Every finding on record at Mp Medical Services, Inc.

It is required that the Interdisciplinary Group, in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan. A revised plan of care includes information from the patient’s updated comprehensive assessment and record of the patient’s progress toward the outcomes and goals specified in the plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. In 10 of 14 (71%) clinical record reviewed, it was revealed that the agency did not ensure the patient's plans of care were revised to reflect progress towards the outcomes and goals. Agency's Policy 1-033, Prioritizing Patient Problems/Needs (November 2021), stated in part "the plan of care should include needs, goals, dates identified and resolution dates. As goals are achieved, additional interventions may be added to the plan of care to direct patient care." CLINICAL RECORD 1: The patient's plan of care, dated 02/28/2025, included the stated goal, “patient/caregiver will verbalize understanding of safety measures re: oxygen use by end of visit on 03/05/2025.” The patient remained on oxygen therapy and as of the date of this review 09/10/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 2: The patient's plan of care, dated 02/17/2023, included the stated goal, “patient/caregiver will verbalize understanding of safe use of Durable Medical Equipment (DME) dispensed to patient on first nursing visit after equipment is present.” The equipment was delivered on 02/17/2023 and the next nursing visit was conducted on 02/21/2023. The DME remained in the home and as of the date of this review 09/10/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 3: The patient's plan of care, dated 05/20/2025, included the stated goal, “patient/caregiver will verbalize understanding of safe use of Durable Medical Equipment (DME) dispensed to patient on first nursing visit after equipment is present.” The equipment was delivered on 05/20/2025 and the next nursing visit was conducted on 05/25/2025. The DME remained in the home and as of the date of this review 09/10/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 4: The patient's plan of care, dated 06/30/2025, included the stated goal, “patient/caregiver will verbalize understanding of oxygen safety measures re: including all elements from oxygen safety checklist by second visit 07/03/2025.” The patient remained on oxygen therapy and as of the date of this review 09/10/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 8: The patient's plan of care, dated 01/14/2023, included the stated goal, “patient/caregiver will verbalize understanding of oxygen safety measures re: including all elements from oxygen safety checklist by second visit 01/17/2023.” The patient remained on oxygen therapy and as of the date of this review 09/10/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 9: The patient's plan of care, dated 11/29/2023, included the stated goal, “patient/caregiver will verbalize understanding of safe use of Durable Medical Equipment (DME) dispensed to patient on first nursing visit after equipment is present.” The equipment was delivered on 11/29/2023 and the next nursing visit was conducted on 12/05/2023. The DME remained in the home and as of the date of this review 09/10/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 11: The patient's plan of care dated 05/24/2025, included the stated goal, “patient/caregiver will verbalize understanding of oxygen safety including all elements from 02 safety checklist by second visit dated 05/30/2025.” The patient remained on oxygen therapy and as of the date of this review 09/11/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 12: The patient's plan of care, dated 01/30/2025, included the stated goal, “patient/caregiver will verbalize understanding of safety measures re: oxygen use by end of visit date of second 02/10/2025.” The patient remained on oxygen therapy and as of the date of this review 09/11/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 13: The patient's plan of care, dated 09/16/2024, included the stated goal, “patient/caregiver will verbalize understanding of safe use of Durable Medical Equipment (DME) dispensed to patient on first nursing visit after equipment is present.” The equipment was delivered on 09/16/2024 and the next nursing visit was conducted on 09/18/2024. The DME remained in the home and as of the date of this review 09/11/2025, there have been no revisions or progress towards the goal documented. CLINICAL RECORD 14: The patient's plan of care, dated 03/19/2025, included the stated goal, “patient/caregiver will verbalize understanding of oxygen safety including all elements from 02 safety checklist by second visit dated 03/27/2025.” The patient remained on oxygen therapy and as of the date of this review 09/11/2025, there have been no revisions or progress towards the goal documented. During an interview on 09/11/2025 the Administrator/Director of Patient Care Services said that the process was to leave the interventions and goals open once they were initiated and confirmed that these had not been revised or closed once the goal dates had expired.

