Every finding on record at Jomel Palliative and Hospice Care, Inc.

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 5 of 14 (36%) clinical records reviewed revealed that the agency did not ensure that each patient had a comprehensive assessment within 5 days of the date of election. Clinical Record 2: The patient elected hospice on 08/29/2024, an initial nursing assessment was done on 08/29/2024 and the chaplain was declined. The Medical Social Worker's initial assessment was completed on 09/13/2024, which was 15 days after the date of the election. Clinical Record 3: The patient elected hospice on 11/17/2023 an initial nursing assessment was done on 11/17/2023 and the initial spiritual assessment was done on 11/22/2023. The Psychosocial assessment was not completed until the social worker assessment done on 11/27/2023 which was 10 days after the date of the election. Clinical Record 6: The patient elected hospice on 11/21/2023 an initial nursing assessment was done on 11/21/2023 and the initial spiritual assessment was on 11/24/2023. The Psychosocial assessment was not completed until the social worker assessment done on 11/27/2023 which was 6 days after the date of the election. Clinical Record 8: The patient elected hospice on 06/07/2024 an initial nursing assessment was done on 06/07/2024 and the initial spiritual assessment was done on 06/10/2024. The Psychosocial assessment was not completed until the social worker assessment done on 06/14/2023 which was 7 days after the date of the election. Clinical Record 12: The patient elected hospice on 07/11/2023 an initial nursing assessment was done on 07/11/2023 and an initial spiritual assessment was done on 07/12/2023. The Psychosocial assessment was not completed until the social worker assessment done on 07/17/2023 which was 6 days after the date of the election. During an interview with the administrator and Director of Nurses on 10/09/2024, they stated that they have a new scheduler and are planning on doing additional education with the scheduler and the social worker.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: Prescription and over-the-counter (OTC) drugs; Supplements; Herbal remedies; and Other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by interview and observation. In 1 of 3 (33%) home visits, it was revealed the agency did not ensure the drug profile was updated with changes in the medication profile. Home Visit 2: During a joint visit with the Social Worker (personnel record 3) on 10/09/2024, the patient stated that she was taking her new medication due to a burning sensation when she had the urge to urinate. A closer examination of the medication revealed that the Mybretriq 25 mg, ordered on 09/26/2024, was not on the medication list, not documented in a comprehensive assessment, dated 10/02/2024 and not discussed in the Interdisciplinary Group meeting, dated 10/03/2024. During an interview with the Director of Nurses on 10/09/2024 she stated that it should have been included in the comprehensive assessment, also stated that it was a documentation issue, and she would do more education with the staff.

It is required that hospice “core” services are substantially provided directly by hospice employees in a manner consistent with acceptable standards of practice. “Core” services include nursing services, medical social work, and counseling. THIS IS A CMS CONDITION LEVEL DEFICIENCY. This condition of participation was not met as evidenced by personnel record review and interviews with the Owner, Administrator and the Director of Nurses which revealed issues with the agency's ability to provide core services in the following areas: Failure to ensure the core services were provided directly by hospice employees. Core services for nursing services, medical social services, and counseling was not being provided by hospice employees. These core services were being provided by 1099 employees {HCDT.2. I/L587}. The cumulative effect of this deficiency has resulted in the hospice organization's inability to ensure the provision of quality of care for the Condition of Participation CFR 418.64: Core Services. The collective deficient practice illustrated systemic process failures that had the potential to affect all patients receiving hospice care and services from the agency.

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; The frequency of service delivery. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 2 (100%) clinical records reviewed revealed the agency did not ensure that the bereavement plan of care included the frequency of service delivery. Document 1: The agency's policy titled Hospice Policy and Procedure Manual Bereavement Counseling Services states in part "j. Maintain documentation of all bereavement interventions or attempts, which will include: i. A bereavement progress note, and ii. An update to the bereavement plan of care, and iii. If applicable, a copy of the mailing (or name of mailing on a progress note with a master copy kept in binder), invitation, funeral service notice, or other material provided to or by the bereaved". Clinical Record 11: The patient elected hospice on 04/02/2023, an initial bereavement assessment was completed. The date of death was 01/12/2024, a bereavement plan of care was present in the electronic medical record but did not contain a frequency of services offered or documentation that a bereavement plan of care was followed. There was no documented evidence of the bereavement progression in the clinical record. Clinical Record 12: The patient elected hospice on 07/11/2023, an initial bereavement assessment was completed. The date of death was 05/09/2024, a bereavement plan of care was present in the electronic medical record but did not contain a frequency of services offered or documentation that a bereavement plan of care was followed. There was no documented evidence of the bereavement progression in the clinical record. During an interview with the Director of Nurses on 10/10/2024, she stated that the bereavement program recently changed to the EMR, and more education is needed.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The clinical record may be maintained electronically. THIS IS A CMS CONDITION LEVEL DEFICIENCY This CONDITION was not met as evidenced by a review of clinical records, documents, and interviews revealed the hospice: Failed to ensure the clinical record included documentation of a written and signed recertification of the terminal illness completed by the medical director no later than two (2) calendar days after the first day of each benefit period and no more than 15 days before the next benefit period began{HCPC.6.I/L676}; Failed to ensure that a complete discharge summary was completed and provided to the attending physician {HCDT.39.I/L683}; and Failed to ensure that a discharge summary was provided to the hospice receiving the patient or the community attending physician{HCDT.40.I/L684}. The cumulative effect of these systemic problems resulted in the hospice agency's inability to ensure the provision of quality health care in a safe environment for the condition of participation CFR 418.104: Clinical Records. The deficient practice illustrated systemic process failures that had the potential to affect all patients cared for by the agency.

