Every finding on record at Odyssey Healthcare of Marion County, LLC

Upon patient record review 2 of 27 (Patients #8,#9) 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 8: The medical record contained a comprehensive spiritual assessment 9/7/23 with a start of care 9/1/23. Patient 9: The medical record contained a comprehensive spiritual assessment 3/28/23 with a start of care 3/22/23.

Upon patient record review 6 of 27 (Patients #2,#6,#7,#13,#17,#18) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 2,6,7,13,17,18: There was no evidence of a comprehensive spiritual assessment.

Upon patient record review, 8 of 27 (Patients #2,#3,#5,#7,#8,#9,#15,#18) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 2,: The medication profile contained oxygen with no defined delivery method. Corrected on site. Patient 3: The medication profile contained clotrimazole-betamethasone topical cream with no area defined for administration. Patient 5: The medication profile contained oxygen with no defined delivery method. Patient 7: The medication profile contained oxygen with no defined delivery method. Patient 8: The medication profile contained duplicative hydrocodone orders with same doses and frequencies dated 9/1/23 and 9/13/23. Corrected on site. Patient 9: The medication profile contained Icy Hot menthol topical foam with no area defined for administration. Corrected on site. Patient 15: The medication profile contained duplicative Ativan PRNs with same dose, dated 4/10/23 and 7/3/23. Corrected on site. Patient 18: The medication profile contained oxygen with no defined delivery method. Corrected on site.

Upon patient record review, 3 of 27 (Patients #7,#8,#10) 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 7: The initial bereavement assessment was completed 7/12/23 with a start of care 6/30/23. Patient 8: The initial bereavement assessment was completed 9/11/23 with a start of care 9/1/23. Patient 10: The initial bereavement assessment was completed 6/19/23 with start of care 6/10/23.

Upon client record review, 2 of 27 (Patients #1,#11) did not have evidence that the hospice follows the individualized plan of care developed in 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. Patient 1: There was no evidence of orders received from the attending physician elected by the patient since admission. Patient 11: There was no evidence of orders received from the attending physician elected by the patient since admission.

Upon patient record review, 9 of 27 (Patients #2,#4,#5,#7,#8,#10,#14,#15,#18) 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: The medical record contained nursing documentation upon recertification visit 9/1/23 identifying patient use of oxygen due to dyspnea. There was no evidence of problems, goals, and interventions related to respiratory dysfunction. Patient 4: The medical record contained nursing documentation upon admission identifying patient issue with dysphagia requiring pureed diet and thickened liquids as aspiration precautions. There was no evidence of problems, goals, and interventions related to dysphagia. Patient 5: The medical record contained nursing documentation upon admission identifying patient issue with dysphagia and recurrent aspiration requiring pureed diet as aspiration precautions. There was no evidence of problems, goals, and interventions related to dysphagia. Patient 7: The medical record contained nursing documentation upon admission identifying patient issue with dyspnea with minimal exertion and high risk of skin impairment related to bedbound status. There was no evidence of problems, goals, and interventions related to respiratory dysfunction and risk for skin impairment. Patient 8: The medical record contained nursing documentation upon admission identifying patient had a urostomy. There was no evidence of problems, goals, and interventions related to urinary dysfunction and need for urostomy. Patient 10: The medical record contained nursing documentation upon recertification visit 8/29/23 identifying patient need for oxygen and feeding tube. There was no evidence of problems, goals, and interventions related to oxygen use and nutritional needs. Patient 14: The medical record contained nursing documentation 9/14/23 identifying reinsertion of catheter. There was no evidence of problems, goals, and interventions related to the need for an indwelling catheter. Patient 15: The medical record contained nursing documentation upon recertification visit 6/12/23 identifying patient history of falls and dysphagia. There was no evidence of problems, goals, and interventions related to fall safety and dysphagia. Patient 18: The medical record contained nursing documentation upon admission identifying patient issue with severe generalized pain. There was no evidence of problems, goals, and interventions related to pain.