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, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 11 (9%) records reviewed revealed the agency failed to ensure the Interdisciplinary Group (IDG) completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. Record #3 was reviewed and identified the patient elected hospice care on 1/21/2022. A review of the record revealed the chaplain conducted an initial spiritual assessment on 1/28/22, 7 days outstanding. There was no physician order, communication, or documented reason for delay. During an interview, the Administrator/DPCS stated that she was unable to locate physician orders, plan of care updates, or a documented reason for a delay in the initial spiritual care assessment in the patient's clinical record. The Administrator/DPCS stated that she was unable to locate physician orders, plan of care updates, or a documented reason for a delay in the initial spiritual care assessment in the patient's clinical record.

It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The assessment update is completed as frequently as the condition of the patient requires and no less frequently than every 15 days. This standard was not met as evidenced by a review of clinical records and interviews. 5 of 11 (45%) records reviewed revealed the agency failed to ensure the comprehensive assessment was updated by the IDG no less frequently than every 21 days, according to the CMS Blanket Waivers implemented during the PHE. Record #10 was reviewed and identified the patient elected hospice care on 2/4/2022. The plan of care ordered registered nurse (RN) visits "monthly." The review of the record revealed there was no comprehensive assessment completed by the RN between the dates of 4/1/2022 and 4/29/2022, 27 days outstanding. Record #7 was reviewed and identified the patient elected hospice care on 7/5/2022. The plan of care ordered registered nurse (RN) visits "monthly." The review of the record revealed there was no comprehensive assessment completed by the RN between the dates of 7/5/22 and 8/1/22, 27 days outstanding. In addition, The review of the record revealed there was no comprehensive assessment completed by the RN after 8/2/2022 and 8/24/2022, 22 days outstanding as of the review. Record #4 was reviewed and identified the patient elected hospice care on 10/14/2021. The plan of care ordered registered nurse (RN) visits "monthly." The review of the record revealed there was no comprehensive assessment completed by the RN between the dates of 7/30/2022 and 8/24/2022, 25 days outstanding as of the review. Record #0 was reviewed and identified the patient elected hospice care on 4/4/2022. The plan of care ordered registered nurse (RN) visits "monthly." The review of the record revealed there was no comprehensive assessment completed by the RN between the dates of 7/22/22 and 8/19/22, 26 days outstanding. Record #6 was reviewed and identified the patient elected hospice care on 12/10/2021. The plan of care ordered registered nurse (RN) visits "monthly." The review of the record revealed there was no comprehensive assessment completed by the RN between the dates of 12/16/2021 and 1/7/2022, and 1/8/2022 and 2/1/2022, 22 days and 24 days outstanding respectively. During an interview, the Administrator/Director of Patient Care Services (DCPS) stated that it was her practice to ensure performance of a comprehensive assessment at least monthly for a LVN supervisory visit to be performed. If there was an aide assigned to a patient, performance of a comprehensive assessment at least every 15 days would occur to include an aide supervisory visit. The Administrator/DPCS stated that she was unaware that the comprehensive assessment was required to be performed at least every 15 days regardless of whether an aide was providing service to a patient. The Administrator/DPCS stated that it was her practice to ensure performance of a comprehensive assessment at least monthly for a LVN supervisory visit to be performed. If there was an aide assigned to a patient, performance of a comprehensive assessment at least every 15 days would occur to include an aide supervisory visit. The Administrator/DPCS stated that she was unaware that the comprehensive assessment was required to be performed at least every 15 days regardless of whether an aide was providing service to a patient.

