Every finding on record at Nj Hospice Holding LLC

Upon patient record review, 2 of 20 (Patient #12, 20) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #12, 20: The section of Informed/Consent/Medicare Benefit Election and Designated Physician form is totally blank for space allocated to identify and confirm patient chose or declined to choose attending physician.

Upon patient record review, 1 of 20 (Patient #13) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #13: During patient visit to ALF, noted that facility hospice Rx profile has (effective 2/12/24) Morphine 20 mg/ml oral concentrate 20 mg/ml oral concentrate - Administer 0.25 ml 2 times a day for pain/sob. The Facility has the same Rx order, but with a frequency of 3x/day, effective 4/24/24.

Upon patient record review, 1 of 20 (Patient #11) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #11- SOC 1/19/24. Bereavement assessment for RN initial says not completed-Completed by social worker. Completed by chaplain. MSW initial assessment visit 1/30/24 (beyond 5 days) r/t patient request and no specific bereavement assessment identified in SC initial visit 1/22/24..

Upon patient record review, 4 of 20 (Patient #2, 4, 10, 13) did not have evidence in the patient record that the hospice has 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: Patient admitted 4/8/24 with Gastrostomy/tube feedings. There no IDG POC problem(s) or goals/interventions related to gastrostomy, assessment, site care, feedings and no reference to coordinating with SNF. Patient #4: Admitted 3/12/24 with sacral wound. Care Plan includes Risk for impaired skin integrity, teach pressure relief measures, avoidance of friction only. No reference to existing wound and/or treatment and/or coordination with facility. Patient #10. Admitted 3/7/24 with Foley catheter. There are no related problem, goals interventions . Patient #13:ALF resident admitted 11/27/23 with indwelling 16 Fr 10 cc balloon Foley catheter. Goal to maintain patency, but no order for related interventions.

Upon patient record review, 2 of 20 (Patient #8,13) 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 #8: Admitted 3/15/24 with melanoma nose. SN frequency initial POC 1wk13 and 10 prn. (1-10 prn for s/sx and death pronouncement). Patient #13 Admitted 11/27/24. SN 1wk4m and 4 prn. 3/29/24 SN 1wk1and 10 prn symptom management or death pronouncement. 10 prn visits is too broad and if needed would indicated frequency adjustment.

Upon patient record review, 4 of 20 (Patient #2,10,12,13) 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 medications and treatments. Patient #2: SNF resident admitted with Foley catheter and gastrostomy tube for feedings. There are no orders related to catheter and gastrostomy. The IDG identifies problem of having catheter, but no orders specific to assessment, care, changes, maintenance, coordination of care for the SNF resident. Upon interview, it is reported that the facility manages catheter and gastrostomy. Education provided regarding coordinated Plan of Care. HA Care Plan includes Jevity 1.5 feeding-aspiration precautions at each visit and catheter care each visit, but no physician order included in record. Patient #10: 3/7/24 Tobramycin 0.3% ophthalmic ointment 0.3% ointment. Apply small film 3x/day for eye infection. Order does not specify which or both eyes. Patient has Foley catheter with no related orders to foley or who will provide care. Patient #12: SNF resident admitted 5/30/23 with indwelling catheter. IDG POC includes GU problem simply stated as indwelling catheter/drainage system patent and functioning without complication. There are no related orders documented in the record. Upon interview, SNF manages Foley. Education provided regarding coordinated Plan of Care. Patient #13:ALF resident admitted 11/27/23 with indwelling 16 Fr 10 cc balloon Foley catheter. Supplies included in orders however, not specific to foley and care. Patient also has Decubitus/Pressure Ulcer BL Buttocks with order to cleanse with NSS apply MediHoney with CA Alginate and cover with foam dressing 3x/week however, order is not specific to who will provide care.

