Every finding on record at Mkb Consulting LLC

Upon patient record review, 3 of 5 (Patient #2,3,4) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #2: POC ordered MSW "as needed". No frequency or specific number of PRN visits listed. Patient #3: POC ordered MSW "1xmonth as needed" Frequency unclear. Patient #4: POC ordered MSW 1-2xm and PRN. Frequency not specific. SC 1-2xm and PRN, without specifics for PRN.

Upon patient record review, 4 of 4 (Patient #1, 2, 3, 4) 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 equipment and supply needs. Patient #1: Documentation shows patient is on oxygen, uses walker and incontinent. Nothing listed under DME or supplies on POC. Patient #2: Documentation shows patient is incontinent. No supplies listed on POC Patient #3: Documentation shows patient has foley catheter. No supplies listed on POC Patient #4: Documentation shows patient has foley catheter, oxygen and incontinent. No equipment or supplies listed on the POC

Upon client record review, 3 of 4 (Patient #2, 3, 4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: MSW routine visit on 7/2 without an order. NP visit on 6/12 without an order. POC ordered SN 2xw beginning 5/12. LVN visit on 5/11. No evidence to support order for this visit or PRN visit. No evidence of any SN visits wk of 6/30. Patient #3: SN ordered 2xwk beginning 3/7. No evidence of a 2nd visit week of 3/7. Patient #4: SC 1-2xm and PRN. SN ordered 2xwk and 3 PRN beginning 6/12. Frequency not specific, 4 SN visits wk of 6/12. Only 1 visit marked as PRN on 6/15. (6/12, 6/12, 6/13, 6/15). 4 SN visits wk of 6/16 on 6/17, 6/18, 6/19 and 6/20. None marked as PRN. No evidence of an order to increase visit frequency.

Upon patient record review 1 of 4 (Patient #1) 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 ordered 3xwk beginning 5/31. No evidence of an aide visit wk of 5/31.

Upon patient client record review, 4 of 4 (Patient #1, 2, 3, 4) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1: IDG dated 6/20 not electronically signed by MSW, IDG dated 7/5 not electronically signed by MSW or RN. Documentation supports that all IDG members were present at meetings. Documentation in patient chart has patient as DNR. POC lists CPR as "Undecided" in error rather than "DNR". Visit by LVN on 6/8, 6/10, 6/14, 6/21, 6/26 and 6/28 not signed by clinician Patient #2: IDG dated 5/11 and 5/16, 5/30 not signed by SC, IDG dated 6/13 and 6/27 not signed by MSW. Visit by NP 6/12 - visit note is blank other than date and time. MSW visit on 7/2 not signed by clinician. SN visit notes on 5/11, 5/13, 5/17, 5/20, 5/22, 5/31, 6/3, 6/5, 6/10, 6/17, 6/20, 6/24, 6/26 not signed by clinicians. Patient #3: RN visit on 5/21 not signed by clinician Patient #4: POC lists Aide as declined and as "3xwk and 2 visits as needed". Contradictory and unclear.

Upon client record review, 1 of 4 (Patient #4) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #4: No evidence a discharge summary was sent to the patient's attending physician.

Upon client record review, 1 of 4 (Patient #4) did not have evidence that the discharge summary includes all required information. Patient #4: DC summary only contains death visit information.