It is required that the hospice medical director or physician-designee provides written and signed recertification of the terminal illness to meet the hospice care benefit requirement. Recertification is completed no later than two (2) calendar days after the first day of each benefit period, and no more than fifteen (15) days before the next benefit period begins. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 12 (17%) clinical records reviewed for patients requiring a physician's recertification of terminal illness revealed that the agency did not ensure that the hospice medical director completed the recertification of terminal illness. Document 3: The agency's policy titled Hospice Policy and Procedure Manual Certification of Terminal Illness states in part "The narrative associated with the 3rd benefit period recertification and every subsequent recertification will include an explanation of why the clinical findings of the face-to-face encounter support a life expectancy of 6 months or less. Followed by the Physician attesting that by signing, the Physician confirms that he/she composed the narrative based on his/her review of the patient's medical record. Followed by the Physician's signature. . Clinical Record 1: The patient elected hospice services on 09/20/2022. The clinical record review revealed that a Recertification of Terminal Illness for periods 11/19/22 to 1/17/23, 1/18/23 to 3/18/23, 3/19/23 to 5/17/2023, 5/18/23 to 7/16/23, 7/17/23 to 9/14/23, 9/15/23 to 11/13/23, 11/14/23 to 1/12/24, 1/13/24 to 3/12/24, 3/13/24 to 5/11/24, and 5/12/24 to 7/10/24 included all required narrative, yet lacked evidence of a physician signature. Clinical Record 9: The patient elected hospice services on 09/12/2022. A review of the clinical record revealed there was no documented evidence of the written Recertification of Terminal Illness for the benefit period 06/03/2023 to 08/01/2023. During an interview with the administrator on 10/09/2024, she stated that she does not know why the recertification is missing.

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: copy of the hospice discharge summary; The patient's record, if requested. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 1 (100%) clinical record reviewed in which the patient was a live discharge revealed that that agency did not ensure that a complete discharge summary was completed and provided to the attending physician. Document 2: The agency's policy titled Hospice Policy and Procedure Manual Discharge from Hospice Care stated in part "Clinical Record J. If a patient is discharged from hospice, the hospice must forward to the patient's attending physician, a copy of each of the following: 1. The hospice Discharge Summary, which includes: a. A summary of the patient's stay including treatments, symptoms and pain management. b. The patient's current plan of care. c. The patient's latest physician orders and d. Any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility". Clinical Record 13: The patient elected hospice on 04/12/2024. The patient signed a revocation of hospice services on 08/29/2024. There was no documented evidence in the clinical record of a discharge summary or that a discharge summary sent to the attending physician. During an interview with the Director of Nurses on 10/10/2024 regarding the discharge summary, she stated that they have identified that the discharge summary was not being generated and have a new process in place to implement with the next discharge.

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; the patient’s latest physician orders; any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review, document review and interview. In 1of 1 (100%) clinical records reviewed in which the patient elected a transfer to another hospice revealed that the agency did not ensure that a discharge summary was provided to the hospice receiving the patient or the community attending physician. Document 2: The agency's policy titled Hospice Policy and Procedure Manual Discharge from Hospice Care stated in part "Clinical Record J. If a patient is discharged from hospice, the hospice must forward to the patient's attending physician, a copy of each of the following: 1. The hospice Discharge Summary, which includes: a. A summary of the patient's stay including treatments, symptoms and pain management. b. The patient's current plan of care. c. The patient's latest physician orders and d. Any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility". Clinical Record 14: The patient elected hospice on 08/02/2023. The patient requested a transfer to another hospice on 12/20/2023. The clinical record contained no documented evidence of a discharge summary or coordination with the receiving hospice agency and the attending physician. During an interview with the Director of Nurses on 10/10/2024 regarding the discharge summary, she stated that they have identified that the discharge summary was not being generated and have a new process in place to implement with the next discharge.