Every finding on record at Life Choice Hospice of Georgia, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs and/or supplements. The medication review process includes the identification of the following: The effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records and interviews. 4 of 7 (57%) applicable clinical records reviewed of patients receiving oxygen therapy revealed that the drug profiles were not updated at the time of each comprehensive assessment. Clinical Record 1: The patient elected the hospice benefit on 9/7/2022. The nursing admission assessment as well as the initial Certification of Terminal Illness (CTI) indicated that the patient required oxygen at 2lpm (liters per minute). Oxygen was not included in the drug profile. Clinical Record 3: The patient elected the hospice benefit on 9/13/2022. The RN assessment completed on 12/13/2022 documented that the patient required intermittent oxygen and that the oxygen was stored appropriately. Oxygen was not included in the drug profile. Clinical Record 9: The patient elected the hospice benefit on 7/22/2022. Nursing notes completed on 7/27/2022 and 9/26/2022 documented that the patient required intermittent oxygen use at 2lpm. Oxygen was not included on the drug profile. Clinical Record 10: The patient elected the hospice benefit on 9/21/2022. The nursing admission assessment as well as the initial CTI documented that the patient was on oxygen therapy at 4lpm. Oxygen was not included on the drug profile. The Area Director of Clinical Operations was interviewed on 12/20/2022 and agreed that oxygen was not included on the drug profiles for each of these patients. She had no additional information to provide.

It is required that bags used to carry medical equipment (e.g., BP cuff) or supplies into or out of the care environment are transported and used in a manner consistent with organizational policy to prevent the spread of infections and communicable diseases. This standard was not met as evidenced by document review, interviews and observation on home visits. POLICY 2 Procedure: C_11G "Bag Technique and Standard Precautions", revision date: 4/22/2020 states in part, "c. Remove needed supplies from the bag and place them on a clean, dry surface or on a water-resistant surface barrier as needed (i.e., the surface is visibly soiled or potentially contaminated due to patient’s living conditions, etc.). The barrier is discarded after use. d. Once patient care has started, do not reach into bag without performing hand hygiene. If gloves are worn, remove the gloves, perform hand hygiene, and then you can reach into the bag." Home Visit 3/Clinical Record 3: The observation visit occurred on 12/20/2022. The employee (RN case manager/personnel record 11) failed to sanitize hands before re-entering the bag. The Area Director of Clinical Operations was interviewed on 12/20/2022 and agreed that the employee will need additional training on bag technique.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: A copy of the hospice discharge summary and the patient's record, if requested. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 2 (50%) applicable clinical records of patients who were discharged revealed that the discharge summary was not forwarded to the patient's attending physician. Clinical Record 11: The patient elected the hospice benefit on 4/20/2020 and was discharged on 10/15/2022. There was no evidence in the clinical record that a copy of the discharge summary was sent to the attending physician. The Area Director of Clinical Operations was interviewed on 12/20/2022 and she agreed that there was no documentation that the discharge summary had been sent.