Upon patient record review, 8 of 27 (Patients #2,#3,#5,#7,#9,#11,#13,#18) 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: The medical record contained an order for oxygen with no defined delivery method. Corrected on site. Patient 3: The medical record contained an order for clotrimazole-betamethasone topical cream with no area defined for administration. Patient 5: The medical record contained an order for oxygen with no defined delivery method. Patient 7: The medical record contained an order for oxygen with no defined delivery method. Patient 9: The medical record contained an order for Icy Hot menthol topical foam with no area defined for administration. Corrected on site. Patient 11: The medical record contained an order for an indwelling catheter that does not include catheter type and size. Patient 13: The medical record contained nursing documentation upon admission identifying patient use of an indwelling catheter. There was no evidence of a catheter order. Corrected on site. Patient 18: The medical record contained an order for oxygen with no defined delivery method. Corrected on site.

Upon patient record review, 12 of 27 (Patients #2,#3,#4,#6,#7.#8,#9,#11,#12,#13,#15,#18) 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 equipment and supply needs. Patient 2: The medical record contained nursing documentation upon recertification visit identifying patient use of a hospital bed, low air loss mattress, over the bed table, and walker. There was no evidence of the bed, mattress, table, and walker included as DME in the plan of care. Corrected Patient 3: The medical record contained nursing documentation upon admission identifying patient use of continuous oxygen. There was no evidence of the oxygen concentrator included as DME in the plan of care. Corrected Patient 4: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, low air loss mattress, over the bed table, and wheelchair. There was no evidence of the bed, mattress, table, and wheelchair included as DME in the plan of care. Corrected bed and table Patient 6: The medical record contained nursing documentation upon recertification visit 8/7/23 identifying patient use of a hospital bed, bedrails, over the bed table, and nebulizer. There as no evidence of the bed, rails, table, and nebulizer included as DME in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed and wheelchair. There as no evidence of the bed and wheelchair included as DME in the plan of care. Corrected on site. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of a walker. There was no evidence of the walker included as DME in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation upon recertification visit 8/31/23 identifying patient use of a hospital bed, bedrails, and bedside commode. There was no evidence of the bed, rails, and commode included as DME in the plan of care. The commode was corrected on site. Patient 11: The medical record contained nursing documentation upon recertification visit 8/8/23 identifying patient use of a hospital bed, bedrails, over the bed table, and wheelchair. There was no evidence of the bed, rails, table, and wheelchair included as DME in the plan of care. Corrected on site. Patient 12: The medical record contained nursing documentation upon recertification visit 7/20/23 identifying patient use of a walker an wheelchair. There was no evidence of the walker and wheelchair included as DME in the plan of care. Corrected on site. Patient 13: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, bedrails, over the bed table, wheelchair, and trapeze. There was no evidence of the bed, rails,table, wheelchair, and trapeze included as DME in the plan of care. Patient 15: The medical record contained an order for ipratropium bromide to be administered via a nebulizer. There was no evidence of the nebulizer included as DME in the plan of care. Corrected on site. Patient 18: The medical record contained an order for ipratropium bromide to be administered via a nebulizer. The record also contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of the nebulizer and oxygen concentrator included as DME in the plan of care. Corrected on site.

Upon client record review, 3 of 27 (Patients #6,#7,#20) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 6: The medical record contains an ordered spiritual care frequency of once monthly. There was no evidence the spiritual care provided visits and documents services patient declined. Corrected with late order entry to dc Patient 7: The medical record contains scheduled social work visit documentation 7/11/23, 7/31/23, and 8/28/23. There was no evidence of an ordered social work frequency after initial order for an evaluation. The ordered spiritual care frequency was 1Q2M2 effective 7/1/23. There was no evidence of spiritual care visits completed. Missed visit documentation 7/31 states reason was end of the month. There was no evidence of an attempt to scheduled a visit in August to meet the frequency and missed visit documentation 9/11/23 states patient refused services. Patient 20: The medical record contains an ordered social work frequency of 1q2m2,1m1 after initial evaluation. There was no evidence of any social work visits completed and no order to discontinue.

