Every finding on record at Interim Healthcare San Diego LLC

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered, and the frequency of service delivery. This standard was not met as evidenced by clinical record review, document review, and interview. The agency's policy, "Interdisciplinary Group Services (Dated: 2008)", stated in part, "5. Following the death of the patient, the identified bereavement needs of the survivor(s) are documented, and a bereavement plan of care is developed." 2 of 2 (100%) clinical records reviewed for patients that expired, the agency did not ensure that the bereavement services reflected the needs of the bereaved per a bereavement plan of care (POC). Clinical Record 5: The patient elected the hospice benefit on 2/7/23. The patient expired on 2/20/23. The clinical record did not include evidence of a post-death bereavement plan of care for the survivor(s). Clinical Record 6: The patient elected the hospice benefit on 1/15/22. The patient expired on 4/3/23. The clinical record did not include evidence of a post-death bereavement plan of care for the survivor(s). Upon interview on 4/25/23, the Administrator, the Interim Alternate Director of Clinical Services, and the Bereavement Coordinator reviewed the above findings and agreed the records lacked a survivor(s) bereavement POC.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum physician certification and recertification of terminal illness as required. This standard was not met as evidenced by clinical record review, document review, and interview. The agency's policy, "Certification of Terminal Illness" [2018], stated in part, "For the purpose of the certification (first 90-day period if this is their first hospice admission...The Hospice Medical Director/Hospice Physician and the individual's attending physician (if any) signs a statement that he/she has certified the terminal illness in accordance with applicable law or regulation or benefit requirements...The Hospice Medical Director/Hospice Physician or the patient's attending physician (if any) documents a brief narrative explanation of the clinical finding that support a life expectancy of six months or less if the terminal illness runs its normal course and is based on review of the patient's medical record or examination of the patient...Written certification of terminal illness is provided by the Hospice Medical Director/Hospice Physician and the attending physician (if any) within two (2) calendar days of the individual's election of hospice care." 1 of 14 (7%) clinical records reviewed, the agency did not ensure that a written initial certification of terminal illness was completed per the agency's policy. Clinical Record 3: The patient elected the hospice benefit on 11/21/22. There was evidence of a verbal CTI on the initial interdisciplinary group (IDG) plan of care dated 11/21/22. A CTI for the 2nd benefit period (2/19/23 to 5/19/23) was present. The record did not include evidence of a written Certification of Terminal Illness (CTI) for the 1st benefit period. Upon interview on 4/26/23, the Administrator and Interim Alternate Director of Clinical Services reviewed and agreed the agency did not ensure that a written initial certification of terminal illness was completed.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice must forward to the receiving facility, a copy of the hospice discharge summary; and the patient’s record, if requested. This standard was not met as evidenced by clinical record review, document review, and interview. The agency's policy, "Transfer, Benefit Revocation and Discharge" [2013], stated in part, "When the patient/family is transferring to another hospice provider, the designated RN ensures that the following information is provided to the receiving provider...The hospice discharge summary...If requested, a copy of the patient/family record." 1 of 1 (100%) clinical records reviewed for a patient that was transferred to another Medicare facility, the agency did not ensure that the discharge summary was forwarded to the receiving facility. Clinical Record 8: The patient elected the hospice benefit on 4/13/23. The patient revoked the hospice benefit on 4/20/23 to pursue aggressive treatment. The clinical record did not include evidence of the discharge summary being forwarded to the receiving facility (hospital). Upon interview on 4/26/24, the Administrator and Interim Alternate Director of Clinical Services (DCS) reviewed and agreed the records above lacked evidence that the discharge summary was forwarded to the receiving facility (hospital). The Interim Alternate DCS reported the patient record was given to the family to bring to the hospital.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary, and the patient's record, if requested. This standard was not met as evidenced by clinical record review, document review, and interview. The agency's policy, "Transfer, Benefit Revocation or Discharge" [2013], stated in part, "In the event that the patient has revoked the benefit or is seeking discharge from hospice services, the Hospice DHCS or designated RN ensures that the following information is forwarded to the patient's attending physician or physician designee... A copy of the hospice discharge summary; and... If requested, a copy of the patient/family record." 2 of 2 (100%) clinical records reviewed for patients that revoked the hospice benefit or were discharged, the agency did not ensure that the discharge summary was forwarded to the patient's attending physician. Clinical Record 7: The patient elected the hospice benefit on 3/10/21. The patient was discharged from hospice care on 2/27/23 due to an extended prognosis. The clinical record did not include evidence that the discharge summary was forwarded to the attending physician. Clinical Record 8: The patient elected the hospice benefit on 4/13/23. The patient revoked hospice care on 4/20/23 to pursue aggressive treatment. The clinical record did not include evidence that the discharge summary was forwarded to the attending physician. Upon interview on 4/26/24, the Administrator and Interim Alternate Director of Clinical Services reviewed and agreed the records lacked evidence that the discharge summary was forwarded to the attending physician.

It is required that the hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by observation, document review, and interview. The hospice's policy, "Provision of Hospice Services to Residents of a SNF/NF or ICF/MR" [2013], stated in part, "The IDG plan of care for a patient who resides in a facility also denotes...Which provider is responsible for providing which functions as stated in the plan of care." 1 of 1 (100%) home visit observed for a patient residing in a skilled nursing facility (SNF), the agency did not ensure that the plan of care specified which provider was responsible for performing specific functions. Home Visit 1/Clinical Record 1: The patient elected the hospice benefit on 3/23/23. The patient resided at a SNF. During the home visit on 4/25/23, a review of the facility's hospice binder and plan of care revealed no documented evidence of which provider was responsible for performing the functions that were agreed upon and included in the POC. Upon interview on 4/25/23, the Administrator and Interim Alternate Director of Clinical Services reviewed and agreed that the record above lacked specifically which provider was responsible for performing the functions that were agreed upon and included in the POC.

It is required that hospice staff, in coordination with SNF/NF or ICF/IDF staff, ensures orientation and training of staff providing care to hospice patients. At a minimum, the orientation and training includes introduction to hospice philosophy, hospice policies and procedures regarding methods of comfort, pain control, and symptom management, principles about death and dying, and individual responses to death, patient rights, and appropriate forms and record keeping requirements. This standard was not met as evidenced by document review and interview. The agency's policy, "Provision of Hospice Services to Residents of a SNF/NF or ICF/MR" [2013], stated in part, "The agency confirms that the staff of the facility in which the patient resides have received orientation and training to hospice care...The Hospice DHCS confirms that the staff of the facility in which the patient resides has received orientation and training related to hospice care which included at least the following topics, or provides for such...Hospice philosophy...Policy and procedures regarding...Pain and symptom management...Comfort interventions...Principles of understanding the death and dying process...Individual responses to death...Hospice patient rights and responsibilities... Appropriate documentation and recording keeping requirements." During a review of the Skilled Nursing Facility (SNF) contract for routine, respite, and inpatient hospice care, the agency did not provide documented evidence that the facility's staff providing care to hospice patients received orientation and training to hospice per the agency's policy. Upon interview on 4/24/23, the Administrator and Interim Alternate Director of Clinical Services reviewed and agreed the agency did not ensure that the facility's staff received orientation and training. During review of a Skilled Nursing Facility (SNF) Contract for Routine, Respite, and Inpatient Hospice care, the agency lacked having the evidence to show that the SNF had received orientation and training of staff providing care to hospice patients.