Every finding on record at Morning Star Hospice and Palliative Care In, LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) records reviewed, it was revealed that the hospice agency did not ensure the initial comprehensive assessment was completed within five (5) days of the election of hospice care. Clinical Record 13: A patient with a hospice benefit election date of 9/1/22, had an initial comprehensive assessment dated 9/1/22, and a social worker assessment dated 9/6/22. The Chaplain's initial spiritual assessment was dated 9/15/22. There was no evidence that the Chaplain contacted the patient prior to 9/15/22. During a joint record review and interview on 7/20/23, the Director of Clinical Services confirmed the hospice did not ensure all accepted service disciples (RN, Social Worker, Chaplain) completed the initial comprehensive assessment within five (5) days.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and 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 clinical record review, document review, and interview. In 1 of 3 (33%) records reviewed, it was revealed that the hospice agency did not ensure an accurate drug profile was maintained. Agency policy PC.M45, Medication Management, stated in part, "The hospice will maintain a current medication list and a current administration record ... A medication profile is maintained for every patient and includes a listing of the current medication orders for each patient." Clinical Record 3: A home visit was conducted on 7/19/23, for a patient with a hospice benefit election date of 3/24/23, in the presence of the Director of Nursing and the Administrator. A medication reconciliation compared the hospice agency's medication profile to the skilled nursing facility (SNF) medication profile. The SNF medication profile included the following: Theregran -M 50 Plus 400-250-375 mcg tablet. Take one (1) tablet orally once a day; Zoloft one-hundred (100) mg. Take one (1) tablet oral daily; Immodium A-D two (2) mg tablet. Take one (1) tablet four (4) times a day as needed (PRN) for diarrhea. The hospice agency medication profile included the following: Zoloft fifty (50) mg. Take one (1) tablet orally daily; Immodium A-D Take one (1) tablet oral every one (1) as needed for diarrhea. The hospice agency profile did not include the medication Theregran. During a joint home visit and record review on 7/19/23, the Administrator confirmed the hospice agency medication profile did not match the skilled nursing facility (SNF) medication profile.

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care and ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. In 1 of 14 (7%) records reviewed, it was revealed that the hospice agency did not ensure implementation of the interdisciplinary plan of care. Agency policy PC.P50, Plan of Care, stated in part, "The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions ... Care provided to an individual patient is in accordance with the plan of care." Clinical Record 6: A patient with a hospice benefit election date of 8/10/22, had a care plan dated 8/10/22 - 11/7/22, which included the following: chaplain services one (1) time every fourteen (14) days. The patient received a chaplain visit on 9/10/22 and 10/1/22. The patient did not receive chaplain services the weeks of 9/11/23 - 9/17/23, or 9/18/23 - 9/24/23. The patient went twenty (20) days without chaplain services, from 9/10/2022 - 10/1/2022. During a joint record review and interview on 7/19/23, the Director of Clinical Services confirmed the Chaplain service was not administered according to the care plan.

It is required that each patient’s individualized written plan of care includes medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, document review, and interview. In 3 of 14 (21%) records reviewed, it was revealed that the hospice agency did not ensure the plan of care included medical supplies and appliances. Agency policy, PC.P50, Plan of Care, stated in part, " The hospice written interdisciplinary plan of care is developed and individualized for each patient and family, and includes all services necessary for palliation and management of the terminal illness, including the following: medical supplies and appliances to meet needs." Clinical Record 2: A patient with a hospice benefit election date of 5/4/23 had an initial comprehensive assessment dated 5/4/23, which stated in part, "Incontinent of bowel and bladder." The plan of care (POC) dated 5/4/23, did not include medical supplies. During the joint record review and interview, the Director of Clinical Services (DCS) confirmed the patient used the following medical supplies: briefs and wipes. Clinical Record 3: A patient with a hospice benefit election date of 3/24/23, had an initial comprehensive assessment dated 3/24/23, which stated in part, "Incontinent of bowel and bladder." The POC dated 3/24/23, did not include medical supplies. During the joint record review and interview, the DCS confirmed the patient used the following medical supplies: briefs and wipes. . Clinical Record 8: A patient with a hospice benefit election date of 12/14/22, had an initial comprehensive assessment dated 12/14/22, which stated in part, "Incontinent of urine." The POC dated 12/14/22, did not include medical supplies. During the joint record review and interview, the DCS confirmed the care plan did not include medical supplies necessary to meet the patient's needs. During the joint record review and interview on 7/18/23, the DCS confirmed the findings and stated, "We do not have a good process to ensure we are listing the supplies on the care plan. I am unsure if everyone knows we need to be doing this."

