Every finding on record at Nyfries, Inc

Based on record review and interview, it was determined that the agency failed to ensure that the comprehensive assessment identifies the pain and other physical needs related to the terminal illness that must be addressed in order to promote the patient's well-being, comfort, and dignity throughout the dying process in 1 of 16 records reviewed (P-12) resulting in the potential for patients dying without their pain/symptoms being controlled. --- P-12: The Start of Care (SOC) was dated 6/30/23. The Plan of Care (POC) identified a terminal diagnosis of Pancreas Cancer. During record review on 8/10/23, it was noted that the comprehensive assessment completed by the Registered Nurse (RN) on 6/30/23 documented, ";Symptom Assessment: Pain: 5." The POC stated, ";Pt (Patient) will need more pain meds on Monday. DOH (Director of Hospice) notified, scheduled II completed and SNV (Skilled Nursing Visit) scheduled for Monday...Pt has abdominal pain, more on the left side, 1-7/10. SN (Skilled Nurse) educated on pain and non-pharmacological pain management." Additionally, the POC documented the following 4 nursing goals. 1. Patient/family wishes regarding end of life choices are honored throughout care. 2. Patient/family/caregiver will demonstrate healthy, functional approach to dealing with patient situation and anticipated loss. 3. Patient/family will express satisfactory control of symptoms. 4. Family/caregiver will verbalize when to notify hospice of concerns, changes in patient condition, and at time of death. The agency failed to specify a pain goal to promote optimal symptoms being controlled. These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Director of Hospice Services) during an interview on 8/10/23 at 1:15 pm.

Based on record review and interview, the hospice failed to provide an initial bereavement assessment of 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 in 5 of 17 (P-1, P-7, P-11, P-12 and P-17) records reviewed, resulting in the potential for lack of support for individuals who may be impacted by the patients death. Findings include: --- P-17: This 83-year-old patient was admitted to hospice on 6/21/23 with diagnoses of Hodgkin lymphoma and anemia. During record review on 8/9/23, it was noted that the start of care admission assessment completed by the registered nurse on 6/21/23 failed to include an initial bereavement assessment. The area to document the bereavement assessment states that no bereavement assessment was completed because no caregiver was present. The narrative note for that visit indicates the patient has a sister that lives nearby, a daughter that lives in Oklahoma, and a grandson in Houston that often contacts the patient. On 6/22/23, the social worker documented an assessment that failed to include a bereavement risk assessment. The narrative note for that assessment indicates the patient has two surviving sisters, one of whom lives locally and helps drive the patient to places. There was no documented bereavement risk assessment by the social worker. The social worker failed to follow agency policy 4-006.1, titled Bereavement Services (revised April 2020) which states, "A bereavement risk assessment will be completed by the hospice social worker at the time of admission to hospice." The findings were reviewed with and acknowledged by Staff-A (administrator) and Staff-B (director of hospice services) during an interview on 8/10/23 at 1:30 p.m. P-7: This 90-year-old patient was admitted to hospice on 3/28/23 with a terminal diagnosis of Parkinsons disease and malnutrition. An initial bereavement assessment was completed on 3/28/23 that failed to indicate other individuals that may be impacted by the patients death. During record review on 8/9/23, it was noted that coordination notes dated 3/31/23, documented the patients son and daughter-in-law visit the patient ";a couple of times a week." No other bereavement assessments were found in the medical record. The finding was reviewed and acknowledged by Staff A & B during an interview on 8/10/23 at 1:45 p.m. P-11: The Start of Care (SOC) was dated 7/13/23. The Plan of Care (POC) identified a terminal diagnosis of Cervical Cancer. During record review on 8/9/23, it was noted that the bereavement risk assessment was completed by the Skilled Nurse (SN) at the SOC. The SN documented, ";Bereavement Risk Assessment: Family/Caregiver: Daughter." A home visit was completed on 8/9/23 with a Medical Social Worker (MSW). It was observed that the patient lives with her daughter and son-in-law. Additionally, the daughter stated that the patients mother visits frequently. The bereavement risk assessment failed to include the patients mother and son-in-law. P-12: The Start of Care (SOC) was dated 6/30/23. The Plan of Care (POC) identified a terminal diagnosis of Pancreas Cancer. During record review on 8/10/23, it was noted that the bereavement risk assessment was completed by the SN at the SOC. The SN completed the bereavement risk assessment but there was no name listed. Additionally, the MSW documented on 7/3/23, ";...three children live close to Marquette and would be willing and able to come provide care. The bereavement risk assessment failed to include the patients daughters. These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Director of Hospice Services) during an interview on 8/10/23 at 1:00 pm. P-1: The Start of Care (SOC) was dated 6/5/2023. The Plan of Care (POC) identified a terminal diagnosis of Congestive Heart Failure (CHF) and Kidney Failure. During record review on 8/10/23, it was noted that the bereavement risk assessment was completed by the Medical Social Worker (MSW) on 6/7/2023. The MSW documented in the Narrative Notes, ";The patient was married for 59 years before her husband passed in 2019. The family had 4 children, 7 grandchildren, and 3 great grandchildren and is catholic and has had visits from the Priest. The patient is living with one of her daughters, who cares for her; and the family members are very close and visit frequently. However, the bereavement risk assessment failed to document the names of the other children and grandchildren, and there was no information found in the record that indicated these family members had been contacted to obtain information for the Bereavement Risk Assessment. These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Director of Hospice Services) during an interview on 8/11/23 at 3:00 pm.

