Every finding on record at La Bella Vita Hospice, Inc.

Observed in Record Review. In review of RR#10 a discharge for extended prognosis, the organization was not able to show documentation that the Notice of Medicare Non-Coverage was presented and signed at least 2 days prior to discharge. Per the DPCS the form was presented to the patient prior to discharge but was left in the patient's home and a copy was not brought back to the office for the patient record.

Observed in Record Review. In 2 of 11 patient records reviewed, The organization failed to conduct and document a patient-specific comprehensive assessment as related to the patient's need for physical, psychosocial, emotional and spiritual care. For example: in review of RR#4, and RR#5 it was noted that the MSW services were declined and therefore the MSW comprehensive assessment was not completed. Later the services of the MSW were requested and visits were made, however the there was no comprehensive psychosocial assessment completed at the time services were initiated. This observation was reviewed with the CEO and DPCS.

Observed in Record Review. In 6 of 11 patient records reviewed, the organization failed to develop a plan of care based on information from the patient's comprehensive assessment to reflect the patient and family goals and interventions. For example: upon review of RR#7 the patient documentation from the comprehensive assessment noted the patient had issues with diarrhea and weight loss, yet there were no goals and interventions to address the GI or nutritional status established. In RR#6 the patient had a primary terminal diagnosis of hepatic failure with issues with confusion, however there was no care plan to address neuro status established. In RR#8 the documentation notes safety concerns related to the patient's uncontrolled movements related to Huntington's, yet there was no goals and interventions to address patient safety established. Also in RR#8 the patient was noted to have difficulty with swallowing, yet there was no goals and interventions to address nutritional status and swallowing. Similar lack of goals and interventions to address issues noted in the patient record can be seen in RR#9, HV#2 and HV#3. These observations were reviewed with the CEO and the DPCS.

Observed in Record Review. In 5 of 11 patient records reviewed, the organization failed to provide at detailed statement of the scope and frequency of services necessary to meet the patient and family needs. For example: In review of RR#4, RR#5, and RR#6 the MSW was providing services to the patient yet the plan of care did not have a frequency for the MSW established. In RR#8 the chaplain was providing services to the patient yet there was no frequency for spiritual care established. In RR#10 the chaplain was scheduled 1 time a month, yet there were only 4 visits documented over 12 months of service. In RR#9 the plan of care had an established hospice aide frequency of 2 times a week, however documentation in the record notes that aide services had been canceled. These observations were reviewed with the CEO and DPCS.

Observed in Record Review. In 9 of 9 patient records reviewed, that were active patients, the organization failed to ensure that the plan of care included all instructions needed for the palliation and management of the terminal illness and related conditions. For example: in all records reviewed the patient was ordered in the comfort kit morphine 100mg/5ml 0.25ml q 2 hours as needed for pain/shortness of breath, may increase by 0.25ml up to 2 ml if needed to promote comfort. There were no specific instructions for the patient/caregiver to know which dose to give for what specified pain level. This observation was reviewed with the CEO and DPCS, where the leadership promptly conferenced with the medical director to provide clarification to the comfort kit order.

Observed in Record Review. In 4 of 6 patient records reviewed, that were receiving hospice aide services, the organization failed to ensure the services rendered by the aide were conducted according to the plan of care ordered. For example: In RR#6 and RR#7, the aide was assigned to give a bed bath but documentation noted that on multiple visits a shower was given. In RR#8, the aide was assigned to give a shower, however documentation on multiple occasions note that a bed bath was provided. There was no indication in the record that these changes in care provided was reported to and approved by the RN. In HV#1 the aide plan of care ordered a bed bath, during home observation the aide conducted the patient's bath utilizing a spray bottle with a cleansing solution provided by the caregiver. The patient was sprayed with the solution and the aide wiped to solution off with a towel. The aide noted that this was per the caregivers request and the caregiver confirmed. There was no indication that the aide had reported the changes to the RN, nor received approval to change the bath type. These observations were reviewed with the CEO and the DPCS.

Observed in Record Review. In 5 of 6 patient records reviewed, where hospice aide services were utilized, the organization did not ensure during the aide supervisory visit that the that services ordered by the IDG and provided by the hospice aide met the patient's needs. For example: In review of HV#3 the aide supervisory visits were not conducted no less frequently that every 14 day as there was a 20 day gap in supervisory visits documented from February to March. Example 2: In RR#6, RR#7, RR#8, and HV#1 the aide supervisory visits were conducted every 14 days, however during the supervisory visit the RN provided an incomplete evaluation as it failed to identify the discrepancies in the type of bath given during the aide's visit, nor did it note the modifications to the bath type in HV#1. These observations were reviewed with the CEO and the DPCS.

Observed in Record Review. In 6 of 11 patient records reviewed, the organization failed to ensure that the physicians narrative for the hospice certification contained all of the required elements to include current subjective and objective medical findings. For example: Upon review of RR#6 the physicians narrative for the CTI lacked current subjective and objective medical findings, and also lacked current medication and treatment orders. Similar findings can be seen in HV#1, HV#2, RR#7, RR#8, RR#9. These observations were reviewed with the CEO and the DPCS.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization failed to ensure the patient record contained information to reflect the patient's care, treatment, and services. For example: upon review of RR#8 the patient was noted to be having difficulty swallowing. The SN documentation included education to the patient on thickened liquids, yet there were no orders noted for thickened liquids on the record. Example 2: In RR#5 and RR#7, the patient was ordered a podiatry consult, however there was no documentation on the record that the consult was conducted, nor the results of the consult. The podiatry visit documentation was requested by the staff during survey and added to the record. In RR#7 the patient had a lesion to the finger and the SN educated on applying triple antibiotic ointment to the lesion. There was no order for the ointment noted in the record. These observations were reviewed with the CEO and the DPCS.