Upon patient record review 4 of 27 (Patients #2,#7,#9,#17) 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: The medical record contained an ordered aide frequency of five times weekly. There was no evidence of aide visits completed since 8/4/23. Corrected on site with late order entry to dc eff 8/4 Patient 7: The medical record contained an ordered aide frequency of three times weekly. There was no evidence of aide visits completed. The record contained 21 missed visit coordination notes that did not provide information per template for reason the frequency was not met other than intermittent comment of patient refusal. Patient 9: The medical record contained an ordered aide frequency of twice weekly. The record stated visits on paper 9/12/23, 9/14/23, 9/19/23, and 9/21/23. There was no evidence of paper visit documentation uploaded into the EMR. The aide care plan contained bathing task for a bed bath every visit and no tasks for oral care, assist with toileting, perineal care, and record of output. Aide documentation of shower given, oral care, assist to toilet, perineal care, and output 9/5/23. Date of last BM task not completed 9/5/23 and 9/7/23 documentation. Patient 17: The medical record contained an ordered aide frequency of five visits weekly. The record contained one completed visit and two missed visits documented the week of 8/13/23 and four visits completed the week of 9/3/23.

Upon patient record review 3 of 27 (Patients #12,#13,#15) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 12: There was no evidence of an aide supervisory visit since 8/15/23. Patient 13: The medical record contained an aide supervisory visit 9/18/23 stating the aide is not following the plan of care, but no additional information was available. Patient 15: There was no evidence of an aide supervisory visit between 8/28/23 and 9/15/23.

Upon personnel record review, 1 of 15 (Personnel #4) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 4: There was no evidence of an initial skills assessment.

Upon client record review, 1 of 27 (Patient #11) 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 11: The medical record contained an order for catheter change that does not specify facility or hospice management for performing task.

Upon observation, there was no evidence the hospice provides orientation to personnel of a SNF/NF or ICF/IID regarding the policies and procedures of the provision of care/service including all required content. Upon review, Palmetto General Hospital, Riviera Health Resort, and Franco Nursing & Rehabilitation facilities did not have evidence hospice provided required training.

Upon personnel record review, 1 of 15 (Personnel #15) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel 15: There was no evidence of a criminal background check for the contracted clinician.

Based on record review and interview, the provider failed to develop and implement emergency preparedness policies and procedures must address the use of volunteers in an emergency or other emergency staffing strategy. --- Findings include: Review of the Comprehensive Emergency Preparedness Plan presented by the Registered Nurse on 03/24/23 revealed no documentation addressing the use of volunteers. Interview conducted with the Registered Nurse on 03/24/23 at 4: 30 PM acknowledged the emergency preparedness plan presented to surveyor on 03/24/23 did not contain policies and procedures addressing the use of volunteers.

Based on observation, record review and interview, the provider failed to demonstrate a current drug profile that reflects a review of all the patients prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy for 4 out of 27 Sampled Patients (SP). (SP#1, SP#2, SP#3 and SP#14) --- Findings include: During a home visit made to SP#1 on 03/21/23 the surveyor reviewed the medications taken by SP#1 in presence of the Licensed Practical Nurse and the patients caregiver. The Medication Report and Plan of Care Update dated 03/13/23 omitted the medications Lisinopril 20 mg 1 tablet by mouth daily as of 02/20/23, Hydrochlorothiazide 125 mg 1 capsule by mouth every morning as of 02/20/23 and Combigan 0.2/0.5% 1 drop to both eyes twice a day as of 02/20/23. Interview conducted with the Licensed Practical Nurse during home visit on 03/21/23 at 7:12 PM stated that medications Combigan, Hydrochlorothiazide and Lisinopril are not listed on the Medication Report profile. During a home visit made to SP#2 on 03/21/23 the surveyor reviewed the medications taken by SP#2 in presence of the Registered Nurse and the patients caregiver. The Medication Report and Plan of Care Update dated 03/20/23 omitted the medication Atorvastatin 10 mg 1 tablet by mouth daily as of 12/17/21. Interview conducted with the SP#2s caregiver on 03/21/23 at 10:12 AM confirmed the patient is taking Atorvastatin. During a home visit made to SP#3 on 03/22/23 the surveyor reviewed the medications taken by SP#3 in presence of the Registered Nurse and the patients caregiver. The Medication Report and Plan of Care Update dated 03/14/23 omitted the medication Erythromycin 5% 1 drop to both eyes at bedtime as of 02/20/23. Interview conducted with the SP#3s caregiver on 03/22/23 at 9:52 AM confirmed the patient is taking Erythromycin. Review of the clinical record of SP#14 revealed the patient receives wound care by the hospice nurse with medication Hydrogel. Further review of the Medication Report and Plan of Care Update dated 03/14/23 omitted the medication Hydrogel. Interview conducted with the Registered Nurse and Administrator on 03/24/23 between 5:24 PM and 5:40 PM acknowledged findings made during survey, provider failed to maintain a current drug profile for patients SP#1, SP#2, SP#3 and SP#14.

