Every finding on record at Kindred Hospice Missouri, LLC

Upon patient record review, 2 of 19 (Patient #1, #8) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1-The plan of care includes a goal that the patient/caregiver will demonstrate required knowledge to manage intermittent straight catheterization. This is not applicable to the plan of care as the patient did not have intermittent catheterizations. Patient #8-The plan of care includes a goal that the patient/caregiver will understand irrigation of the urinary catheter. This is not applicable to the plan of care as the patient did not have orders for catheter irrigation.

Upon patient record review, 2 of 19 (Patient #1, #8) did not evidence the plan of care included all orders necessary for the palliation and management of the terminal illness and related conditions, including specific orders for treatments. Patient #1-On 09/07/23 the nurse documents the patients diet was changed from regular to mechanical soft. The plan of care was not updated with orders for a mechanical soft diet. Patient #8-The plan of care includes orders to assess urinary catheter site for s/s infections. The orders are not specific to the catheter type, size, balloon size and frequency to be changed.

Upon patient record review, 2 of 19 (Patient #8, #11) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #8-On 08/24/23 the initial Chaplain evaluation visit indicated the patients religious preference was Methodist. The revised plan of care/IDG documentation on 08/30/23 does not address the patient's religious preference. The section for religious preference is blank on the IDG documentation. Patient #11-The Chaplain visited the patient on 08/16/23, 8/28/23 and 9/11/23 and identified spiritual needs for monthly visits. The IDG notes on 08/30/23 and 09/13/23 document the patient declines Chaplain visits.

Upon patient record review, 3 of 19 (Patient #1, #9, #11) did not have evidence in the patient record that hospice aide assignments and duties are: • Complete/accurate written patient care instructions prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 Patient #1-The Aide care plan does not include fall precautions which are applicable to the patient. Patient #9-The Aide care plan does not include aspiration precautions which are applicable to the patient. Patient #11-The Aide care plan includes Oxygen precautions. Oxygen precautions are not applicable to the plan of care as the patient is not on oxygen.

Upon patient record review, 1 of 19 (Patient # 6) did not evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group and included in the plan of care. Patient #6-On a Home visit with the Aide at the Skilled Nursing Facility, the Aide was observed removing a dressing from the patients left heel after consultation with the Facility Director of Nursing. The Hospice Aide care plan assignment includes an assignment from the Hospice RN that the patient has a wound dressing that needs to be left in place.

Upon patient record review, 2 of 19 (Patient #1, #4) did not have evidence that all entries are accurate. Patient #1- On 09/07/23 the nurse documents the patient sustained a fall on 08/05/23 resulting in a skin tear. The nurse also documents the PA visited the patient on 08/06/23 and decreased the patients Oxycodone. The August dates are in error and the correct dates were 09/05/23 for the fall and 09/06/23 for the PA visit. Patient #4-On 07/12/23 the Nurse Practitioner performed a face to face and documented the patient has a pressure ulcer to the left heel. Upon chart audit and interview with leadership, the documentation is inaccurate as the patients left heel wound was inactivated/healed 06/22/23.