Every finding on record at P & N Hospice and Palliative Care Inc

Based on record review and interview, the ​hospice failed to be primarily engaged in providing nursing services, medical social services and counseling services to any potential patients admitted to the hospice in that: The hospice did not have any current nurses, social workers, and counsellors employed who would be available to provide services and oversight to any patients admitted for care. This failure places any potential patients at risk of not receiving effective oversight of pain and symptom management, at risk of not having their nursing needs met or their services not being appropriately supervised, at risk of not having psychosocial assessments to help identify issues or assist with facilitating the patients care and treatment in their end of life, and places potential patients and family members at risk of not receiving the support services needed during the patients end stage of life. --- In an interview on 11/06/24 at 12:35pm with the administrator during the entrance conference, she was asked to provide a staff list and a list of all the IDG (Inter-Disciplinary Group) team members. Record review of the staff list provided by the administrator on 11/08/24 revealed in part names and title of a medical director, an administrator, a supervising nurse, a nurse, a social worker, and a chaplain. In an interview on 11/08/24 at 11:05 am with the Administrator, when asked who the members of the IDG were, she said the agency had a medical director, social worker, chaplain, and an IDG nurse. When asked if any of the staff were being paid by the agency, she said ";no." When asked if anyone from the staff list were active employees of the agency, she said no, and added the only active employee of the agency at the moment were herself as the administrator and the alternate administrator who was also the medical director. When asked why there was no IDG, she said the agency had no patients for more than a year and they were preoccupied with the ";paperwork" for the stock transfer that they did not think to form the IDG. The last patient the agency had was in June 2023. She added, she was responsible for making sure that IDG was in place. In a telephone interview on 11/08/24 at 3:47 pm with person listed as the Hospices supervising nurse, she stated she was never a supervising nurse at the hospice agency and had never heard of the hospice. She added, she thought she worked with the medical director, but she was never involved with the hospice. At 3:51 pm on 11/08/24 surveyor placed a telephone call to the person listed as chaplain, but the phone rang without an answer. In a telephone interview on 11/08/24 at 3:53 pm with the person as IDG nurse, she said she had never worked at the hospice agency, and she never heard of it before. In a telephone interview on 11/08/24 at 4:01 pm with person listed as social worker, he said, he may have worked with the medical director for a short period of time before, but not at or with the hospice agency. Record review of the agencys policy titled, ";Interdisciplinary Group Membership and Responsibilities" dated October 2016 revealed in part...... ";Purpose: To define the membership and responsibilities of the interdisciplinary group. Policy: The interdisciplinary group will collaborate with the patients attending physician to develop an individualized written plan of care. 1. The P & N Hospice and Palliative Care interdisciplinary group membership includes at a minimum; A. Physician, B. Registered Nurse, C. Social Worker, D. Pastoral or other counselor."

