Every finding on record at Legacy Hospice Ga

It is required that each patient’s individualized written plan of care reflects patient and family goals, and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (16%) clinical records reviewed revealed the patient's individual written plan of care (POC) lacked goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The patient elected the hospice benefit on 2/22/24. The initial nursing assessment dated 2/22/24 stated the patient had a rash (prescribed Keflex) impaired skin integrity to buttocks (prescribed Calmoseptine) and pain (prescribed Norco). The clinical record interdisciplinary group (IDG) POC dated 2/22/24 included these identified problems but lacked goals and interventions for altered skin Integrity and pain. Clinical Record 2: The patient elected the hospice benefit 12/15/2023. The initial nursing assessment dated 12/15/23 stated the patient had depression (prescribed Citalopram). The interdisciplinary group (IDG) POC dated 12/27/23 included identified problem but lacked goals and interventions for depression. The Nursing assessment dated 1/21/24 identified patient had urinary tract infection (prescribed Cephalexin). The interdisciplinary group (IDG) POC dated 1/21/24 included identified problem but lacked goals and interventions for urinary tract infection. Clinical Record 3: The patient elected hospice benefit 3/31/2023.The Nursing assessment dated 4/9/23 identified patient had urinary retention (prescribed Flomax), urinary tract infection (prescribed Keflex), seizures (prescribed Dilantin), and constipation (prescribed Dulcolax and MiraLAX) The interdisciplinary group (IDG) POC) and dated 4/19/23 included identified problem but lacked goals and interventions for urinary retention, urinary tract infection. seizures, and constipation. The Administrator/Director of Clinical Services and Director of Clinical Education confirmed in an interview on 2/28/2024 that the patient’s individualized written plan of care did not include planned interventions based on problems identified in the initial and updated comprehensive assessments.

Based on review of records, staff interviews, and review of agency policy, it was determined that the hospice agency failed to develop a coordinated individualized written plan of care (POC) for one patient (P) (P#3) of 3 sampled patients (P#1, P#2, P#3). --- The findings include: Record review for P#3 revealed patient was admitted to hospice on 4-19-2023 for a diagnosis of respiratory failure. Review of the document titled, " Visit Note Report" dated 4/19/2023 patient had a tracheostomy tube (a hole that surgeons make through the front of the neck and into the windpipe to keep it open for breathing). Review of the document titled, "Hospice Certification and Plan of Care" revealed no physician orders for the care of the tracheostomy tube or site. Review of the document titled, "Hospice IDG Comprehensive Assessment and Plan of Care Update Report" dated 4/27/23, 5/11/23, and 8/2/23, revealed no physician orders for care of tracheostomy for P#3. An interview conducted on 9/6/2023 at 1:10 p.m. with Licensed Practical Nurse (LPN) CC, revealed she provided care for P#3s tracheostomy. LPN CC revealed orders for tracheostomy care were on the nursing home chart. An interview conducted on 9/6/2023 at 1:25 p.m. with Registered Nurse (RN) BB, revealed she provided care to P#3s tracheostomy. RN BB stated tracheostomy care is a part of a patients plan of care and should contain specific physician orders for cleaning and replacement of tube. On 9/6/2023 at 4:00 p.m. the Director of Nursing (DON) confirmed the POC lacked physician orders for care of P#3s tracheostomy. The DON further stated the plan of care did not specifically identify the provider responsible for each intervention included in the plan of care. The agency was unable to provide a policy regarding the development of a POC.

Based on employees record reviews, and staff interview it was determined that the hospice agency failed to manage employees mileages from Dublin, Hazlehurst, and Saint Simons office location. There were eight sampled patients (P) (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8). --- Findings Include: Review of clinical and employees records revealed that the nursing staff drove from Coastal Hospice at Saint Simon office to Hazlehurst location, and Remarkable hospice at Dublin to visit patients. Mileages were between 68 to 130 miles to visit a patient. On 5/15/2023 at 3:30 p.m., an interview conducted with Administrator and owner revealed that he used the same staff for the three locations: Remarkable hospice at Dublin; Coastal hospice at Hazlehurst; and Coastal hospice at Saint Simon. He explained that this is because these three hospices belonged to him. The Administrator/owner confirmed that the employees mileages started from approximately 68 to 130 miles, and he confirmed that the company indeed paid the employees mileages.