Every finding on record at Md Choice Hospice Inc

Upon patient record review, 4 of 14 (Patient 1,7,10,11) 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 1 medication profile includes “Ciprofloxacin Hydrochloride 0.3% ophthalmic solution 1-2 drops every 2 hours while awake x 2 days then every 4 hours for 5 days for conjunctivitis” with no indication of left, right or both eyes. Patient 7 medication profile includes “Acetaminophen 650 mg supp” 1 rectally every 4 hours as needed mild to mod pain/fever above 99.0 and Norco 5mg-325 mg tab 1 tab po every 4 hours as needed for pain” with no daily dosage limit. Patient 10 medication profile includes “Acetaminophen 650 mg supp” 1 rectally every 4 hours as needed mild to mod pain/fever above 99.0 and Tylenol ES 500 mg tab 1 tab po twice a day as needed for mild to mod pain” with no daily dosage limit. Patient 11 medication profile includes “Acetaminophen 650 mg supp” 1 rectally every 4 hours as needed mild to mod pain/fever above 99.0 and Acetaminophen 650 mg tab 1 tab oral every 6 hours as needed mild pain/fever” with no daily dosage limit.

Upon patient record review, 1 of 14 (Patient 6) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 6 plan of care with unclear advanced directives; CPR preference is undecided.

Upon patient record review, 4 of 14 (Patient 1,7,10,11) 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 plan of care includes “Ciprofloxacin Hydrochloride 0.3% ophthalmic solution 1-2 drops every 2 hours while awake x 2 days then every 4 hours for 5 days for conjunctivitis” with no indication of left, right or both eyes. Patient 7 plan of care includes “Acetaminophen 650 mg supp” 1 rectally every 4 hours as needed mild to mod pain/fever above 99.0 and Norco 5mg-325 mg tab 1 tab po every 4 hours as needed for pain” with no daily dosage limit. Patient 10 plan of care includes “Acetaminophen 650 mg supp” 1 rectally every 4 hours as needed mild to mod pain/fever above 99.0 and Tylenol ES 500 mg tab 1 tab po twice a day as needed for mild to mod pain” with no daily dosage limit. Patient 11 plan of care includes “Acetaminophen 650 mg supp” 1 rectally every 4 hours as needed mild to mod pain/fever above 99.0 and Acetaminophen 650 mg tab 1 tab oral every 6 hours as needed mild pain/fever” with no daily dosage limit.

Upon patient record review 4 of 14 (Patient 1,5,8,14) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 1 Aide assignment notes 5XW. Week of 7/6-7/12/25 there were no visits made. Patient 5 Aide assignment starting 7/1/25 5XW, there were no visits 6/29/25-7/5/25. Patient 8 Aide assignment notes 2XW. Week of 2/2/25-2/8/25 there were no visits made. Patient 14 Aide assignment notes 3XW. Week of 2/23/25-03/01/25 there were no visits made.

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). This standard was not met as evidenced by clinical record review and interview. 2 of 11 (18%) clinical records reviewed revealed the hospice did not ensure nursing visits followed the visit frequencies in the plan of care and/or physician's orders. Clinical Record 6: The skilled nursing visit frequency of "SN one time a week" was assigned on the plan of care. Review of clinical record revealed one missing nursing visit the weeks of 6/26/22, 7/10/22 and 7/24/22. Clinical Record 7: The skilled nursing visit frequency of one visit every 2 weeks was assigned on the plan of care. Review of clinical record revealed one missing nursing visit the weeks of 7/20/22 and 8/3/22. During interview on 8/12/22, the QAPI Coordinator, who was designed by the Administrator, confirmed she could not locate the missing nursing visits, Interdisciplinary group communication documentation and/or physician's orders/plan of care updates for the missing nursing visits. During interview on 8/12/22, the QAPI Coordinator, who was designed by the Administrator, stated she could not locate the missing nursing visits, Interdisciplinary group communication documentation and/or physician's orders/plan of care updates for the missing nursing visits.