Based on record review, interview and observation, the ​hospice failed to be primarily engaged in providing nursing services to any potential patients admitted to the hospice in that: The hospice did not have any current nurses employed who would be available to provide services and oversight to any patients admitted for care. This failure places any potential patients at risk of not receiving effective oversight of pain and symptom management, at risk of not having their nursing needs met or their services not being appropriately supervised during the patients end stage of life. --- In an interview on 11/06/24 at 12:35pm with the administrator during the entrance conference, she was asked to provide a staff list and a list of all the IDG (Inter-Disciplinary Group) team members. Record review of the staff list provided by the administrator on 11/08/24 revealed in part names and title of a medical director, an administrator, a supervising nurse, a nurse, a social worker, and a chaplain. In an interview on 11/08/24 at 11:05 am with the Administrator, when asked who the members of the IDG were, she said the agency had a medical director, social worker, chaplain, and an IDG nurse. When asked if any of the staff were being paid by the agency, she said ";no." When asked if anyone from the staff list were active employees of the agency, she said no, and added the only active employee of the agency at the moment were herself as the administrator and the alternate administrator who was also the medical director. When asked why there was no IDG, she said the agency had no patients for more than a year and they were preoccupied with the ";paperwork" for the stock transfer that they did not think to form the IDG. The last patient the agency had was in June 2023. She added, she was responsible for making sure that IDG was in place. In a telephone interview on 11/08/24 at 3:47 pm with person listed as the Hospices supervising nurse, she stated she was never a supervising nurse at the hospice agency and had never heard of the hospice. She added, she thought she worked with the medical director, but she was never involved with the hospice. At 3:51 pm on 11/08/24 surveyor placed a telephone call to the person listed as chaplain, but the phone rang without an answer. In a telephone interview on 11/08/24 at 3:53 pm with the person as IDG nurse, she said she had never worked at the hospice agency, and she never heard of it before. In a telephone interview on 11/08/24 at 4:01 pm with person listed as social worker, he said, he may have worked with the medical director for a short period of time before, but not at or with the hospice agency. Record review of the agencys policy titled, ";Interdisciplinary Group Membership and Responsibilities" dated October 2016 revealed in part...... ";Purpose: To define the membership and responsibilities of the interdisciplinary group. Policy: The interdisciplinary group will collaborate with the patients attending physician to develop an individualized written plan of care. 1. The P & N Hospice and Palliative Care interdisciplinary group membership includes at a minimum; A. Physician, B. Registered Nurse, C. Social Worker, D. Pastoral or other counselor."

Based on record review, interview and observation, the ​hospice failed to be primarily engaged in providing medical social services to any potential patients admitted to the hospice in that: The hospice did not have any current social workers employed who would be available to provide services and oversight to any patients admitted for care. This failure places any potential patients at risk of not having the appropriate psychosocial assessments to help identify issues or assist with facilitating the patients care and treatment in their end of life, and places potential patients and family members at risk of not receiving the support services needed during the patients end stage of life. --- In an interview on 11/06/24 at 12:35pm with the administrator during the entrance conference, she was asked to provide a staff list and a list of all the IDG (Inter-Disciplinary Group) team members. Record review of the staff list provided by the administrator on 11/08/24 revealed in part names and title of a medical director, an administrator, a supervising nurse, a nurse, a social worker, and a chaplain. In an interview on 11/08/24 at 11:05 am with the Administrator, when asked who the members of the IDG were, she said the agency had a medical director, social worker, chaplain, and an IDG nurse. When asked if any of the staff were being paid by the agency, she said ";no." When asked if anyone from the staff list were active employees of the agency, she said no, and added the only active employee of the agency at the moment were herself as the administrator and the alternate administrator who was also the medical director. When asked why there was no IDG, she said the agency had no patients for more than a year and they were preoccupied with the ";paperwork" for the stock transfer that they did not think to form the IDG. The last patient the agency had was in June 2023. She added, she was responsible for making sure that IDG was in place. In a telephone interview on 11/08/24 at 3:47 pm with person listed as the Hospices supervising nurse, she stated she was never a supervising nurse at the hospice agency and had never heard of the hospice. She added, she thought she worked with the medical director, but she was never involved with the hospice. At 3:51 pm on 11/08/24 surveyor placed a telephone call to the person listed as chaplain, but the phone rang without an answer. In a telephone interview on 11/08/24 at 3:53 pm with the person as IDG nurse, she said she had never worked at the hospice agency, and she never heard of it before. In a telephone interview on 11/08/24 at 4:01 pm with person listed as social worker, he said, he may have worked with the medical director for a short period of time before, but not at or with the hospice agency. Record review of the agencys policy titled, ";Interdisciplinary Group Membership and Responsibilities" dated October 2016 revealed in part...... ";Purpose: To define the membership and responsibilities of the interdisciplinary group. Policy: The interdisciplinary group will collaborate with the patients attending physician to develop an individualized written plan of care. 1. The P & N Hospice and Palliative Care interdisciplinary group membership includes at a minimum; A. Physician, B. Registered Nurse, C. Social Worker, D. Pastoral or other counselor."