Based on observation, interviews and record reviews, this hospice failed to update the comprehensive assessment in collaboration with the Physician, of changes that have taken place on 1 of 27 sample patients. (SP). SP # 4. --- Observation conducted during the home visit for SP # 4 on 3/21/2023 around 10:10 AM, patient do not have any GT (Gastric Tube); Visiting Nurse, and the patients personal care giver confirmed patient do not have any GT. ";She can swallow her oral medications." Visiting Nurses Visit Note Report for SP # 4 on 3/21/2023 reads under nutritional assessment: soft diet; Gastrointestinal assessment: did not show patient has a GT (Gastric Tube). Review of Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and Plan of Care Update Report for meetings dated 2/22/2023 and 3/8/2023 for Benefit period 2/6/2023 to 4/6/2023 reads medication lists: Cinacalcet 90 mg tablet 1 tablet -route G-tube 3 times daily; Docusate sodium 100 mg 1 tablet – route G-tube daily; Magnesium 400 mg 1 tablet route G-tube daily; Metoprolol tartrate 25 mg give 12.5 tablet route G-tube daily; Potassium Bicarbonate- Citric Acid 20 meq (milliequivalent) effervescent 1 tablet route G-tube daily; Tylenol 8 hour 650 mg tablet extended release 1 tablet route G-tube every 6 hours prn for pain and fever; Zinc Sulfate 220mg (50 mg) 1 capsule route G-tube daily. Phone interview with RN who took care of SP # 4 before the Visiting Nurse on 3/24/2023 at around 11:54 AM revealed she took care of the patient for a long time. ";The patient has no G tube before I stopped taking care of her." Phone interview with Visiting Nurse, on 3/24/2023 at around 12:05 PM revealed he is supposed to reconcile the patients medications. Review of the Policy title Clinical Record, Policy No. 2-009 reads: Hospice personnel providing patient care ... Documentation in the clinical/ record will be timely, detailed, accurate and reflect the care or services provided. Review of Comprehensive Assessment Policy No. 4-042 reads: Policy – A comprehensive patient assessment will be performed by the interdisciplinary group no later than 5 calendar days after the election of hospice care in consultation with attending physician, if any. This policy was not carried out.

Based on observation, record review and interview, the hospice staff failed to follow accepted standards of practice, including the use of standard precautions to prevent the transmission of infections and communicable diseases for 2 out of 6 Sampled Patients (SP) with home visits done. (SP#2 and SP#3) --- Findings included: Observation made during home visit of SP#2 on 03/22/23 at 9:12 AM, the Registered Nurse (Staff A) donned on clean gloves to remove old dressing from the sacral pressure ulcer wound. Using the same pair of dirty gloves, surveyor observed Registered Nurse picking from non-sterile gauze pack to cleanse and pat dry using a scissor to touch the wound. Observation made during home visit of SP#3 on 03/21/23 at 10:05 AM, Registered Nurse (Staff B) completed wound care on sacral wound. Then at 10:07 am the Staff B with the dirty gloves proceeded to perform wound care on SP#3s Left foot gangrene toes with non-sterile gauze and betadine solution and left open to air. Interview conducted with the Registered Nurse (Quality Assurance) and Administrator on 03/24/23 between 5:24 PM and 5:40 PM confirmed above findings that the hospice staffs failed to maintain infection control when performing wound care procedures to SP#2 and SP#3.

