Every finding on record at Ihc Hospice. Inc

Based on record reviews, interview, and review of the hospice's policy and procedures, the hospice failed to ensure the Interdisciplinary Team (IDT) conducted an initial comprehensive assessment within 5 days of the patient signing the Notice of Election (NOE) for hospice benefits for 4 of 5 patient charts reviewed. (Patient # 1, #2, #3, and #5) --- The findings include: On 04/25/23 at 12:54 PM, review of Patient #3's chart revealed the patient was admitted on 03/02/22 for malignant neoplasm of the lungs. There was no initial Plan Of Care (POC) by the IDT within 5 days of the patient's admission on 03/02/2023. During an interview on 04/26/23 at 11:17 AM, Nurse Practitioner (NP) #1 stated, ";We did not complete an initial POC". On 04/25/23 at 8:45 AM, review of Patient #5 chart revealed the patient was admitted on 03/07/22 for Hypertensive Heart and Heart failure. There was no initial POC by the IDT within 5 days of the patient's admission on 03/07/22. During an interview on 04/26/23 at 1:20 PM, NP 1 stated, ";We did not complete an initial POC." Hospice policy, entitled, ";Plan of Care", revealed, ";2. A preliminary plan is developed following the comprehensive admission assessment. This preliminary plan is reviewed by the Interdisciplinary Team (IDT) and finalized within 5 days of the admission visit [Day of Admission=Day #1) ...". On 4/25/23, at 9:14 AM Patient #1's record was reviewed. Patient #1 was admitted to the hospice on 3/6/23 with a diagnosis of Mesothelioma (a type of lung cancer). There was no documented evidence of IDT collaboration for establishment of the initial plan of care within five days of the patient admission. On 4/26/23, at 9:23 AM the Nurse Practitioner/Interim Director of Nurses (NP/IDON) was interviewed. During a concurrent review of Patient #1's record, the NP/IDON confirmed the findings. On 4/25/23, at 12:18 PM Patient #2's record was reviewed. Patient #2 was admitted to the hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. There was no documented evidence of IDT collaboration for establishment of the initial plan of care within five days of the patient admission. On 4/26/23, at 10:30 AM, the NP/IDON was interviewed. During a concurrent review of Patient #2's record, the NP/IDON confirmed the findings.

Based on record reviews, interview, review of the hospice policy and procedure, the hospice failed to ensure that the patient's initial bereavement risk assessment level was completed for 4 of 5 patient charts reviewed. (Patient 1, 2, 4 and 5) --- The findings include: Record review on 04/25/23 at 12:54 PM of P 4 revealed P 4 was admitted to the hospice facility on 05/28/21 for malignant neoplasm of the prostrate. Further review of the chart revealed no documentation of an initial bereavement risk assessment. During an interview on 04/26/23 at 12:45 PM with Nurse Practitioner (NP) 1 verified the findings. Record review on 04/25/23 at 8:45 AM of P 5 revealed P 5 was admitted to the hospice facility on 03/07/22 for Hypertensive heart and heart failure. Further review of the chart revealed no documentation of an initial bereavement risk assessment. During an interview on 04/26/23 at 1:20 PM with NP 1 verified the findings. Facility policy, entitled ";Bereavement Program" revealed, ";A bereavement assessment, completed within 5 calendar days of admission for all Hospice patients by the assigned bereavement staff, and updated during the course of care, at the time of death, and during the bereavement follow up...". On 4/25/23, at 9:14 AM Patient #1's record was reviewed. Patient #1 was admitted to the hospice on 3/6/23 with a diagnosis of Mesothelioma (a type of lung cancer). There was no documented evidence an initial bereavement risk assessment was completed for Patient #1. On 4/26/23, at 9:23 AM the Nurse Practitioner/Interim Director of Nurses (NP/IDON) was interviewed. During a concurrent review of Patient #1's record, the NP/IDON confirmed no initial bereavement risk assessment was completed for Patient #1. On 4/25/23, at 12:18 PM Patient #2's record was reviewed. Patient #2 was admitted to the hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. There was no documented evidence an initial bereavement risk assessment was completed for Patient #2. On 4/26/23, at 10:30 AM the NP/IDON was interviewed. During a concurrent review of Patient #2's record, the NP/IDON confirmed no initial bereavement risk assessment was completed for Patient #2. On 4/26/23, at 11:35 AM, during an interview with the Chaplain, he/she stated he/she did not do an initial bereavement risk assessment for Patients #1 or #2.