Upon patient record review 2 of 20 (Patient #3, 5) 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 #3: Admitted 3/14/24 with HA Care Plan frequency of HA 5/wk. Task assignment for shampoo 2x/wk. HA documented shampoo was done daily: April 9, 10, 11, 12 (T-Fri). Patient #5: Admitted 3/8/24 with HA Care Plan frequency of HA 5/wk. Task assignment for shampoo 2x/week. HA documented shampoo was done daily April, 8, 9, 10, 11, 12. (M-F)

Upon patient client record review, 3 of 20 (Patient #11,12,20) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #11: The admission Informed Consent/Medicare Benefit Election and Designated Attending Physician Form has a hospice benefit effective date of 1/19/24. Both the wife/POA and witness signatures are dated 1/22/24, making the election date retroactive to signature. Patient #12: The admission Informed Consent/Medicare Benefit Election and Designated Attending Physician Form has a hospice benefit effective date of 5/20/24. Both the POA and witness signatures are dated 5/31/24, making the election date retroactive to signature. In addition, the section of Informed/Consent/Medicare Benefit Election and Designated Physician form is totally blank for space allocated to identify and confirm patient chose or declined to choose attending physician. Patient #20: The section of Informed/Consent/Medicare Benefit Election and Designated Physician form is totally blank for space allocated to identify and confirm patient chose or declined to choose attending physician.

Upon patient client record review, 7 of 20 (Patient #2, 3, 6, 8, 13, 14, 19) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patients #2, 3, 6, 8, 13, 14, 19: Patient's chose attending physician other than hospice physician. There is no attending CTI for the initial benefit period for these patients.

Upon client record review, 4 of 20 (Patient #2, 4, 10, 12) 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 #2: SNF resident admitted with Foley catheter and gastrostomy tube for feedings. There is no documented evidence of coordinated Plan of Care between the hospice and SNF (and patient) regarding catheter and gastrostomy. Patient #4: SNF Resident admitted 3/12/24 with wound care to sacral wound. There is no documented evidence of a coordinated Plan of Care between the hospice and SNF (and patient) regarding wound care. Patient #10: Patient has Foley catheter with no related orders/coordination of care. Patient #12: SNF resident admitted 5/30/23 with indwelling catheter. There is no documented evidence of coordinated Plan of Care between the hospice and SNF (and patient) regarding catheter.

