Every finding on record at Interim Healthcare of the Twin Cities, Inc.

Based on interview and document review, the agency failed to comprehensively assess the bereavement needs of family and other individuals involved with patients and incorporate them into the plan of care for 5 of 14 patients (P3, P5, P14, P10, P13) in the sample. --- P3's initial certification and plan of care (POC), dated 8/26/22, identified P3 admitted to hospice on 8/26/22, had diagnoses of Alzheimers disease with early onset, dementia with other behavior disturbances, and major depressive disorder. The initial social worker (SW) visit dated 8/29/22, identified the patient was married with five children (one deceased). The subsequent social service, nursing, and chaplain visits did not identify any information about the children. None of the children had bereavement risk assessments completed. The initial skilled nurse visit note identified a bereavement risk assessment was completed for the husband, who was primary caregiver, with a score of 22 indicating low bereavement risk. P5s initial certification and POC dated 6/13/23, identified P5 admitted to hospice on 6/13/23 and had a diagnosis of Alzheimers disease with late onset. The SW initial assessment dated 6/13/23, identified son (FMA) as the caregiver bereaved. Bereavement score was 14 indicating a low risk. The narrative note identified P5 had two children that were local and supportive. The initial nursing visit note (SNV) identified FMA as caregiver and a bereavement risk score of 19 indicating low risk. SNV narrative note identified P5 had two sons FMA and FMB. FMA lived nearby and visited the patient often. FMB lived in Hawaii and was recently in town visiting P5. FMA reported FMB was shocked at how much P5 had declined since he saw her last over Christmas in 2022. FMA stated he noticed a decline within the last three to four months as well. There was no further information regarding FMB and no initial bereavement assessment was completed. A bereavement risk assessment was done for FMA by Chaplain on 6/14/23, with a score of 18 indicating low risk. No bereavement risk assessment or mention was made of FMB. Subsequent assessments did not identify a bereavement risk assessment for FMB. P14s initial certification and POC dated 3/24/23, identified admission to hospice on 3/24/23. Diagnoses included senile degeneration of brain and dementia. The SNV initial assessment dated 3/27/23, identified bereavement assessments completed on son FMF, daughter FMG and daughter FMH. All three were assessed as having low risk for bereavement. Review of the SW initial visit note dated 3/29/23, identified P14 had 6 children, FMF, FMG and FMH who live nearby and are the primary caregivers. One of the other children (FMI) also lives in metro, one (FMJ) lives in Ohio and one (FMK) in China. There was no initial bereavement assessment or any information regarding FMI, FMJ and FMK involvement. P10s initial certification and POC dated 7/20/23, identified P10 was admitted to hospice on 7/20/23, diagnoses included malignant neoplasm of pancreas, bed confinement status, and depression. The initial medical SW visit dated 7/24/23, identified P10 had a wife and two stepchildren. The initial skilled nurse visit note included a bereavement risk assessment completed for P10's wife who was the primary caregiver with a score of 23 indicating moderate risk. Neither of the stepchildren had bereavement risk assessments completed. P13s initial certification and POC dated 6/9/23, identified P13 admitted to hospice on 6/9/23, with a diagnosis of leukemia. The initial medical SW visit dated 6/9/23, identified P13 had three adult children and included a bereavement assessment. The bereavement risk assessment was completed for one of P13s children who was the primary caregiver with a score of 23 indicating moderate risk. The two other children did not have bereavement risk assessments completed. During an interview on 8/7/23, at 10:23 a.m. the supervisor of bereavement services stated the hospice care team is expected to ";cast a wide net" when assessing for bereavement needs of a patients family and/or friends. Spiritual care director specified the patients hospice care team should look wider than just the primary caregiver when assessing for bereavement support needs.

Based on interview and document review the agency failed to consistently implement a system to identify all infectious and communicable disease to ensure they implemented appropriate actions and precaution when necessary for 1 of 14 patients (P8) who had two infections while on hospice that were not identified and tracked. This had the potential to affect all hospice patients receiving hospice care. --- Findings include: P8s Hospice Certification and Plan of Care (POC) for the certification period 5/19/23 to 8/16/23, identified P8 was admitted to the hospice agency on 5/19/23, with a diagnosis of encephalopathy. The POC identified resident resided at a skilled nursing facility. P8's skilled nursing visit (SNV) note dated 6/12/23, identified P8 had right eye matter and could only open the eye at approximately 30%. Included in the note P8 tested positive for C-Diff (clostridium difficile a bacterium that causes and infection of the large intestine (colon). Symptoms can range from diarrhea to life-threatening damage to the colon). P8 was started on antibiotics Flagy and Vancomycin (antibiotics used to treat C-Diff). SNV note dated 6/26/23, identified ongoing loose odorous stools despite completion of antibiotic treatment. Antibiotic treatment was extended. SNV note dated 7/3/23, identified loose foul-smelling stools continued. Physician ordered Vancomycin twice daily for 7 days. The note also identified ";redness to right eye, unable to open right eye due to drainage. Slight crusty drainage noted to left eye". Physician ordered Erythromycin ointment and Tobramycin drops (antibiotic ointment and drops used for eye infection) for 7 days. A SNV note dated 7/10/23, identified physician was notified of continuing foul odor stools and ordered Vancomycin 1 time daily to continue for 1 week. A SNV note dated 7/17/23, identified physician was notified of patient complaining of stomach pain and continued foul-stools. Vancomycin was continued for 1 week. The facility infection control logs for June and July of 2023, did not identify the C-Diff or the eye infection, cultures performed, signs/symptoms, treatment or if resolved. During an interview on 8/10/23,at 12:51 p.m.; with the chief operating office stated the above findings were not identified on the agency infection control logs. The policy Exposure Control Plan: Recognizing and Reporting Home Acquired Infectious Conditions in Patients, updated 7/11/2023, identified patients that develop infection 72 or more hours after admission to hospice care is reported and trended.