Based on record review, interview, and review of hospice policy and procedures, the hospice failed to provide documentation of updated comprehensive assessments that included the patient's progress towards desired outcomes for 3 of 4 Patients. (Patient 3, 4, and 5) --- The findings include: On 04/25/23 at 2:54 PM, review of Patient 3's chart revealed the patient was admitted on 03/02/22 for malignant neoplasm of the lungs. There was no documentation of an updated comprehensive assessment by the IDT which included P 3's progress towards desired outcomes. During an interview on 04/26/23 at 11:17 AM, Nurse Practitioner (NP) 1 stated, ";I dont know of a way to document that in the chart." On 04/25/23 at 12:54 PM, review of Patient 4's chart revealed the patient was admitted on 05/28/21 for malignant neoplasm of the prostrate. There was no documentation of an updated comprehensive assessment by the IDT which included P 3's progress towards desired outcomes. During an interview on 04/26/23 at 12:45 PM, NP 1 verified the findings. On 04/25/23 at 8:45 AM, review of Patient 5's chart revealed the patient was admitted on 03/07/22 for hypertensive heart disease and heart failure. There was no documentation of an updated comprehensive assessment by the IDT which included P 3's progress towards desired outcomes. During an interview on 04/26/23 at 1:20 PM, NP 1 verified the findings.

Based on record review, interview, and review of hospice policy and procedures, the hospice failed to ensure the Interdisciplinary team (IDT) and/or IDT meetings included the core members for 5 of 5 patient charts reviewed. (Patient 1, 2, 3, 4 and 5) --- The findings include: Facility policy, entitled ";Interdisciplinary Team" revealed, ";CORE MEMBERSHIP—The IDT includes at least the following individuals who are Hospice and/or Palliation Choices employees: A. Registered Nurse B. Licensed Medical Social Worker C. Chaplain/Spiritual Counselor D. Hospice Medical Director, as appropriate...". Record review on 04/25/23 at 12:54 PM of P 3 revealed P 4 was admitted to the hospice on 03/02/22. Review of certification period 03/02/22 to 05/30/22 revealed IDT meetings by the facility with no Masters Social Worker (MSW) present for the following meeting days: 03/04/22, 04/08/22 and 05/06/22. During an interview on 04/26/23 at 11:17 AM with NP 1 verified the findings. Record review on 04/25/23 at 12:54 PM of P 4 revealed P 4 was admitted to the hospice on 05/28/21. Review of certification period 11/24/21 to 01/22/22 revealed IDT meetings by the facility with no MSW and/or Chaplain present for the following meeting days: 12/28/21. Further review also revealed no documentation of IDT meetings on 10/29/21, 11/12/21, 11/25/21 and 12/10/21. During an interview on 04/26/23 at 12:45 PM with Nurse Practitioner (NP) 1 verified the findings. Record review on 04/25/23 at 8:45 AM of P 5 revealed P 5 was admitted to the hospice on 03/07/22. Review of certification period 03/07/22 to 06/04/22 revealed IDT meeting by the facility with no MSW present for the following meeting day: 04/01/22. During an interview on 04/26/23 at 1:20 PM with NP 1 verified the findings. On 4/25/23, at 9:14 AM Patient #1's record was reviewed. Patient #1 was admitted to the hospice on 3/6/23 with a diagnosis of Mesothelioma (type of lung cancer). The Nurses "Admit Visit" note dated 3/6/23, indicated, "...Patient/family is accepting of...MSW (Medical Social Worker)..." There was no documented evidence a MSW visited or contacted the patient or his/her family and there was no documented evidence a MSW was part of the IDT or any IDT meetings. On 4/26/23, at 10:05 AM, the Nurse Practitioner/Interim Director of Nurses (NP/IDON) was interviewed. During a concurrent review of Patient #1's record, the NP/IDON confirmed there was no documented evidence a MSW visited or contacted the patient or his/her family and there was no documented evidence a MSW was part of the IDT or any IDT meeting for Patient #1. On 4/25/23, at 2:29 PM, Patient #2's record was reviewed. Patient #2 was admitted to hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. The Nurses "Admit Visit" note dated 11/1/22 indicated, "...patient/family is accepting of...MSW..." There was also no documented evidence a MSW visited or contacted the patient or his/her family and there was no documented evidence a MSW was part of the IDT or IDT meetings. On 4/26/23, at 10:30 AM the NP/IDON was interviewed. During a concurrent review of Patient #2's record, the NP/IDON stated, "an MSW didn't go (visit Patient #2)." The NP/IDON confirmed there was no documented evidence a MSW was part of the IDT or any IDT meetings for patient #2.