Based on record review and interview, the agency failed to provide supervision of hospice aides in 1 (P-7) of 9 records with hospice aide services ordered, resulting in the potential for unmet care needs and poor patient outcomes. Findings include: --- P-7: This 90-year-old patient was admitted to hospice on 3/28/23 with a terminal diagnosis of Parkinsons disease and malnutrition. In the second certification period (6/26/23-9/23/23), skilled nursing and hospice aide services are ordered once a week for 13 weeks. During record review on 8/9/23, it was noted that a supervisory aide visit was performed on 7/26/23, requiring the next supervisory visit take place by 8/9/23. Skilled nursing visits were performed on 7/31/23, 8/1/23, and 8/8/23, none of which included a supervisory nursing visit. The finding was reviewed by Staff A & Staff B during an interview on 8/10/23 at 1:45 p.m. and Staff B acknowledged that no supervisory visit had been done by 8/9/23.

Based on record review and interviews, the hospice agency failed to document the definitions of abbreviations used in the patient's clinical record in 1 of 19 (MR#2) records reviewed, resulting in clinical documentation that is unclear or difficult to understand. Findings included: --- MR#2: The patient was admitted to the Hospice on 6/28/2023 with diagnoses of Hypertensive Heart and Chronic Kidney Disease with Heart Failure and with Stage 5 End Stage Chronic Kidney Disease. Upon review of the record, it was noted that undefined abbreviations were used in documenting the patient's hospice care resulting in difficulty understanding the care that was provided to the patient during the course of care. Examples included: "Pt has hx of PNA, DVT". "HCA visits added to SP." "PU prevention/pressure relieving techniques." "Contacts made as a result of this Visit: "CSS". {sic} The first sentence contained 10 words, 5 of which were abbreviations resulting in unclear communication of the patient's hospice care. There were no definitions found in the charting for the abbreviations "PNA, DVT, HCA, SP, or CSS". When questioned about the many abbreviations noted in the patient's charting, Staff-A and Staff-B stated, "we do have a document defining the abbreviations." When asked to provide a copy of the document for review, the document had not been provided to this surveyor by the time of exit from the agency. Staff-B stated she "could not find the document that defined the agency's abbreviations." These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Director of Hospice Services) during an interview on 8/10/23 at 3:00 pm.