Based on record review, interview and observation, the ​hospice failed to be primarily engaged in providing counseling services to any potential patients admitted to the hospice in that: The hospice did not have any current counsellors employed who would be available to provide services and oversight to any patients admitted for care. This failure places any potential patients at risk of not having the appropriate psychosocial assessments to help identify issues or assist with facilitating the patients care and treatment in their end of life, and places potential patients and family members at risk of not receiving the support services needed during the patients end stage of life. --- In an interview on 11/06/24 at 12:35pm with the administrator during the entrance conference, she was asked to provide a staff list and a list of all the IDG (Inter-Disciplinary Group) team members. Record review of the staff list provided by the administrator on 11/08/24 revealed in part names and title of a medical director, an administrator, a supervising nurse, a nurse, a social worker, and a chaplain. In an interview on 11/08/24 at 11:05 am with the Administrator, when asked who the members of the IDG were, she said the agency had a medical director, social worker, chaplain, and an IDG nurse. When asked if any of the staff were being paid by the agency, she said ";no." When asked if anyone from the staff list were active employees of the agency, she said no, and added the only active employee of the agency at the moment were herself as the administrator and the alternate administrator who was also the medical director. When asked why there was no IDG, she said the agency had no patients for more than a year and they were preoccupied with the ";paperwork" for the stock transfer that they did not think to form the IDG. The last patient the agency had was in June 2023. She added, she was responsible for making sure that IDG was in place. In a telephone interview on 11/08/24 at 3:47 pm with person listed as the Hospices supervising nurse, she stated she was never a supervising nurse at the hospice agency and had never heard of the hospice. She added, she thought she worked with the medical director, but she was never involved with the hospice. At 3:51 pm on 11/08/24 surveyor placed a telephone call to the person listed as chaplain, but the phone rang without an answer. In a telephone interview on 11/08/24 at 3:53 pm with the person as IDG nurse, she said she had never worked at the hospice agency, and she never heard of it before. In a telephone interview on 11/08/24 at 4:01 pm with person listed as social worker, he said, he may have worked with the medical director for a short period of time before, but not at or with the hospice agency. Record review of the agencys policy titled, ";Interdisciplinary Group Membership and Responsibilities" dated October 2016 revealed in part...... ";Purpose: To define the membership and responsibilities of the interdisciplinary group. Policy: The interdisciplinary group will collaborate with the patients attending physician to develop an individualized written plan of care. 1. The P & N Hospice and Palliative Care interdisciplinary group membership includes at a minimum; A. Physician, B. Registered Nurse, C. Social Worker, D. Pastoral or other counselor."

It is required that the hospice ensures that each patient and the primary caregiver(s) receive education and training, provided by the hospice, as appropriate to their responsibilities for care as stated in the plan of care. This standard was not met as evidenced by review of clinical records and interview. 1 of 6 (17%) clinical records failed to provide accurate and clear education to the patient/primary caregiver as appropriate to their responsibilities for care of the patient. Record #48499: Interventions on the IPOC stated "dysphagia precautions- educated pt is NPO", "Patient will maintain all pureed diet as instructed and family will understand all dysphagia precautions to adhere to in the home til end of cert, and "SN to continue to offer family to use other measures for appetite example (ensure can 1x a day). In an interview with the Administrator it was confirmed that the education to the patient/caregiver was not clear and accurate.

It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. The hospice has a means to authenticate entries or to identify the author of each entry. If the hospice uses electronic records, electronic authentication utilizes a user ID and password protection. This standard was not met as evidenced by review of clinical records. In 1 of 6 (17%) clinical records, the Hospice Medical Director failed to sign or date his signature on the physician order. Record #14708: The physician order dated 7/12/2021 did not include the physician signature or date. In an interview with the administrator on 11/17/2021, it was confirmed that the physician signature and date was missing.