Every finding on record at Noble Care Hospice

Upon patient record review 1 of 14 (Patient #4) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient 4: No evidence that psychosocial assessment was completed within 5 days after admit. Assessment completed on 01/12/2024.

Upon patient record review, 2 of 14 (Patient #3,4) 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 3: No evidence that initial bereavement risk assessment was completed within 5 days of admit. Admitted on 07/10/2023, assessment completed on 03/06/2024. Patient 4: No evidence that initial bereavement risk assessment was completed within 5 days of admit. Admitted on 12/31/2023, assessment completed on 01/12/2024.

Upon client record review, 5 of 14 (Patient #2,3,4,7,9) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient 2,3,4,7,9: No evidence that the Chaplain placed updates in the IDG console nor is there evidence that he signed IDG notes for the following dates: January 12th and 26th & February 9th and 23rd.

Upon client record review, 4 of 14 (Patient #1,2,7,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: Plan of care has SN frequency as once a week. Patient received 2 visits weekly starting with the week of 12/10/2023 until current. No evidence of an order to increase visits. Patient 2: Plan of care has Chaplain visit frequency set at once a month. No evidence that the patient received a visit for the month of February 2024. No evidence of an order to decrease visits for the month or a visit refusal from the patient/caregiver. Patient 7: Patient declined Chaplain services at the start of care. Patient has received chaplain visits monthly since November 2023. No evidence that the change was requested by the patient/caregiver or that an order was obtained to start chaplain visits for those months. Patient 10: Patient declined Chaplain services at the start of care. Patient received chaplain visits for the months of November 2023, January 2024, and February 2024. No evidence that the visits were requested by the patient/caregiver or that an order was obtained to start chaplain visits for those months.

Upon patient record review 2 of 14 (Patient #2,4) 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 2: Plan of care has aide frequency as twice a week starting on 01/28/2024. No evidence that the patient received 2 visits for that week. Patient received 1 visit on 02/02/2024. No evidence of an order to decrease visits for that week or a visit refusal from the patient/caregiver. Patient 4: Plan of care has aide frequency as twice a week starting on 12/31/2023. No evidence that the patient received 2 visits for that week. Patient received 1 visit on 01/05/2024. No evidence of an order to decrease visits for that week or a visit refusal from the patient/caregiver.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient 10: No evidence that clinical information was documented on the recertification CTI before the new recertification period. CTI for the current benefit period, which started on 02/24/2023, is missing a documented narrative by the medical director.