Based on staff interviews, review of facility policy and procedure, and a review of facility documents, it was determined that the hospice failed to ensure that bereavement services are provided for fourteen (14) of fourteen (14) patients (#11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24) in accordance with its policy. Findings include: Reference: The facility policy titled, "Policy #B-1.0 Bereavement Program and Services" states, "... .Policy: Bereavement services are provided as part of the (Name of Facility) Interdisciplinary Team [IDT] Care Plan. ... . Assessment of bereavement needs is the responsibility of the Hospice IDT, with assessment beginning at the hospice admission and following through a full year plus, according to an organized and individualized plan of care developed for each bereaved individual. ... . Hospice services do not cease upon death of the patient. For a period of thirteen (13) months following the death, supportive services focus on the unique needs of the surviving loved ones experiencing grief. ... . Procedure: Bereavement Services-The Bereavement Counselor is responsible for the development and oversight of the individualized bereavement plan of care. ... . 8. Bereavement mailings, samples of which follow this policy, are sent out by the Administrative Volunteer under the direction of the Bereavement Counselor, and include he following: A. Sympathy Card: Within one (1) week of the patient's death... . B. Hospice Services Survey: Within one (1) month after death ... . C. Personalized Letters: A hospice bereavement letter series is sent to the bereaved who are indicated on the risk assessment and willing to receive support. Each letter reminds the bereaved person of the continued support and availability of the bereavement team. ... ." 1. On 2/15/22, Staff #2 provided a list of Patient Start of Care dates and Patient Deaths for the the months of December 2021 and January 2022. A review of this list was conducted and revealed the following: a. The following patient families/caregivers did not receive Bereavement Services in accordance with the facility policy and procedure: (i) Patient #11 Start of Care Date: 12/17/21; Date of Death: 12/21/21 (ii) Patient #12 Start of Care Date: 1/6/22; Date of Death: 1/11/22 (iii) Patient #13 Start of Care Date: 11/23/21; Date of Death 1/28/22 (iv) Patient #14 Start of Care Date: 12/3/21; Date of Death 12/27/21 (v) Patient #15 Start of Care Date: 1/17/22; Date of Death 1/20/22 (vi) Patient #16 Start of Care Date: 12/1/21; Date of Death 12/2/21 (vii) Patient #17 Start of Care Date: 1/14/22; Date of Death 1/19/22 (viii) Patient #18 Start of Care Date: 1/10/22; Date of Death 1/18/22 (ix) Patient #19 Start of Care Date: 12/27/21; Date of Death 12/30/21 (x) Patient #20 Start of Care Date: 1/24/22; Date of Death 1/27/22 (xi) Patient #21 Start of Care Date: 10/28/21; Date of Death 12/5/21 (xii) Patient #22 Start of Care Date: 11/24/21; Date of Death 12/3/21 (xiii) Patient #23 Start of Care Date: 11/30/21; Date of Death 12/25/21 (xiv) Patient #24 Start of Care Date: 12/24/21; Date of Death 12/25/21 2. On 2/15/22, the following was indicated during interview: a. At 12:50 PM, Staff #2 stated that December 2021 and January 2022 was a challenging time for the facility, due to staffing vacancies. The Chaplain (Staff #18) resigned without notice on December 3, 2021. Efforts to fill the vacancy were ongoing immediately. A new Chaplain (Staff #13) was hired the second week of January 2022 and began working on February 7, 2022. b. At 2:30 PM, Staff #1 stated that he/she and the Social Worker attempted to reach out and communicate with the families/caregivers of their deceased patients during these times, but no documentation was entered in the medical record to detail the bereavement interventions. (i) Staff #1 further stated that for the months of December 2021 and January 2022, the facility did not have a bereavement coordinator. 3. These findings were confirmed by Staff #1 and Staff #2.

Based on medical record review, staff interviews, and review of policies and procedures, it was determined that the facility failed to ensure that spiritual counseling needs are assessed and/or arranged for each patient and their families. Findings include: Reference: Facility document, "Spiritual Counselor ... B. Primary Responsibilities ... 1. Provides the comprehensive assessment of spiritual needs of hospice patients, families and/or caregivers within five (5) calendar days of patient's election to the hospice benefit or according to patient/family wishes on the Spiritual Care Assessment Form. ..." 1. On 2/15/22, a medical record review of five (5) of ten (10) medical records (#2, #4, #6, #8, and #10) was facilitated by Staff #1. The review revealed there was no documented evidence in section, "Spiritual Assessment," that the following patients/families received comprehensive assessments for spiritual counseling services/needs within the five (5) calendar days of starting hospices services: a. Patient #2 - Start of Care Date: 12/21/2021 b. Patient #4 - Start of Care Date: 2/1/2022 c. Patient #6 - Start of Care Date: 11/16/2021 d. Patient #8 - Start of Care Date: 12/10/2021 e. Patient #10 - Start of Care Date: 1/21/2022 3. The medical record review of two (2) of ten (10) medical records (#3 and #9), in the presence of Staff #1, revealed there was no documented evidence in section, "Spiritual Assessment," that the facility facilitated or ensured clergy arrangements were met based on the spiritual needs assessed for the following patients: a. Patient #3 - Start of Care Date: 12/3/21, documented in "Spiritual Assessment: Denomination: Roman Catholic ... Clergy Status: Wants clergy notified ..." b. Patient #9 - Start of Care Date: 11/29/2021, documented in "Spiritual Assessment: Active in faith/church - Spiritual Resources and Support: Not assessed ..." 4. On 2/15/22 at 3:00 PM, Staff #1 confirmed the above findings.