Every finding on record at Ohio Hospice and Palliative Care

Based on employee interviews (EMP) and reviews of agency policy, patient admission packets, and clinical records (CR) the agency failed to provide patients and patient representative/families with a copy of the hospices written policies and procedures on the management and disposal of controlled drugs for one (1) of ten (10) CRs reviewed. (CR 5) --- Findings included: A review of the agency document Patient Admission Handbook on 2/26/24 at approximately 10:00 am revealed patient teaching..."...How to Manage Medications at Home...Do...Non-Controlled Substances: dispose of all medications by dissolving agent...Consult the FDA-approved list of medicines that are considered safe to flush... Contact ...for the location of take back events or pharmacy drop boxes. ..." A review of agency clinical policies on 2/26/24 at approximately 1:00 pm revealed: Agency policy titled Safe Drug Disposal Procedure, effective 11/14/17, read: ";2. In a long-term care facility setting, hospice employees will dispose of controlled substances with the facilities nursing staff by... 3. In the home, the hospice staff will encourage the patient and/or designated caregiver to dispose of medications (including controlled substances) that are no longer ordered, due to discontinued use or death of the patient. ... 4. Hospice staff are responsible for the education of patients and families regarding the proper medication disposal methods. ..." Agency policy titled Narcotic Destruction, effective 5/1/08, read: ";Standard: It is the hospice nurses ethical responsibility to inform/assist the patient/caregiver of their responsibility in disposing of narcotics. Procedure: ...2. If the patient resides in a facility, the medications are to be disposed of in accordance with the facilitys policies and procedures. 3. If a hospice nurse, with patients/caregivers approval, participates in the disposal of medication, the method of disposal and amount disposed is documented and cosigned with a witness on the Narcotic Destruction Form and placed in the hospice medical record. Only licensed hospice staff will participate in medication destruction." A Clinical record (CR) review was conducted on 2/28/24 between approximately 10:00 to 1:00 pm: CR5: Start of Care (SOC): 12/28/23, Certification Period Reviewed (Cert): 12/28/23 – 3/26/24. CR contained a Plan of Care dated 12/28/23 which contained orders for controlled substances with a start date of 12/28/23. CR contained no evidence that a written policy/procedure on the management and disposal of controlled drugs was provided to the patient or patient family/representative at the time that controlled substances were ordered on 12/28/23. During an interview with EMP1 (Administrator) on 2/28/24 at approximately 2:00 pm it was determined that the hospice agency did not provide copies of the hospices written policies and procedures on the management and disposal of controlled drugs to patients or patient representative/families. EMP1 verified that the information within the Patient Admission Handbook was the only document provided to all patients and patient family/representatives to review the management and disposal of controlled drugs. The above finding was reviewed during an exit conference on 2/28/24 at approximately 2:45 pm with EMP1 (Administrator), EMP2 (Project Manager), and EMP3 (Alternate Administrator).

Based on a review of inpatient agreements (AG) and interviews with staff (EMP) it was determined that the hospice agency failed to maintain training materials and verification of training for personnel within contracted inpatient facilities for one (1) of one (1) inpatient agreements reviewed. (AG1) --- Findings included: A review on 2/28/24 at approximately 2:00 pm of agency agreements revealed: AG1: Entry date: 5/6/21. Titled Inpatient and Respite Care Service Agreement revealed: ";3. Services and Responsibilities of Hospice...3.5 Nursing Facility Orientation. Hospice personnel must assure orientation of Nursing facility staff furnishing care to Hospice Patients in the hospice philosophy, including Hospice policies and procedures regarding methods of comfort, pain control, symptom management, as well as principles about death and dying, individual responses to death, patient rights, appropriate forms, and record keeping requirements. ..." During an interview on 2/28/24 at approximately 2:00 pm with EMP1 (Administrator) it was determined that a roster of trained individuals and the training program/materials for AG1 were not available for review. The above finding was reviewed during an exit conference on 2/28/24 at approximately 2:45 pm with EMP1 (Administrator), EMP2 (Project Manager), and EMP3 (Alternate Administrator).

