Every finding on record at Missouri Palliative & Hospice Care Northwest LLC

Upon patient record review, 1 of 14 (Patient #6) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #6: The 03/11/25 IDG note documented a skin concern that was identified at the 03/11/25 nurse home visit, "Patient has a skin tear to right upper arm". A wound treatment order was obtained on 03/11/25 for, "Cleanse with wound cleanser, pat dry, apply Opti-foam or gauze, then a bandage. Change as needed". This is not a complete treatment order, as it is missing the location of the wound to be treated, the indication for when the 'as needed' wound treatment was to be changed, and did not include the persons responsible for the wound care. (The nurse had documented in her visit note that she had left the order and the supplies with the SNF staff.)

Upon patient record review, 1 of 14 (Patient #6) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #6: The Physician CTI documented 03/02/25 noted the patient's use of a Hoyer Lift. This was not on the current POC.

Upon patient record review, 2 of 14 (Patients #3 and 4) did not contain evidence that a revised Plan of Care included information from the patient's updated comprehensive assessment(s), and must note the patient's progress towards outcome/goals from the plan of care: Patient #3: During the Surveyor-attended home visit on 03/11/25, the patient was noted to have x3 steri-strips on her left elbow. The patient reports that she had poorly maneuvered her electric wheelchair, and bumped her elbow on a wall, about a week ago. This alteration in skin integrity, and its treatment, had not been updated to the current Hospice POC. Patient #4: The current Plan of Care reflects an entry for Volunteer interventions. The last Volunteer home visit was made 08/22/24.

Upon personnel record review, 1 of 12 (Personnel #8) did not contain evidence that the Aide Skills Competency Assessment had been conducted per CMS requirements: Personnel #8: DOH was 01/23/23. An Aide Skills Competency assessment was conducted between 01/03/23 and 01/30/23. However, there was no documented evidence that the following subject areas had been evaluated through written examination, oral examination, or after observation of a Hospice Aide with a patient: • Observation, reporting and documentation of patient status, and the care or service furnished. • The physical, emotional, and developmental needs of and ways to work with the populations served by the Hospice. • Adequate nutrition and fluid intake.

Upon patient record review, 1 of 14 (Patient #8) did not contain evidence that the 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 #8: The Aide POC effective 02/28/25 assigned all of the following tasks to be provided by the Aide "if requested": 1) Shower; 2) Shampoo; 3) Shave; 4) Brush Teeth; 5) Oral Care; 6) Dressing; 7) Bedpan/Urinal; and 8) Nail Care.

Upon patient record review 2 of 14 (Patients #1 and 8) did not contain evidence that the Hospice Aide had provided services that are: • Ordered by the Interdisciplinary Group • Included in the Aide Plan of Care Patient #1: During Surveyor-attended home visit on 03/11/25, the Aide reported that she had been providing a bed bath for this patient for several weeks. However, the current Aide POC continued to assign a 'shower every visit". The Aide was not following the Aide POC. Patient #8: A verbal order was obtained on 02/04/2025 for Aide services to be provided at a frequency of 2x per week. The first Aide visit made/documented was not until 02/28/25.

Upon personnel record review, 1 of 13 (Personnel #8) did not contain evidence that the Registered Nurse had made an annual on-site visit to the location where a patient is receiving care, in order to observe and assess each Aide while he or she is performing care, which included the evaluation of all required subject matter. The supervising nurse must assess an Aide's ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include all required content: Personnel #8: An annual on-site visit was made in 2024. However, the following subject matter were not evaluated for: • Compliance with Infection Control policies and procedures • Correct reporting of changes in a patient's condition

Upon client record review, 1 of 14 (Patient #6) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #6: The 03/11/25 IDG note documented a skin concern that was identified at the 03/11/25 nurse home visit, "Patient has a skin tear to right upper arm". A wound treatment order was obtained on 03/11/25 for, "Cleanse with wound cleanser, pat dry, apply Opti-foam or gauze, then a bandage. Change as needed". This is not a complete treatment order, as it did not include the persons responsible for the wound care. (The nurse had documented in her visit note that she had left the order and the supplies with the SNF staff.)

Upon patient record review, 1 of 10 (Patients #2) did not contain evidence that the Hospice had 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 #2: The record reflected elsewhere that this patient had a DPOA for Healthcare. This Advance Directive status was not included on the Plan of Care.

Upon patient record review, 1 of 10 (Patient #5) did not contain evidence of an Initial Certification of Terminal Illness, composed by his Attending Physician.

Upon patient record review, 6 of 10 (Patients #1, 3, 4, 6, 7, and 8) did not contain evidence that all entries were appropriately authenticated in accordance with the organizations policies and procedures and currently accepted standards of practice. Patients #1, #3, #6, #7, #8 For each of the Aide (RH) entries within these clinical record(s) the Aide signature did not include his credentials attached to his signature. Patient #4 The record reflected that routinely scheduled Chaplain care/services had been discontinued 02/28/22. However, the 03/17/22 IDG Meeting notes included a Spiritual visit frequency of "3 p.r.n."; without a baseline visit frequency.

Upon inpatient contract review, 1 of 1 applicable (Cass Regional Medical Center/GIP/RIP) did not contain a provision that the inpatient provider has established patient care policies consistent with those of the Hospice, and agrees to abide by the palliative care protocols established by the Hospice for its patients.

Upon inpatient contract review, 1 of 1 applicable (Cass Regional Medical Center/GIP/RIP) did not contain a provision that a copy of the Discharge Summary shall be provided to the Hospice at the time of discharge from the inpatient facility.

Upon SNF/NF contract review, 1 of 1 applicable (Pleasant Valley Manor) did not contain a provision that specifies the provision of Hospice services in the Facility, to include: A provision that the SNF/NF or ICF/IID immediately notifies the Hospice if: • A significant change in a patient's physical, mental, social or emotional status occurs • Clinical complications appear that suggest a need to alter the plan of care • When a need to transfer a patient from the SNF/NF or ICF/MR arises, and the hospice makes arrangements for, and remains responsible for, any necessary continuous care or inpatient care necessary related to the terminal illness and related conditions • A patient dies

Upon SNF/NF contract review, 1 of 1 applicable (Pleasant Valley Manor) did not contain a provision that specifies that it is the Hospice's responsibility to continue to provide services at the same level and to the same extent as those services would be provided if the SNF/NF resident were in his or her own home.

Upon SNF/NF contract review, 1 of 1 applicable (Pleasant Valley Manor) did not contain a provision that specifies that the Hospice may use the SNF/NF nursing personnel where permitted by state law, and as specified by the SNF/NF, to assist in the administration of prescribed therapies included in the Plan of Care; only to the extent that the Hospice would routinely use the services of a Hospice patient's family in implementing the Plan of Care.

Upon SNF/NF contract review, 1 of 1 applicable (Pleasant Valley Manor) did not contain a provision that specifies that the Hospice must report all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property, by anyone unrelated to the Hospice, to the SNF/NF Administrator within 24 hours of the Hospice becoming aware of such alleged violation.

Upon SNF/NF contract review, 1 of 1 applicable (Pleasant Valley Manor) did not contain a provision that specifies the responsibilities of the Hospice and the SNF/NF to provide Bereavement services to SNF/NF personnel.

Upon patient record review, 1 of 1 applicable (Patient #1) did not contain evidence that the Hospice had provided the following information to the SNF: Physician Certification of the Terminal Illness.