It is required that the hospice designates a registered nurse member of the IDG to ensure the implementation of the interdisciplinary plan of care. 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), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire. This standard was not met as evidenced by a review of clinical records and interviews. 3 of 11 (27%) records reviewed revealed that the agency failed to ensure that skilled nursing services were followed per the plan of care (POC). Record #6 was reviewed and identified the patient elected hospice care on 12/10/2021. The physician's order documented registered nurse (RN) visits "monthly" and "skilled nurse visits weekly." No skilled nursing visit was documented as completed the week of 12/20/2021. The record did not include evidence of a documented missed visit or communication with the physician. Record #5 was reviewed and identified the patient elected hospice care on 9/14/2021. The POC effective 3/9/2022, ordered one licensed vocational nurse (LVN) and one RN visit each week. There was no physician order or communication with the physician documented for an RN visit missed the visit week of 3/20/2022. Record #3 was reviewed and identified the patient elected hospice care on 1/21/2022. The physician's order documented RN visits "twice monthly" and LVN visits to be "performed weekly." There was no LVN visit documented as completed the week of 2/6/2022. The record did not include evidence of a documented missed visit or communication with the physician. The Administrator/DPCS stated that physician orders changing RN, LVN or skilled nurse visit frequency and/or missed visit notes were absent from patient records. The records lacked documentation justifying the reason for the missed visits. The Administrator/DPCS provided documentation of a physician order obtained effective 12/10/21 for a Physical Therapy evaluation to be performed for pain and safety training to be conducted in one visit. The hospice IDG individualized plan of care updates did not include an established plan of care for ongoing physical therapy visits or treatment.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and is included in the plan of care. This standard was not met as evidenced by a review of clinical records and interviews. 2 of 5 (40%) records reviewed in which aide services were provided revealed the hospice agency failed to ensure aide visits were performed as ordered by the Interdisciplinary Group ( IDG), as included in the plan of care.. Record #8 was reviewed and identified the patient elected hospice care on 1/24/2022. The aide visit note dated 2/4/2022, did not include documentation of services the aide completed. The visit note was blank and did not indicate whether the aide completed the following assigned tasks: "clean nails; shave, range of motion, adult diapers changed." Record #5 was reviewed and identified the patient elected hospice care on 9/14/2021. The aide visit note dated 4/7/2022, did not include documentation of services the aide completed. The visit note was blank and did not indicate whether the aide completed the following assigned tasks: "check pressure areas, oral care with toothettes, oxygen safety, seizure precautions, or vital signs." In addition, review of the aide visit notes dated 3/11/2022 and 3/31/2022 revealed aide did not complete the assigned tasks: check pressure areas, toothettes, aspiration precautions, infection control standards, oxygen safety, seizure precautions, and check vitals. The week of 3/13/2022, the plan of care ordered aide visits to be performed twice weekly. The aide documented an extra visit performed on 3/17/22, for that week. There was no evidence of communication with the physician or physician order changing the aide frequency of visits. During an interview and a joint review of the records, the Administrator/DPCS provided a blank aide plan of care note printed from the EMR to explain that aides are required to address each assigned task on daily aide visit notes as either "Performed: Yes" or "Performed: No". If the task is not performed, a comment is to be entered as to why the task was not performed (i.e. "patient refused"). The Administrator/DPCS provided a blank aide plan of care note printed from the EMR to explain that aides are required to address each assigned task on daily aide visit notes as either "Performed: Yes" or "Performed: No". If the task is not performed, a comment is to be entered as to why the task was not performed (i.e. "patient refused").

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes including the care and services provided. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 1 (100%) of records reviewed in which the patient received physical therapy revealed the agency failed to ensure that the patient record contained all physical therapy visit notes including the care and services provided. Record #6 was reviewed and identified the patient elected hospice care on 12/10/2021. The physical therapy reassessment visit noted dated 1/7/2022, documented therapy would continue "1W4 effective 1/9/2022." The record contained no visit notes following the completed physical therapy reassessment visit dated 1/7/2022. In addition, the record was missing evidence of a physical therapy discharge summary. During an interview and a joint review of the record, the Administrator/ Director of Patient Care Services contacted the contract therapy company that provided the therapy services to the patient on the final day of the site visit; the therapy company indicated that they were having technical difficulties with their electronic medical record; the visit notes and discharge summary were not provided for review prior to the exit conference. The Administrator DPCS contacted the contract therapy company that provided the therapy service to the patient on the final day of the site visit; the therapy company indicated that they were having technical difficulties with their electronic medical record; the visit notes and discharge summary were not provided for review prior to the exit conference.