Every finding on record at Leader Family Hospice, LLC

Based on review of agency policies, clinical records (CRs) and interview with agency Executive Director (EMP# 1), it was determined that the hospice failed to ensure the updated comprehensive assessment included medication changes on the hospice plan of care for one (1) of thirteen (13) CRs reviewed. (CR# 7) Findings: Policy 'Medications:Profiles PC:M60' reviewed on May 26, 2022 at approximately 10:45 a.m. reads, "PROCEDURE:...2. The patient's medication profile is reviewed by the Interdisciplinary Group (IDG) whenever there is a significant change and, at a minimum, every fifteen days...4. The patient's medication profile review includes, but is not limited to" a. determining accuracy and completeness of the profile...5. Changes to the patient's medications profile will be communicated to the hospice pharmacy provider and the hospice medication profile in the electronic medical record will be reconciled with the pharmacy profile with all changes..." Policy 'Physician Orders PC.P30' reviewed on May 26, 2022 at approximately 11:15 a.m. reads, "PROCEDURE:...3. Reasons orders are obtained from physicians including, but are not limited to...a. Initiate new medication, change medication, or discontinuance of medication;..." Review of CRs conducted on May 26, 2022 between approximately 11:00 a.m. and 3:00 p.m. revealed the following: CR# 7, Start of Care (SOC), 5/13/2022: Current certification period reviewed: 5/13/2022-8/10/2022. Primary Diagnosis: Heart Failure, unspecified. - Skilled nursing visit comment on 5/20/2022 reads, "...SN (skilled nurse) handed off report to CM (Country Meadows) nurse, she stated on 5/18 BS (blood sugar) 572-pt got 20 units Humalog, per PCP (primary care physician) instructions. N.O. (new order) on 5/18 for Humalog 5 units TID (three times a day), hold for BS > (blood sugar greater than) 120 AND Humalog sliding scale before breakfast and supper..." SN 'Discipline Synopsis' on 5/20/2022 reads, "SNRV-**CHANGE: INSULIN ORDERS for hyperglycemia..." No documentation provided of hospice updating medication list to include new Humalog instructions from 5/20/2022 skilled nursing note. An interview conducted with EMP# 1 on May 27, 2022 at approximately 12:15 p.m. confirmed the policy/procedure as current and the above findings.

Based on review of agency policies, clinical records (CRs) and interview with agency Executive Director (EMP# 1), it was determined that the hospice failed to provide skilled nursing (SN), home health aides (HHA), masters social worker (MSW), and chaplain (CHAP) as indicated on the Plan of Care for six (6) of thirteen (13) CRs reviewed. (CR# 3, CR# 4, CR# 5, CR# 7, CR# 8 and CR# 9) Findings: Policy 'Plan of Care PC.P40' reviewed on May 26, 2022 at approximately 11:00 a.m. reads, "POLICY: The care and services provided to patients and their families are in accordance with an individualized, written plan of care established by the hospice IDG (interdisciplinary group) in collaboration with the patient's attending physician (if any), and, if appropriate, the patient and/or his/her representative." Policy 'Physician Orders PC.P30' reviewed on May 26, 2022 at approximately 11:15 a.m. reads, "PROCEDURE:...3. Reasons orders are obtained from physicians including, but are not limited to...b. change in visit frequency if not within the range specified in the patient's plan of care..." Review of CRs conducted on May 26, 2022 between approximately 11:00 a.m. and 3:00 p.m. revealed the following: CR# 3, Start of Care (SOC), 12/15/2021: Current certification period reviewed: 4/14/2022-6/12/2022. Primary Diagnosis: Hypertensive heart disease with heart failure. Plan of Care Frequency Orders: "Skilled Nursing (SN) 2w10 (twice a week for 10 weeks), Home Health Aide (HHA) 3w10 (three times a week for 10 weeks)..." - 1 missing SN visit for week 1 (March 14, 2022-March 16, 2022). - 1 missing HHA visit for week 1 (March 14, 2022-March 16, 2022). CR# 4, SOC, 11/4/2021: Current certification period reviewed: 5/3/2022-7/1/2022. Primary Diagnosis: Parkinson's disease. Plan of Care Frequency Orders: "Skilled Nursing (SN) 3w9 (three times a week for 9 weeks)..." - 1 missing SN visit for week 1 (May 3, 2022-May 7, 2022). CR# 5, SOC, 4/3/2021: Current certification period reviewed: 4/28/2022-6/26/2022. Primary Diagnosis: Unspecified dementia with behavioral disturbance. Plan of Care Frequency Orders: "Skilled Nursing (SN) 1w1 (one time a week for 1 week); 5/1/22- 2w14 (two time a week for 14 weeks) with 6 prns (as needed visits)..." - 1 extra SN visit for week 2 (May 1, 2022-May 7, 2022). - 1 extra SN visit for week 3 (May 8, 2022-May 14, 2022). No additional physician orders for extra SN visit for week 2 and week 3. CR# 7, SOC, 5/13/2022: Current certification period reviewed: 5/13/2022-8/10/2022. Primary Diagnosis: Heart Failure, unspecified. Plan of Care Frequency Orders: "Skilled Nursing (SN) 2w13 (two times a week for 13 weeks), 3 prn...Home Health Aide (HHA) 2w13 (two times a week for 13 weeks)..." - 1 missing SN visit for week 1 (May 13, 2022-May 14, 2022). - 2 missing HHA visits for week 1 (May 13, 2022-May 14, 2022) CR# 8, SOC, 4/13/2022: Current certification period reviewed: 4/13/2022-7/9/2022. Primary Diagnosis: Dementia in oth diseases classd elswhr w/o behavrl disturb. Plan of Care Frequency Orders: "Masters Social Worker (MSW) 1 encounter every 2nd week for 13 weeks...Chaplain (CHAP) 1 encounter every 2nd week for 14 weeks..." - 1 extra CHAP visit for week 2 (April 17, 2022-April 23, 2022). - 1 extra MSW visit for week 4 (May 1, 2022-May 7, 2022). CR# 9, SOC, 3/4/2022: Current certification period reviewed: 3/4/2022-6/1/2022. Primary Diagnosis: Mild protein-calorie malnutrition. Plan of Care Frequency Orders: "Skilled Nursing (SN) 1w1 (one time a week for one week), 2w13 (twice a week for 13 weeks)...Masters Social Worker (MSW) 1 encounter every 2nd week for 8 weeks and 3 prn visits...Chaplain (CHAP) 1 encounter every 2nd week for 14 weeks and 4 prn visits..." - 1 extra SN visit for week 1 (March 4, 2022-March 5, 2022). - 1 extra CHAP visit for week 3 (March 13, 2022-March 19, 2022). - 1 missing CHAP visit for week 4 (March 20, 2022- March 26, 2022). - 1 extra CHAP visit for week 5 (March 27, 2022-April 2, 2022). - 1 missing CHAP visit for week 6 (April 3, 2022- April 9, 2022). - 1 extra CHAP visit for week 7 (April 10, 2022-April 16, 2022). - 1 missing CHAP visit for week 8 (April 17, 2022-April 23, 2022). - 1 extra CHAP visit for week 9 (April 24, 2022-April 30, 2022). - 1 missing CHAP and 1 missing MSW visits for week 10 (May 1, 2022-May 7, 2022). - 1 extra CHAP and 1 extra MSW visits for week 11 (May 8, 2022-May 14, 2022). - 1 missing CHAP and 1 missing MSW visits for week 12 (May 15, 2022-May 21, 2022). An interview conducted with EMP# 1 on May 27, 2022 at approximately 12:15 p.m. confirmed the policy/procedure as current and the above findings.