Based on record review, interview, and review of hospice policy and procedures, the hospice failed to ensure the plan of care (POC) was specific to 1 of 5 Patients. (Patient 5) --- The findings include: On 04/25/23 at 8:45 AM, review of Patient 5's chart revealed the patient was admitted on 03/07/22 for hypertensive heart disease and heart failure. Review of Patient 5s initial Registered Nurse (RN) assessment on 03/07/22 revealed continuous Oxygen usage at 2 liters per nasal cannula. The plan of care (POC) revealed no documentation of the patient's Oxygen usage. During an interview on 04/26/23 at 1:20 PM, NP 1 verified the findings.

Based upon record review and interview, the hospice failed to ensure that the primary care giver (PCG) and/or patient received education and training as appropriate to their responsibilities for the care and services identified in the plan of care for two of five patients reviewed. (Patient 1 and 2) --- Record review on 04/25/23 at 10:45 AM of Patient (P) 4 revealed P 4 was admitted to the hospice facility on 05/28/21 for malignant neoplasm of prostrate. Review of P 4s medication administration record (MAR) for certification period 11/24/21 to 01/22/22 revealed Eliquis 2.5 mg 1 tablet 2 times a day to prevent thromboembolism in chronic atrial fibrillation. Review of P 4s plan of care (POC) revealed no documentation for education related to bleeding precautions. During an interview on 04/26/23 at 12:45 PM with Nurse Practitioner (NP) 1 stated, ";It (bleeding precautions) should have been added to the POC". Findings: On 4/25/23, at 9:59 AM Patient #1's record was reviewed. Patient #1 was admitted to the hospice on 3/6/23 with a primary diagnosis of Mesothelioma (a type of lung cancer). The Hospice Plan of Care for the certification period 3/6/23 to 6/3/23 indicated, "Teach and instruct on medication administration and schedule, potential side effects and adverse interactions, importance of taking medications as prescribed..." The Medication Profile indicated Patient #1 had Morphine Sulfate (narcotic used for pain relief) and lorazepam (Ativan - used to treat anxiety) ordered on 3/6/23. There was no documented evidence the patient or his/her caregiver were instructed on the use of Morphine or Ativan. The nurses visit note dated 3/10/23 indicated, "When I arrived pt (patient) appeared to look as though he may be actively dying however, after questioning his medication it appeared he was medicated, wife and family had been giving morphine and Ativan throughout the night. I advised to ease up on the medication..." On 4/26/23, at 9:23 AM the Nurse Practitioner/Interim Director of Nurses (NP/IDON) was interviewed. During a concurrent review of Patient #1's record, the NP/IDON confirmed there was no documentation indicating Patient #1's caregiver had been instructed on the use of Morphine or Ativan. A review of the Hospice's policy titled, "Medication Management," on 4/26/23, indicated, "Patient education regarding medication is provided with teaching documented in the medical record." On 4/25/23, at 4:30 PM Patient #2's record was reviewed. Patient #2 was admitted to the hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. The Hospice Plan of Care for the certification period 11/1/22 to 1/29/23 indicated, "...Medications...alclometasone...topical cream...2 times per day as needed...lesion related to Parotid CA (cancer)...Goals...Caregiver will demonstrate ability to perform necessary care and procedures..." A physician's order dated 11/1/22 indicated to perform wound care to the left cheek daily. The nurse did not make daily visits and there was no documented evidence the patient or caregiver were instructed on wound care to the patients left cheek. On 4/26/23 at 10:30 AM the NP/IDON was interviewed. During a concurrent review of Patient #2's record, the NP/IDON confirmed there was no documentation indicating the patient or caregiver were instructed on wound care.

