Every finding on record at Onecare Hospice, LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. 2 of 19 (11%) clinical records reviewed revealed the agency did not ensure that when psychosocial services were accepted, the social worker and spiritual counselor completed the initial assessments within the five-day requirement. Clinical Record 8: Patient elected hospice benefit on 2/2/23. The initial social worker (MSW) assessment was documented on 2/8/23, which was day 6. The record did not contain documentation as to why the visit was not completed within the 5-day requirement. Clinical Record 18: Patient elected hospice benefit on 5/12/22. The initial chaplain assessment was documented on 5/27/22, which was day 15. The record did not contain documentation as to why the visit was not completed within 5 days. Personnel Record 2: During joint record review on 7/11/23, the DON reported that both of these disciplines had been accepted and confirmed that there was not any documentation to indicate the patient and/or families had requested visits outside of the 5-day requirement.

It is required that the comprehensive assessment includes 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. Information gathered from the initial bereavement assessment is incorporated into the plan of care and considered in the bereavement plan of care. This standard was not met as evidenced by clinical record review and interview. 5 of 19 (26%) clinical records reviewed revealed the agency did not ensure that initial bereavement risk assessments were completed. Clinical Record 1: Patient elected the hospice benefit on 4/21/23. The clinical record did not include documented evidence that the initial bereavement risk assessment was completed. Clinical Record 2: Patient elected the hospice benefit on 7/6/23. The clinical record did not include documented evidence that the initial bereavement risk assessment was completed. Clinical Record 11: Patient elected the hospice benefit on 5/25/23. The clinical record did not include documented evidence that the initial bereavement risk assessment was completed. Clinical Record 13: Patient elected the hospice benefit on 12/10/21. The clinical record did not include documented evidence that the initial bereavement risk assessment was completed. Clinical Record 18: Patient elected the hospice benefit on 5/12/23. The clinical record did not include documented evidence that the initial bereavement risk assessment was completed. Personnel Record 2: The DON confirmed, during the joint record review on 7/11/23, that none of the above clinical records contained evidence that the initial bereavement risk assessment had been completed. Furthermore, it was reported that in these cases the spiritual counselor had been declined and the bereavement risk assessment was included within that discipline's initial assessment which was the reason they were missed.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by an RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review, interview and observation. 3 of 15 (20%) clinical records reviewed, in which aide services were accepted, revealed the agency did not ensure that the hospice aide care plan provided specific instructions regarding patient care, thus leaving the aide to make decisions which is outside the scope of practice. Clinical Record 1: Patient elected the hospice benefit on 4/21/23 and was admitted with terminal diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer's Disease. Admission physician orders documented Oxygen at 3 liters (L) continuous. The aide care plan, effective from 4/21/23 to current, listed relevant task "shower". During the home visit observation on 7/10/23, the aide was observed removing the patient's oxygen for the shower. The aide care plan did not provide instructions as to if the aide could or could not remove the oxygen for care. During the joint clinical record review, the director of nursing (DON, Staff 2) reported that there is an area on the aide care that "the RN should have checked" to provide that guidance to the aide. Clinical Record 5: Patient elected the hospice benefit on 1/12/23 and was admitted with a terminal diagnosis of Alzheimer's Disease. The hospice aide care plan, effective from 4/12/23 to current, listed "as directed" as the frequency description for the aide to perform each task. Clinical Record 14: Patient elected the hospice benefit on 1/26/23 and was admitted with a terminal diagnosis of hemiplegia following cerebral infarction. The initial nursing assessment dated 1/26/23 documented the patient was alert to person only and had mumbled speech. The hospice aide care plan, effective from 4/26/23 to current, listed "as directed" as the frequency description for the aide to perform each task. Personnel Record 2: During joint record review on 7/11/23, the DON confirmed that the frequency description of "as directed" without any additional details, such as who the decision maker was and/or what specific directions the aides were to follow did not conform to the agency process and said, "they should not have been written that way."

It is required that a hospice aide provides services that are included in the plan of care. This standard was not met as evidenced by clinical record review and interview. 1 of 15 (7%) clinical record reviewed, in which aide services were accepted, revealed the agency did not ensure that the hospice aide performed only those tasks listed on the plan of care. Clinical Record 1: Patient elected the hospice benefit on 4/21/23 and was admitted with terminal diagnoses of COPD and Alzheimer's Disease. In the hospice aide visit documentation notes on 6/8/23 the aide stated, "shaved facial hair and all ADL's (activities of daily living) completed. Applied Calmo (Calmoseptine) to peri area." The aide care plan, effective 4/21/23 to 6/22/23, did not include "shaving" as an assigned task nor did it provide instructions to apply any type of lotion or cream during the task "peri-care". Personnel Record 2: During the joint record review on 7/11/23, the DON reviewed the aide and RN documentation and confirmed that the aide was not provided instructions, per the plan of care, to perform these tasks.