falls. The bolster and mechanical lift interventions should have been included in the plan of care.