Based on observation, interview and record review, the hospice failed to ensure the medication lists were accurate in the plan of care for three of five records reviewed (Patients #1, 2, and 5). --- Record review on 04/25/23 at 8:45 AM of P 5 revealed P 5 was admitted to the hospice facility on 03/07/22 for hypertensive heart disease and heart failure. Further review of the chart revealed no documentation in the plan of care (POC), and/or medication administration record (MAR) of oxygen usage 2 liters via nasal cannula P 5 was using. During an interview on 04/26/23 at 1:20 PM with NP 1 verified the findings. Findings: On 4/25/23, at 9:14 AM, Patient #1's record was reviewed. Patient #1 was admitted to the hospice on 3/6/23 with a diagnosis of Mesothelioma (type of lung cancer). The record included a document dated 3/7/23 with the name of Patient #1's physician, MD #1, on the top of the document indicating, "...Advise (RN #1) ok to d/c (discontinue) WIXELA...ok to Rx (prescribe)...DUONEB 0.5 MG - 3 MG/3 ML SOLUTION VIA NEBULIZER QID PRN (four times a day as needed..." the note was signed by MD #1. The Hospice Plan of Care for the certification period 3/6/23 to 6/3/23 was reviewed. The medications Wixela and Duoneb were not on the plan of care medication list. On 4/26/23 at 10:22 AM the Nurse Practitioner/Interim Director of Nurses (NP/IDON) was interviewed. During a concurrent review of Patient #1's record, the NP/IDON confirmed there was a physician's order indicating the patient was on Wixela and it was changed to albuterol, but neither medication was on the plan of care medication list and should have been. On 4/25/23, at 12:18 PM Patient #2's record was reviewed. Patient #2 was admitted to the hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. The nurses visit note dated 11/9/22 indicated, "...immodium ordered..." The plan of care medication list was reviewed and immodium was not included. On 4/26/23, at 10:30 AM an interview was conducted with the NP/IDON. During a concurrent review of Patient #2's record, the NP/IDON confirmed the nurses note indicated immodium was ordered but was not included in the plan of care medication list. On 4/26/23, the hospice's policy titled, "Medication Management," was reviewed. The policy indicated, "...Medication Profile...The medication profile is updated on an ongoing basis with new medication, changes in medication..."

Based on record review, interview, and review of the hospice policy and procedures, the hospice failed to provide documentation of infection control data reviewed and monitored by the hospice. --- The findings include: Hospice policy, entitled, ";Infection control Surveillance & (and) Management Program", revealed, ";Client Surveillance...4. The Performance Excellence team quarterly aggregated and analyzes infection surveillance data. 5. Clinical audits are performed as needed by the Performance Excellence team or designee to ensure ongoing compliance with infection control procedures and reduce the morbidity, mortality and suffering associated with infection...". Review of the hospice infection control data on 04/26/23 at 1:30 PM revealed no documentation of the infection control data being reviewed, analyzed, and/or monitored. During an interview on 04/26/23 at 2:04 PM, the Alternate Administrator stated, ";There is no Performance Excellence team. It no longer exists as of January 2023.

Based on record review, interview, and review of facility policy and procedures, the hospice facility failed to ensure that bereavement plan of care (POC) was completed for 2 of 2 bereaved patient charts reviewed. (Patient (P) 2 and 5). --- The findings include: Record review on 04/25/23 at 8:45 AM of P 5 revealed P 5 was admitted to the hospice facility on 03/07/22 for hypertensive heart disease and heart failure. Further review of the chart revealed no documentation of a bereavement POC post the patient expiring on 04/04/22. During an interview on 04/26/23 at 11:57 AM with Chaplain 1 stated, ";The care plan that I do wouldnt be very helpful because its very generic". Facility policy, entitled ";Bereavement Program" revealed, ";4. Documentation: A file is created and maintained by the Bereavement Coordinator assigned to the client. All staff involved with the patient can maintain communication with the survivors. The file includes the assessment, plan, schedule and reports of all contact attempts and visits made with the survivors...". On 4/25/23, at 12:18 PM Patient #2's record was reviewed. Patient #2 was admitted to the hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. Patient #2 died on 12/4/23. There was no documented evidence the hospice completed a bereavement plan of care for Patient #2. During an interview with the Chaplain/Bereavement Coordinator (CH/BC) on 4/26/23, at 11:35 AM, the CH/BC stated the computer care plan is very generic and not very helpful. The CH/BC was not able to provide a bereavement care plan for Patient #2.

