Every finding on record at Palermo Hospice Inc

Upon patient record review, 3 of 14 (Patient #1, 4, 7) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1: POC ordered RN 1 per month - 1 per 2 week. Frequency isn't clear. Patient #4: POC ordered RN one time per month. Frequency doesn't meet requirements of every 14 days. RN POC ordered MSW "every certification period". MSW Frequency doesn't specify how many times per episode. Patient #7: POC ordered MSW and SC "every certification period". Frequency doesn't specify how many times per episode.

Upon client record review, 5 of 14 (Patient #4, 6, 7, 8, 10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: POC ordered SC 1 time per month. No evidence of an SC visit in June or an order to change the frequency. Patient #6: POC ordered SC and MSW 1 time per month. No evidence of an SC or MSW visit in June or an order to change the frequency. Patient #7: POC ordered RN every 14 days. RN made visit on 6/10, 6/14 and 6/24. No evidence of an order for the extra visit made on 6/14. Visit not marked as PRN. POC ordered on 4/29 for treatment to skin tear on coccyx. No evidence in any SN notes of the any wound care being performed or when the wound was healed. Patient #8: POC ordered SN 1xwk. 2 SN visits made the week of 6/1, 6/10, 6/24, 7/8 and 7/22. No evidence of an order to increase or change the SN frequency. Patient #10: POC ordered SN1xwk. No evidence of an SN visit wk of 7/22.

Upon patient client record review, 1 of 14 (Patient #3) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #3: HA visits dated 7/16, 7/19, 7/23 and 7/26 not signed by clinician.