Every finding on record at Kingfisher Health - Dallas, LLC

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. This standard was not met as evidenced by a review of clinical records. 6 of 8 (75%) of records reviewed revealed that the agency did not ensure the medication profile was complete and included all supplements and alternative treatments that affect drug therapy. Record #6 was reviewed and identified the patient elected hospice care on 3/11/2022. The skilled nursing (SN) assessment dated 3/11/2022, documented that the patient was oxygen dependent. The plan of care (POC) dated 3/11/2022, contained orders for oxygen "2L/min via NC." The medication profile dated 3/11/2022, did not include oxygen. Record #3 was reviewed and identified the patient elected hospice care on 8/2/2022. The POC dated 8/2/2022, included orders for oxygen "2L/min via NC continuous." The medication profile dated 8/2/2022, did not include oxygen. Record #7 was reviewed and identified the patient elected hospice care on 7/15/2022. The POC dated 7/15/2022, included orders for oxygen "2L/min via nasal cannula (NC)." The medication profile dated 7/15/2022 through 7/25/2022, did not include oxygen. Record #4 was reviewed and identified the patient elected hospice care on 5/17/2022. The SN visit note dated 5/22/2022, read in part, "gave Tylenol 500 mg PO for fever." A review of the record revealed no orders for Tylenol. The medication profile did not include Tylenol. Record #1 was reviewed and identified the patient elected hospice care on 4/14/2022. The SN assessment dated 4/14/2022, documented the patient was oxygen dependent. The POC dated 4/14/2022, contained orders for oxygen "2L/min via NC continuous." The medication profile dated 4/14/2022 did not include oxygen. Record #0 was reviewed and identified the patient elected hospice care on 4/14/2022. The POC dated 4/14/2022, included orders for oxygen "2-4L/min via NC PRN for comfort and to maintain O2 sats at >88%." The SN visit note dated 4/28/2022, documented that oxygen "was placed on patient for comfort." The medication profile dated 4/14/2022 through 4/29/2022, did not include oxygen. 6 of 8 (75%) of records revealed that the agency did not ensure that the medication profile was complete and included all supplements and alternative treatments that affect drug therapy.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. This standard was not met as evidenced by a review of clinical records. 1 of 8 ( 12%) records reviewed revealed the hospice did not ensure that the plan of care specified care and services necessary to meet the needs of the patient. Record #1 was reviewed and identified the patient elected hospice care on 4/14/2022. The skilled nursing (SN) assessment dated 4/14/2022, documented in part, "Stage 1 ulceration to buttocks...Mepilex currently in place...Son or DIL will change Q72 hours and SN will assist with changing dressing at SNV." The plan of care dated 4/14/2022, did not include the orders for the dressing changes or the Mepilex. 1 of 8 ( 12%) clinical records revealed that agency did not ensure that the plan of care specified care and services necessary to meet the needs of the patient.

It is required that all hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire. This standard was not met as evidenced by a review of clinical records. 2 of 8 (25%) records reviewed revealed the hospice did not ensure that medical social services were provided according to the plan of care. Record #4 was reviewed and identified the patient elected hospice care on 5/17/2022. The start of care plan of care (POC) dated 5/17/2022 through 8/14/2022, and the recertification POC dated 8/15/22 through 11/12/2022, each ordered medical social worker "2 times per month." A review of the record revealed that medical social worker (MSW) visits were documented as completed on 5/21/22, 6/28/22, 7/20/22 and 8/27/22, the actual frequency was 1 time per month. There was no evidence of documented missed visits or additional physician orders changing the frequency of visits. Record #1 was reviewed and identified the patient elected hospice care on 4/14/2022. The POC dated 4/14/2022 through 6/12/2022 ordered "Medical Social Worker 2/mo." A review of the record revealed the MSW completed the initial visit on 4/15/2022. There was no evidence of a second MSW visit for the month of April. There was no evidence of a documented missed visit or an additional physician order changing the frequency of visits. 2 of 8 (25%) of records reveal that the agency did not ensure that the medical social services were provided according to the plan of care.

It is required that the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including the drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records. 1 of 8 (12%) of records reviewed revealed that the agency did not ensure the plan of care included the drugs necessary to meet the needs of the patient. Record #4 was reviewed and identified the patient elected hospice care on 5/17/2022. A review of the record revealed the skilled nursing visit note dated 5/22/2022, read in part, "gave Tylenol 500 mg PO for fever." The medication profile did not include Tylenol. A review of the record revealed no order for Tylenol.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by a review of clinical records. 3 of 5 (60%) records reviewed of patients receiving aide services, revealed the hospice did not ensure that aide care plans included specific instruction to the aide related to the care of the patient receiving oxygen. Record #7 was reviewed and identified the patient elected hospice care on 7/15/2022. The plan of care (POC) dated 7/15/2022, ordered oxygen "2L/min via nasal cannula PRN." The skilled nursing (SN) visit noted dated 7/24/2022 documented that the patient was wearing oxygen and wanted to smoke. The aide care plan dated 7/15/2022, was missing instructions to the aide related to the patient's use of oxygen and smoking. Record #3 was reviewed and identified the patient elected hospice care on 8/2/2022. The POC dated 8/2/2022, ordered oxygen "2L per NC continuous." The aide care plan dated 8/2/2022, was missing instructions to the aide related to the patient's use of oxygen. Record #1 was reviewed and identified the patient elected hospice care on 4/14/2022. The POC dated 4/14/2022, ordered "continuous oxygen via NC." The SN initial comprehensive assessment dated 4/14/2022, documented that the patient was oxygen dependent. The aide care plan dated 4/14/2022, assigned the task "complete shower", but was missing instruction to the aide related to the patient's use of oxygen. 3 of 5 (100%) applicable clinical records reveal that the agency did not ensure that aide care plans included specific instruction to the aide related to the care of patient receiving oxygen.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care. This standard was not met as evidenced by a review of clinical records. 2 of 5 (40%) records reviewed of patients receiving aide services revealed the hospice agency did not ensure that the aide provided services included on the plan care. Record #7 was reviewed and identified the patient elected hospice care on 7/15/2022. The plan of care dated 7/15/2022, ordered hospice aide services "2 x weekly." A review of the clinical record revealed there were no aide services provided the week of 7/15/2022 through 7/16/2022, the actual frequency was 0 times one week. Record #0 was reviewed and identified the patient elected hospice care on 4/14/2022. The plan of care dated 4/14/2022, ordered hospice aide services "2 x weekly." A review of the clinical record revealed there were no aide services provided the week of 4/14/2022 through 4/16/2022, the actual frequency was 0 times one week. 2 of 5 (40%) clinical records reveal that the hospice agency did not ensure that the aide provided services included on the plan care.