Every finding on record at Liberty Hospice Care Inc

Based on record review and interview, the agency failed to designate an interdisciplinary team who worked together to meet the needs and supervised the care and services the needs of a hospice client and family facing terminal illness for 3 of 6 inactive clients (Clients #3, # 5, and #6), in that: There was no written evidence that interdisciplinary meetings were performed. This deficient practice places all the agency's clients at risk of having their care inadequately coordinated among the core disciplines. --- The findings included:   Review of Patient #3's clinical record (Plan of Care) revealed a start of care date of 9/1/2021 for a plan of care certification period from 2/28/2022 through 5/28/2022 with diagnoses Alzheimer’s Disease (memory disorder).  Further record review of the plan of care revealed core services ordered were skilled nursing visits once weekly for 9 weeks, medical social worker visits once monthly, and chaplain service visits once monthly. Further record review revealed visit documentation from the core services of skilled nursing, medical social services, and the chaplain. There was no evidence that the IDG supervised the care. Further record review revealed that there were no interdisciplinary meeting minutes with the medical director, nurse, medical social worker and chaplain for Client #3  Review of Patient #5's clinical record (Plan of Care) revealed a start of care date of 2/6/2022 for a plan of care certification period from 2/6/2022 through 5/6/2022 with diagnoses of chronic obstructive pulmonary disease (lung disease that makes it difficult to breathe) and arthritis (painful joints).  Further record review of the plan of care revealed core services ordered were skilled nursing visits once weekly for 9 weeks, medical social worker visits once monthly, and chaplain service visits once monthly. There was no evidence that the IDG supervised the care. Further record review revealed no interdisciplinary meeting minutes with the medical director, nurse, medical social worker and chaplain every two weeks for Client #3.   Review of Patient #6's clinical record (Plan of Care) revealed a start of care date of 11/24/2021 for a plan of care certification period from 11/24/2021 through 2/12/2022 with a diagnosis of skin cancer.  Further record review of the plan of care revealed core services ordered were skilled nursing visits once weekly for 9 weeks, medical social worker visits once monthly, and chaplain service visits once monthly. There was no evidence that the IDG supervised the care. Further record review revealed that there were no interdisciplinary meeting minutes with the medical director, nurse, medical social worker and chaplain for Client #6.   During an interview with the Alternate Administrator on 10/14/2025 at 4:00 pm., the Alternate Administrator acknowledged the above findings.  The Alternate Administrator further stated that she was not the Alternate Administrator during this time but also stated the importance of the hospice agency to have had an Interdisciplinary meeting with the medical director, nurse, medical social worker and chaplain every two weeks.  Review of the agency’s policy titled, “Interdisciplinary Group/Core Services,” revision date 2/1/2020, revealed in part, “The Agency will establish and maintain a group of professional individuals…who are employees of the hospice and will provide all core services…the Agency will maintain documentation of interdisciplinary group by dated meeting minutes…”

Based on record review and interview, the agency failed to include a discharge summary for 1 of 6 discharged clients (Client #3), whose clinical records were reviewed. This deficient practice places all the agency's clients at risk of inadequate coordination of services. --- The findings included:  Review of Patient #3's clinical record (Plan of Care) revealed a start of care date of 9/1/2021 for a plan of care certification period from 2/28/2022 through 5/28/2022 with diagnoses Alzheimer’s Disease (memory disorder).  Further record review of the plan of care revealed core services ordered were skilled nursing visits once weekly for 9 weeks, medical social worker visits once monthly, and chaplain service visits once monthly. Record review of Client #3 clinical records did not contain a discharge date nor a reason for discharge.  Further record review revealed that the clinical record for Client #3 did not contain a discharge summary.   During an interview with the Alternate Administrator on 10/14/2025 at 4:00 pm., the Alternate Administrator acknowledged the above findings.  The Alternate Administrator further stated that she was not the Alternate Administrator during this time but was informed that the patient expired.  The Alternate Administrator revealed that the discharge summary was important because it describes the type of discharge that the client received.  Review of the agency’s policy titled, “Patient Discharge,” revision date 3/1/2020, revealed in part, “The patient’s record will reflect discharge planning activities, coordination with other care providers, the patient’s response and understanding…and a reasonable notice prior to discharge, whenever possible…The discharge summary will include: the date and reason for discharge B.  Any instructions or referral information given to the patient or family. C.  Patient identifying information.  D.  Patient’s physician.  E.  Hospice diagnosis.  F.  Significant health history.  G.  Discharge orders, instructions, medication profile and allergies. H.  A brief description of services provided and ongoing needs that cannot be met.  I.  Status of patient at time of discharge.  J.  Presence of Advance Directive.  K.  End of life decisions…P.   Any other documentation that will assist in post discharge continuity of care or that is request by the physician…”

Upon patient record review, 1 of 6 (Patient #3) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #3: Medication profile included Hydromorphone 4 mg take 1 and 1/2 tab po prn. There is no evidence of PRN reason.

Upon patient record review, 2 of 6 (Patient # 1, 3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1 Order dated 1/24/21 included the following medications Acetaminophen, Atropine, Bisacodyl, Lorazepam, Morphine, and Ondansetron denoted PRN without a reason for PRN. Patient #3: Hydromorphone listed on order dated 11/1/21. No evidence of PRN reason.

Upon patient record review, 1 of 6 (Patient #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #5: Patient receives nutrition via g tube. No evidence of the nutrition equipment or supply needs on the plan of care.

Upon client record review, 3 of 6 (Patient #4,5,6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4 POC starting 11/8/21 SW ordered 1xmo, visit performed 11/10/21 with no further visits performed, no evidence of missed visits or evidence of order to discontinue. Chaplain ordered 1xmo, visit performed 11/10/21 with no further visits performed, no evidence of missed visits or evidence of order to discontinue. Patient #5 POC dated 2/22/22 SW ordered eval. No evidence of evaluation, missed visits, refusal or order to discontinue. Chaplain ordered eval. No evidence of evaluation, missed visits, refusal or order to discontinue. Patient #6 POC orders dated 2/28/22 SW ordered eval. No evidence of evaluation, missed visits, refusal or order to discontinue. Chaplain ordered eval. No evidence of evaluation, missed visits, refusal or order to discontinue.

Upon patient record review, 1 of 1 applicable (Patient # 4) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #4: Aide care plan/assignment dated 11/8/21 denote both Bath and Shower.