Based on record review and interview, the hospice failed to appoint a hospice employee as an Administrator responsible for the day-to-day operation of the hospice. --- On 4/24/23 at 1:08 PM, during an interview with the Chief Operating Officer (COO), the COO stated the "true Administrator" was the CEO, and she was not available. On 4/26/23, at 4:50 PM, the document titled, "Annual Administrator of Record," revealed, "As the President and CEO...I hereby appoint the following as the Administrator of Record...CEO (e.g. name of the CEO)" was indicated. On 4/26/23 at 4:55 PM, during an interview with the COO, the COO stated the CEO who designated herself/himself as the hospice Administrator was "not an employee" of the hospice.

Based on record reviews and interview, the hospice failed to provide documentation of a discharge summary sent to the patients physician post discharge from the hospice for 2 of 2 Patients. (Patient #3 and #4) --- The findings include: Record review on 04/25/23 at 12:54 PM revealed Patient #3 was admitted on 03/02/22 for malignant neoplasm of the lungs. There was no documentation of a discharge summary completed and/or sent to the attending physician post the patient's discharge on 05/30/22 to seek aggressive treatment. During an interview on 04/26/23 at 11:17 AM, Nurse Practitioner (NP) #1 stated, ";I dont know where we would document that in the chart." Record review on 04/25/23 at 12:54 PM revealed Patient # 4 was admitted on 05/28/21 for malignant neoplasm of the prostrate. There was no documentation of a discharge summary completed and/or sent to the attending physician post Patient #4s discharge on 01/01/22 by the hospice for cause. During an interview on 04/26/23 at 12:45 PM, NP #1 verified the findings.

Based on record reviews, interview, and review of hospice policy and procedures, the hospice staff failed to dispose of controlled drugs for 2 of 4 patients. (Patient #2 and #5) --- The findings include: Facility policy, entitled ";Management and Disposal of Controlled Substances in the Home" revealed, ";D. In the State of South Carolina, the Hospice nurse must dispose of any and all Controlled Substance of Schedule II, III, IV and V in the home with a witness present. The nurse must record the medication and strength as well as the quantity of medication that was destroyed and obtain a witness signature to verify. This form will be incorporated into the EHR (electronic health record)...". Record review on 04/25/23 at 8:45 AM of P 5 revealed P 5 was admitted to the hospice on 03/07/22 for hypertensive heart disease and heart failure. Review of P 5s medication administration record (MAR) revealed lorazepam 1 tablet every 6 hours as needed and morphine 0.25 ml (milliliters)-0.50 ml every 2 hours as needed. Review of the electronic medical record revealed P 5 expired on 04/04/22 with a nursing note that the facility was unable to open for review and/or provide documentation of disposal of the controlled medications at P 5s home. During an interview on 04/26/23 at 1:20 PM, NP 1 verified the findings. Findings: On 4/25/23, at 12:18 PM, Patient #2's record was reviewed. Patient #2 was admitted to the hospice on 11/1/22 with a diagnosis of Cancer of the Parotid (salivary) Gland. The Nurses visit note dated 12/4/22 indicated Patient #2 "...passed away peacefully at home...Medications were wasted with (name of pharmacy) Pharmacy..." There was nt medication disposal form in Patient #2's record. On 4/26/24, at 11:00 AM, the Nurse Practitioner/Interim Director of Nurses (NP/IDON) was interviewed. During a concurrent review of Patient #2's record, the NP/IDON stated there was no documented evidence the medications were disposed of. The NP/IDON confirmed the findings were not according to the hospice's policy.