Every finding on record at Life Choice Hospice of New Hampshire, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: 1. Prescription and over-the-counter (OTC) drugs; 2. Supplements; 3. Herbal remedies; 4. Other alternative treatments that could affect drug therapy. 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 interview. 2 of 13 (15%) records reviewed revealed that the drug profile was not updated with all of the patient's current medications. Clinical Record 8: The patient elected the hospice benefit on 7/20/2022 with a primary diagnosis of Acute Respiratory Failure. The initial Certification of Terminal Illness (CTI) noted that the patient requires continuous oxygen. In a nurses note from 8/31/2022 it was noted that the patient was utilizing oxygen "only at night". Oxygen does not appear on the medication profile. In an interview with the Administrator on 9/28/2022, she agreed that oxygen was not present on the medication profile. She had no additional information to provide, Clinical Record 11: The patient elected the hospice benefit on 11/25/2020 with a primary diagnosis of COPD. The initial CTI indicated that the patient was on continuous oxygen. Oxygen was not present on the medication profile. The Administrator was interviewed on 9/29/2022 and agreed that oxygen was not present on the medication profile. She had no additional information to provide,

It is required that hospice care and services provided to patients and families follow the individualized plan of care established by: the hospice IDG in collaboration with the attending physician (if any); the patient or patient representative; the primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by a review of clinical records and interview. 1 of 13 (8%) records reviewed revealed that visits were not completed as documented in the plan of care. Clinical Record 10: The patient elected the hospice benefit on 7/25/2022 with a primary hospice diagnosis of COPD. The Social Worker completed the initial assessment on 7/28/2022 with a defined visit frequency of 1 time each month. There was no social worker visit completed for the month of August 2022 and there were no notes documenting why the visit was missed. The Administrator was interviewed on 9/28/2022 and agreed that there was no documentation of a Social Worker visit completed in August.

It is required that the hospice medical director or physician designee reviews the clinical information for each patient being evaluated for admission and provides written certification that it is anticipated that the patient's life expectancy is six months or less if the illness runs its normal course. The physician considers the following when making this determination: The primary terminal condition. This standard was not met as evidenced by a review of clinical records and interviews. 3 of 13 (23%) records reviewed revealed that the primary terminal condition was not identified in the certification of terminal illness (CTI). Clinical Record 9: The patient elected the hospice benefit on 3/15/2022 with a primary diagnosis of Acute Respiratory Failure. In the recertification CTI, completed on 8/30/2022, the narrative stated, in part, "98-year-old woman with oxygen dependent CHF CLIV...." There was no documentation or order in the record to change the primary diagnosis. The Administrator was interviewed on 9/28/2022 and agreed that the diagnosis in the CTI narrative did not match the patient's admitting diagnosis. Clinical Record 11: The patient elected the hospice benefit on 11/25/2020 with a primary diagnosis of COPD. In the recertification CTI, completed on 3/11/2022, the narrative stated, in part, "86-year-old woman with Senile Degeneration of the Brain...." There was no documentation or order in the record to change the primary diagnosis. The Administrator was interviewed on 9/28/2022 and agreed that the diagnosis in the CTI narrative did not match the patient's admitting diagnosis. Clinical Record 2: The patient elected the hospice benefit on 7/28/2022 with a primary diagnosis of Alzheimer's Disease. In the initial CTI, the narrative stated that the primary diagnosis was Parkinson's Disease. There was no documentation or order in the record to change the primary diagnosis. The Administrator was interviewed on 9/28/2022 and agreed that the diagnosis in the CTI narrative did not match the patient's admitting diagnosis.