Based on record review and interview, the provider failed to provide Nursing services that must ensure that the nursing needs of the patient(s) are met as identified in the patients initial assessment, comprehensive assessment, and updated assessments for 1 out of 27 Sampled Patients (SP). (SP#20) --- Findings include: The clinical record review for SP#20 revealed the Plan of Care established the Skilled Nursing frequency 1 time a week as of 06/02/22. The Registered Nurse failed to provide the 2 scheduled visits for date range 06/02/22 to 06/16/22. Interview conducted with the Registered Nurse (Quality Assurance) on 03/24/23 at 1:33 PM confirmed no visits made to SP#20 by the Registered Nurse. The Registered Nurse stated the assigned nurse had a medical emergency and informed the office to re-assign the case, but when the patients daughter was notified, she refused any other staff and preferred to wait on the nurse. The Registered Nurse acknowledged the clinical record omitted notation of request and clarified it was verbally notified to her only.

Based on observation, record review and interview, the provider failed to maintain a clinical record that contain each patient's responses to medications, symptom management, treatments, and services for 1 out 27 Sampled Patients (SP). (SP#1) --- Findings include: During a home visit made to SP#1 on 03/21/23 the surveyor observed Licensed Practical Nurse provide medications administration to SP#1. The clinical record review of SP#1 revealed the Plan of Care ordered skilled nursing service twice a day for administrations of all medications. Review of the skilled nurse service notes for date range 01/15/23 to 03/20/23 revealed the progress note from all the skilled nurses providing care to SP#1 omit to document the name of each medication administered at each visit made. Interview conducted with the Registered Nurse on 03/22/23 at 3:05 PM acknowledged the hospice staff do not document the medications administered in the narrative of each note.

Based on record reviews and interview, the provider failed to demonstrate a completed discharge summary for 2 out of 27 Sampled Patients (SP). (SP#21 and SP#27) --- Findings include: Review of the clinical record for SP#27 revealed the patient was admitted to service with an election date of 10/12/2022 and was discharged on 11/22/2022 due to ";for not following POC (plan of care)." Further review of the clinical record omitted a summary of the patients stay including treatments, symptoms, and pain management; the patients current plan of care; the patients latest physician orders; and any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility. Interview conducted with the Registered Nurse on 03/22/2023 at 12:37 PM acknowledged findings, failure of the provider to have a complete clinical record with discharge summary completed. Review of the Clinical record for SP # 21 (benefit period from 12/9/2022 to 2/6/2023) revealed her Hospice Services have been revoked on 12/10/2022 because the patients legal representative wants to seek aggressive treatment. Review of Physicians order reads: " discharge patient due patient revoked looking x (for) aggressive treatment." Further review of all of her clinical records revealed an omitted documentation stating a summary of the patients stay including treatments, symptoms and pain management; patients current plan of care; the patients latest physician orders, and any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility. Interview with the RN (Registered Nurse) on 3/23/2023 at around 3:00 PM revealed that the discharge summary is the last Visit Note Report dated 12/10/2022. Further review of this note revealed the Assessment, and in that item it showed the following: indicate date of discharge: 12/10/2022; patient discharge initiated by: family; reason for discharge: revoked; discharge location: hospital; indicate reason for hospitalization: subcarinal hemorrhage; indicate name of hospital: name of hospital; indicate team members notified: medication review: plan of care review; facility given report to hospital staff. The documentation lacks the required elements of a discharge summary. Above findings acknowledged by the RN on 3/23/2023 at around 3:00 PM.

Based on record reviews and interviews, the hospice failed to demonstrate that all drugs and treatment necessary for the palliation and management of terminal illness and related conditions in order to meet the needs of the patient were assessed and included in 1 out of 3 sample patients. (SP). SP #3. Findings include: Review of SP #3's Hospice Certification and Plan of Care, with a start of care of 6/8/2022, and Certification Period 6/8/2022 to 8/6/2022. A review of SP#3's medication list showed the following medications were approved by the hospice physician: Bumetanide, Elequis, Levofloxine, Quetiapine, Senna, Zolpiden, Montelucast. On 7/13/2022 at 2:30 PM, the Director of Clinical Services stated in the presence of Staff - A: " there was a miscommunication. The hospice nurse did not get all the information about all the patient's medications. The ALF did not provide all the lists of the medications that the patient had. The patient was just admitted from another ALF on June 8th." These findings were acknowledged by the Directors of Clinical Services, and the Quality Manager on 7/14/2022 at 12:30 PM.