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review, document review, and interview. In 1 of 1 (100%) records reviewed, it was revealed that the hospice agency did not forward a copy of the hospice discharge summary to the patient's attending physician. Hospice policy PC.D20, Discharge from Hospice, sub-section seven (7), stated in part, "When the patient is discharged from hospice (by discharge, transfer, or revocation), the hospice provides a copy of the clinical record (if requested) and the hospice discharge summary to the patient's attending physician and any new agency providing care." Clinical Record 13: A patient with a hospice benefit election date of 9/1/22, revoked hospice services on 9/7/22 due to an unwitnessed fall with a suspected hip fracture. The documented phone call on 9/7/22, stated the following: the hospice agency received a call from the nursing facility regarding a patient fall; the hospice agency contacted the Power of Attorney (POA) to coordinate desired care; the POA decided to revoke hospice services to seek aggressive treatment for hip fracture repair; and the patient was sent to a local hospital for aggressive hip fracture treatment. The hospice revocation form was signed by the POA on 1/3/23. There was no evidence that the discharge summary was sent to the patient's attending physician. There was no documentation of care coordination between the hospital receiving the patient and the hospice agency. During a joint record review and interview on 7/19/22, the Director of Clinical Services confirmed the finding.

It is required that the hospice designates a member of each Interdisciplinary Group who is responsible for a patient/resident in a SNF/NF or ICF/IDF. The designated IDG member provides overall coordination of care of the patient/resident, working with the facility representative staff. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) records reviewed, it was revealed that the hospice agency did not ensure the provision of overall coordination of care of the patient/resident. Clinical Record 3: A patient with a hospice benefit election date of 3/24/23, had a physician order documented by the RN on 4/18/23, signed by the physician on 4/20/23, that stated, "Clean open areas to bilateral legs with soap and water. Apply Calcium alginate to those areas and cover with foam dressings. Apply ace wraps for protection." The care plan dated 4/20/23 - 6/21/23 stated, "Clean open areas to bilateral legs with soap and water. Apply Calcium alginate to those areas and cover with foam dressings. Apply ace wraps for protection." There was no documentation that the hospice agency coordinated care with the SNF, by providing specific instruction on the following: who would complete the wound care orders (hospice and/or SNF); and wound care frequency. During a joint record review and interview on 7/18/23, the Director of Clinical Services confirmed the finding and stated that the hospice agency completed wound care at various intervals, but was not sure if the SNF had provided wound care.

It is required that a social worker has a baccalaureate degree in social work from an institution accredited by the Council on Social Work Education and at least one (1) year of social work experience in a health care setting. This standard was not met as evidenced by personnel record review and interview. In 1 of 10 (10%) personnel records reviewed, it was revealed that the hospice agency did not ensure a Bachelor's Degree Social Worker had at least one (1) year of experience in the health care setting. Personnel Record 7: The personnel record was reviewed for a social worker with a hire date of 8/3/22. The personnel record included a diploma for a bachelor's degree in Social Work and a bachelor's degree in Psychology. The personnel record included a resume that stated the following: "Obtained a Bachelor of Science Degree in psychology August 2022; and Bachelor of Social Work 2022." During an interview on 7/19/23, the Director of Clinical Services confirmed the following: on 8/3/22, a staff member confirmed the bachelor's degree upon hire; the social worker did not have one year of experience in the health care setting; the social worker had approximately two-hundred (200) hours of experience as a student intern; and this was the person's first job as a social worker following graduation. During a joint record review and interview on 7/19/23, the Administrator confirmed the finding and stated, "I thought, as long as another Social Worker with a Master's Degree supervised them, we were in compliance."