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes: the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by a review clinical record review, document review and interview. 2 of 2 (100%) applicable clinical records reviewed revealed the hospice did not ensure adherence to the agency's Bereavement Services policies and procedures. Clinical Record 10: The patient elected hospice care on 4/13/22 and the initial pre-bereavement assessment was documented on 4/14/22 with a low bereavement risk level. Patient expired 6/15/22. There was no after death bereavement assessment, bereavement plan of care, bereavement contacts and bereavement letters, as required in agency policy. The nursing visit documentation on date of death 6/15/22 included "bereavement serviced offered" with no documentation of services being accepted or declined. During phone interview 8/12/22, with the QAPI Coordinator present, the Bereavement Counselor stated "Yes, I see that it is missing. I must have missed this bereavement assessment, plan of care and bereavement contacts". Clinical Record 0: The patient elected hospice care on 2/27/22 and the initial pre-bereavement assessment was documented on 3/1/22 with a low bereavement risk level. Patient expired 4/12/22. Review of the clinical record revealed no documented bereavement letter sent to the bereaved, as assigned on the bereavement calendar. The social worker documented a post death visit assessment on 4/13/22 which identified "family grieving patient's death, provided counseling and support" with no documentation if bereavement services offered and if accepted or declined. The bereavement plan of care titled "bereavement calendar" included one intervention "send bereavement letter 4/15/22" followed by a red "overdue." During a phone interview 8/12/22, with the QAPI Coordinator present, the Bereavement Counselor stated "I must have missed this bereavement letter." Policy "Bereavement Services", No. 2-010.1, no date, included, "A bereavement assessment will be completed at the time of admission", "After death has occurred, the bereavement assessment will be updated and the family/caregiver needs will be discussed at the next interdisciplinary group meeting", "Bereavement interventions will reflect the family/caregiver's choice to participate in the bereavement program", "Within two weeks after the death of a patient, a sympathy card will be sent to the bereaved", after three to five weeks after the patient's death, a bereavement assessment will be completed by the bereavement counselor, this assessment will identify grief issues", "If a person is noted as experiencing normal grief, the bereavement counselor will contact the bereaved person for ongoing assessment and support at three, six and nine months after the patient's death", and "A bereavement file will be maintained on each family/caregiver unit of care and contain the following: all bereavement assessments made, a bereavement plan of care and all bereavement clinical notes that have been written and/or letters sent to the bereaved". During interview 8/12/22, the CEO stated the Bereavement Counselor role had recently been taken over by the Spiritual Counselor. Additionally during phone interview 8/12/22, the Bereavement Counselor stated that he found the bereavement section in the electronic medical record "not easy" to document. Policy "Bereavement Services", No. 2-010.1, no date, included, "A bereavement assessment will be completed at the time of admission", "After death has occurred, the bereavement assessment will be updated and the family/caregiver needs will be discussed at the next interdisciplinary group meeting", "Bereavement interventions will reflect the family/caregiver's choice to participate in the bereavement program", "Within two weeks after the death of a patient, a sympathy card will be sent to the bereaved", after three to five weeks after the patient's death, a bereavement assessment will be completed by the bereavement counselor, this assessment will identify grief issues", "If a person is noted as experiencing normal grief, the bereavement counselor will contact the bereaved person for ongoing assessment and support at three, six and nine months after the patient's death", and "A bereavement file will be maintained on each family/caregiver unit of care and contain the following: all bereavement assessments made, a bereavement plan of care and all bereavement clinical notes that have been written and/or letters sent to the bereaved". During interview 8/12/22, the CEO stated the Bereavement Counselor position had recently been given to the Spiritual Counselor. Additionally during phone interview 8/12/22, the Bereavement Counselor stated that he found the bereavement section in the electronic medical record "not easy" to document.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by a review clinical records and interviews. 1 of 9 (11%) applicable clinical records of patients receiving hospice aide services reviewed revealed the hospice did not ensure the hospice aide was compliant with the visit frequency as assigned on the plan of care. Clinical Record 6: The Hospice Aide visit frequency was two times a week. Documentation in the clinical record revealed three hospice aide visits the week of 7/5/22 without a physician's order or plan of care update. During interview on 8/12/22, the QAPI Coordinator, who was designated by the administrator, stated she could not locate a physician's order and/or updated plan of care for the extra Hospice Aide visit the week of 7/5/22. During interview on 8/12/22, the QAPI Coordinator, who was designated by the Administrator, stated she could not locate a physician's order and/or plan of care for the extra Hospice Aide visit the week of 7/5/22. .