Based on a review of agency policy and procedure, a review of clinical records (CRs), and staff interview, the agency failed to ensure that the written plan of care included individualized scope and frequency of services necessary to meet the specific patient and family needs for eleven (11) of eleven (11) CRs reviewed with completed written plans of care (CR1-CR11). Findings Included: A review of agency policy and procedure, reviewed on 11/29/2021 at approximately 3:35 p.m. revealed: "PLAN OF CARE ... Standard: All hospice care and services furnished to patients and their families must follow an individualized Plan of care established by the Hospice Interdisciplinary Group (IDG) in collaboration with the Attending Physician (if any), the patient or designated representative, and the primary caregiver in accordance with the patients needs if any of them desire. Procedure: ... The individualized Plan of care will reflect patient and family goals and interventions based on problems identified in the initial and subsequent comprehensive assessments ... including: ... 2. The scope and frequency of services necessary to meet the specific patient and family needs. ... " A review of CR1, conducted on 11/17/2021 at approximately 12:10 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 8/25/2021, certification period reviewed 8/25/2021 to 11/22/2021 and a terminal diagnosis of "Unspecified severe protein-calorie malnutrition". A further review revealed that the plan of care included Counselor 20 visits prn (as needed) for bereavement/spiritual needs Start date 8/25/21, end date 11/22/2021, Volunteer 20 visits prn for companionship Start date 8/25/21, end date 11/22/2021. Review found that the patient had one counselor visit on 8/27/21 for initial assessment, and nine volunteer visits on 8/29/21, 9/5, 12, 19 & 25/2021, 10/3, 9, 16 & 23/2021. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 8/31/2021, 9/14 & 28/2021, 10/12 & 26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR2, conducted on 11/17/2021 at approximately 12:45 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 10/21/2021, certification period reviewed 10/21/2021 to 1/15/2022 and a terminal diagnosis of "Heart Failure". A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 10/21/2021, end date 1/18/2022, Volunteer 20 visits prn for companionship Start date 10/21/2021, end date 1/18/2022. Review found that the patient had one counselor visit on 10/21/21 for initial assessment, and one volunteer visit on 10/23/2021. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 10/26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR3, conducted on 11/17/2021 at approximately 1 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 6/10/2020, certification period reviewed 10/3/2021 to 12/1/2021 and a terminal diagnosis of "Cerebral Atherosclerosis". A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 10/3/2021, end date 12/1/2021, Volunteer 20 visits prn for companionship Start date 10/3/2021, end date 12/1/2021. Review found that the patient had no counselor or volunteer visits during the certification period. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 10/12 & 26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR4, conducted on 11/17/2021 at approximately 1:15 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 9/28/2021, certification period reviewed 10/12/2021 to 1/9/2022 and a terminal diagnosis of "Parkinson ' s Disease " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 10/12/2021, end date 1/9/2022, Volunteer 20 visits prn for companionship Start date 10/12/2021, end date 1/9/2022. Review found that the patient had one counselor visit on 10/2/21 for initial assessment, and one volunteer visit on 10/23/2021. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 10/12 & 26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR5, conducted on 11/17/2021 at approximately 1:35 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 10/8/2021, certification period reviewed 10/8/2021 to 1/5/2022 and a terminal diagnosis of "Unspecified Diastolic Heart Failure " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 10/8/2021, end date 1/5/2022, Volunteer 20 visits prn for companionship Start date 10/8/2021, end date 1/5/2022. Review found that the patient had one counselor visit on 10/13/21 for initial assessment, and no volunteer visits during the certification period. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 10/12 & 26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR6, conducted on 11/17/2021 at approximately 2 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 10/11/2021, certification period reviewed 10/11/2021 to 1/8/2022 and a terminal diagnosis of "Alzheimer ' s Disease with late onset " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 10/11/2021, end date 1/8/2022, Volunteer 20 visits prn for companionship Start date 10/11/2021, end date 1/8/2022. Review found that the patient had one counselor visit on 10/14/21 for initial assessment, and two volunteer visits on 10/25 & 27/2021. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 10/26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR7, conducted on 11/17/2021 at approximately 2:12 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 11/5/2021, certification period reviewed 11/5/2021 to 2/2/2022 and a terminal diagnosis of "Parkinson ' s Disease " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 11/5/2021, end date 2/2/2022, Volunteer 20 visits prn for companionship Start date 11/5/2021, end date 2/2/2022. Review found that the patient had one counselor visit on 11/9/21 for initial assessment, and no volunteer visits during the certification period. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR8, conducted on 11/17/2021 at approximately 2:34 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 6/2/2020, certification period reviewed 9/25/2021 to 11/23/2021 and a terminal diagnosis of "Heart Failure Unspecified " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 9/25/2021, end date 11/23/2022, Volunteer 20 visits prn for companionship Start date 9/25/2021, end date 11/23/2022. Review found that the patient had no counselor or volunteer visits during the certification period. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 9/28/2021, 10/12 & 26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR9, conducted on 11/17/2021 at approximately 2:47 p.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 9/17/2021, certification period reviewed 9/17/2021 to 12/15/2021 and a terminal diagnosis of "Heart Failure " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 9/17/2021, end date 12/15/2021, Volunteer 20 visits prn for companionship Start date 9/17/2021, end date 12/15/2021. Review found that the patient had one counselor visit on 9/20/21 for initial assessment, and no volunteer visits during the certification period. Frequencies were not addressed or adjusted during Interdisciplinary Group (IDG) meetings on 9/28/2021, 10/12 & 26/2021 or 11/9/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR10, conducted on 11/18/2021 at approximately 9:50 a.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 6/17/2021, certification period reviewed 6/17/2021 to 9/14/2021 and a terminal diagnosis of "Alzheimer ' s Disease unspecified " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 6/17/2021, end date 9/14/2021, Volunteer 20 visits prn for companionship Start date 6/17/2021, end date 9/14/2021. Review found that the patient had one counselor visit on 6/18/2021 for initial assessment, and no volunteer visits during the certification period. Patient ceased to breath on 6/21/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. A review of CR11, conducted on 11/18/2021 at approximately 10:05 a.m. revealed a "Hospice Certification and Plan of Care" with a start of care date of 6/30/2021, certification period reviewed 6/30/2021 to 8/28/2021 and a terminal diagnosis of "Malignant Neoplasm of unspecified bronchus or lung " . A further review revealed that the plan of care included Counselor 20 visits prn for bereavement/spiritual needs Start date 6/17/2021, end date 9/14/2021, Volunteer 20 visits prn for companionship Start date 6/30/2021, end date 8/28/2021. Review found that the patient had one counselor visit on 7/2/2021 for initial assessment, and two volunteer visits on 7/10 & 24/2021. Patient ceased to breath on 7/25/2021. Bereavement counseling and volunteer visit orders did not reflect and were not individualized to address the specific patient's needs. Review found that all patients in the sample had the same frequencies for bereavement counseling and volunteer services, regardless of need for services. An interview with EMP3 (Volunteer Coordinator) on 11/16/2021 at 11:40 a.m. revealed that currently there was only one volunteer for the hospice. Findings were discussed and confirmed with EMP1 (administrator) and EMP2 (Clinical Director) during exit interview on 11/18/2021 at 2:30 p.m. When EMP 1 and EMP2 were asked about the large frequency of visits EMP2 said " I ' m not sure where those frequencies started. " Also questioned appropriateness of all patients having volunteer services ordered at such a large frequency with only one volunteer, EMP1 and EMP2 verbalized agreement it was not appropriate.

Based on review of agency policy, clinical records (CR) and staff (EMP) interview it was determined the agency failed to ensure the discharge summary included a summary of the patient's stay including treatments, symptoms, and pain management, for one (1) of two (2) CR of discharged patients reviewed. (CR10) Findings Included: Review of "Patient Discharge" policy 11/29/2021 at 3:30 p.m. read "The Hospice RN (Registered Nurse) documents a detailed Discharge Summary which is forwarded to the patient's Attending Physician for signature and filed on the patients chart." Review of CR10 on 11/18/2021 at approximately 9:50 a.m. revealed a start of care (SOC) 6/17/2021, patient ceased to breath on 6/21/2021. Record selected for review reason discharged case. Discharge summary dated 6/21/2021, authenticated by physician 6/23/2021. Summary section of discharge summary was blank. Discharge summary failed to contain a summary of the patient's stay including treatments, symptoms, and pain management. Finding was confirmed with EMP1 (administrator) and EMP2 (Clinical Director) during exit interview on 11/18/2021 at 2:30 p.m. Repeat finding 11/30/2018