Every finding on record at Laredo Superior Homecare LLC

It is required that the hospice designates a registered nurse (RN) member of the Interdisciplinary Group (IDG) to provide coordination of care, ensure continuous assessment of each patient’s and family’s needs, and ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed revealed that the hospice did not ensure a RN provided coordination of care or ensure continuous assessment of patient's and family's needs. Clinical Record 1 The plan of care (POC) dated 8/14/2023 ordered nursing visits two times a week. The week of 8/27/2023, 9/3/2023, and of 9/24/2023 there was only one skilled nursing visit documented. There was no documented evidence of why the visits were not provided as ordered. Clinical Record 2: The POC dated 10/27/2023 ordered nursing visits two times a week. Missed SN visits were noted the of The week of 11/19/2023 and 11/26/2023. There was documented evidence of why the visits were not provided as ordered. Clinical Record 7: The POC dated 9/27/2023 for SN frequency of two times a week. Missed visits were noted the week of 10/8/2023 and 10/18/2023. There was documented evidence of why the visits were not provided as ordered. During an interview on 1/19/2024, the RN Clinical Educator agreed that the SN frequency RN did not meet the ordered frequencies for all three patients.

It is required that the Interdisciplinary Group, in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient's condition requires but no less frequently than every 15 calendar days. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed revealed that the hospice did not ensure the patient's medications were reviewed by the hospice medical director every 15 calendar days during IDG. Clinical Record 1: The hospice election of benefit was dated 06/29/2023. The Interdisciplinary team (IDG) meeting notes reviewed revealed that there was no documented evidence that the medications were reviewed by the Medical Director as part of the review of the POC on 07/11/2023 and 07/25/2023. Clinical Record 2: The hospice election of benefit was dated 10/27/2023. The IDG meeting notes reviewed revealed that there was no documented evidence that the medications were reviewed by the Medical Director as part of the review of the POC on 10/31/2023. Clinical Record 6: The hospice election of benefit was dated 12/07/2023. The IDG meeting notes reviewed revealed that there was no documented evidence that the medications were reviewed by the Medical Director as part of the review of the POC on 12/12/2023. Clinical Record 7: The hospice election of benefit was dated 09/27/2023 The IDG meeting notes reviewed revealed that there was no documented evidence that the medications were reviewed by the Medical Director as part of the review of the POC on 10/27/2023. During an interview on 01/19/2024, Clinical Educator agreed there was no documented evidence that the medical director reviewed the patient's medications at the IDG meetings.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 3 of 10 (30%) clinical records reviewed revealed that the hospice did not ensure that the hospice aides were supervised by a registered nurse no less than every 14 days. Clinical Record 1: The hospice election of benefit was dated 6/29/2023. The aide visit was completed on 07/10/2023. There was no documented evidence of Registered Nurse (RN) a supervisory visit until visit was dated 11/22/2023 (135 days). Clinical Record 2: The hospice election of benefit was dated 10/27/2023. The visit was completed on 10/27/2023. There was no documented evidence of an RN supervisory visit until 12/08/2023 (42 days). Clinical Record 6: The hospice election of benefit was dated 12/07/2023. The aide visit was completed on 12/08/2023. There was no documented evidence of an RN supervision visit ever completed as of the date of interview/record review on 1/18/2024 (42 days) During an interview on 01/18/2024, the Clinical Educator agreed RN supervisory visits had not been completed every 14 days.

It is required that if a patient revokes the election of hospice care, or is discharged from hospice in accordance with 418.26, the hospice must forward to the patient’s attending physician a copy of the hospice discharge summary. In 1 of 2 (50%) clinical records reviewed revealed that the hospice did not ensure that a copy of the hospice discharge summary was forwarded to the attending physician. Clinical Record 11: A clinical record review on 01/19/2024 revealed the patient was admitted to the hospital on 06/26/2023. There was no documented evidence that the discharge summary was forwarded to the attending physician. During a joint record review and interview on 01/19/2024, the registered nurse, Clinical Educator agreed the hospice did not forward the hospice discharge summary to the attending physician.