Every finding on record at Mesquite Hospice Care LLC

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation, and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 2 of 9 (22%) Clinical records reviewed for patients that accepted hospice aide services revealed that the hospice agency did not ensure the hospice aide provided services ordered by the Interdisciplinary Group (IDG). Clinical Record 3: The patient elected their hospice benefit on 10/08/2024 with a terminal diagnosis of End Stage Renal Disease. The plan of care dated 10/08/2024 listed the following relevant visit frequency, hospice aide twice a week. The hospice aide care plan, effective 10/09/2024, assigned the tasks of a bed bath on Tuesdays and a chair bath to be completed on Fridays. The hospice aide completed and documented a visit note on 11/19/2024 (Tuesday) stating that a chair bath had been given. The record lacked evidence as why the aide did not provide services as ordered by the Interdisciplinary Group. Clinical Record 8: The patient elected their hospice benefit on 07/31/2024 with a terminal diagnosis of malignant carcinoma of the lung. The plan of care dated 07/31/2024 listed the hospice aide visit frequency as three times a week. The aide care plan, effective as 08/02/2024 included the task of oral care each visit. The hospice aide documented a visit on 08/02/2024 and reported oral care was not completed. The record lacked evidence as why the aide did not provide services ordered by the Interdisciplinary Group. During an interview on 11/21/2024, the Director of Nursing agreed that the hospice aide had not followed the plan.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 2 of 9 (22%) clinical records reviewed, in which aide services were accepted, revealed that the hospice agency did not ensure that the hospice aide reported and documented changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a Registered Nurse (RN) as the changes related to the plan of care. Clinical Record 3: The patient elected their hospice benefit on 10/08/2024 with a terminal diagnosis of End Stage Renal Disease. The plan of care dated 10/08/2024 listed the visit frequency for the hospice aide as twice a week. The hospice aide care plan, effective 10/09/2024, included the following relevant tasks to be completed each visit: assisting with dressing, combing hair, applying lotion, oral care, and shampooing hair. On 10/11/2024 an aide visit note reported the following tasks were not completed: assisting with dressing, combing hair, applying lotion, oral care, and shampooing hair. The hospice aide care plan, effective 10/09/2024, also included the relevant tasks of a bed bath on Tuesdays and a chair bath to be completed on Fridays. The hospice aide completed and documented a visit note on 11/19/2024 (Tuesday) stating that a chair bath had been given. There was no documented evidence that the RN was notified of these changes in the aide plan of care. Clinical Record 8: The patient elected their hospice Medicare benefit on 07/31/2024 with a terminal diagnosis of malignant neoplasm of the lung. The aide plan of care effective as of 08/02/2024 included the relevant task of oral care each visit. The hospice aide documented a visit on 08/02/2024 and reported oral care was not completed. There was no documented evidence that the uncompleted task was reported to a registered nurse. During an interview on 11/21/2024, the Director of Nursing agreed that the hospice aide did not report the changes that related to the plan of care to a registered nurse.

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: A summary of the patient’s hospice stay, including treatments, symptoms, and pain management; The patient’s current plan of care; The patient’s latest physician orders; Any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 4 (25%) clinical records reviewed, for patients who were discharged and required a discharge summary, it was revealed that the agency did not ensure the discharge summary included at least a summary of the patient's hospice stay including treatments, symptoms, and pain management, the current plan of care, and physician orders. Agency Policy: HCL/PE.20 Mcr, Last Reviewed 09/01/2024, stated in part, “The hospice will forward a copy of the discharge summary to the patient's attending physician upon discharge. The hospice discharge summary will include a summary of the patient's care (pain management, symptoms, and treatments), current plan of care including medication profile, and the latest physician orders.” Clinical Record 4: The patient elected their hospice Medicare benefit on 07/12/2024. The patient was revoked on 09/23/2024 due to no longer wanting hospice services. The live discharge note, documented by the registered nurse on 09/23/2024, included a checked box that indicated a copy of the discharge summary was sent to the attending physician. There was no documented evidence that the discharge summary contained all required components including a summary of the hospice stay, current plan of care, physician orders (including medications and treatments). During an interview on 11/20/2024, the Director of Nursing was asked if a discharge summary with all components was completed. The Director of Nursing stated the electronic medical record did not generate a discharge summary for the hospice. The Director of Nursing reviewed the hospice agency policy and agreed that there was no evidence that a discharge summary, with all required components, had been completed.