Every finding on record at Parc Hospice, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over the counter (OTC) drugs. This standard was not met as evidenced by clinical record review and observation. In 1 of 8 (12%) records reviewed it was revealed that the agency did not ensure that the drug profile contained the patient's current prescription and over the counter (OTC) drugs. Clinical Record 5: During the home visit observation on 10/18/2023 the caregiver informed the nurse that she had continued to give the patient Tylenol and it was providing adequate pain relief. Tylenol was not included on the medication profile at the time of the home visit and during the chart review on 10/18/2023. During interview on 10/19/2023, the DPCS reviewed the associated record and stated that the medication identified during the 10/8/2023 home visit had since been added to the medication profile.

It is required that each patient’s individualized written plan of care reflects patient and family goals, and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 8 (12%) records reviewed it was revealed that the agency did not ensure that each patient’s written plan of care reflected the goals identified and planned interventions based on problems identified. Clinical Record 1: The election of benefit form was dated 04/03/2023. The plan of care dated 09/30/2023 included an aide frequency of '2xweek' and a diagnosis of Diabetes Mellitus. The plan of care did not include a goal related to the provision of aide services nor any interventions related to Diabetes Mellitus. The comprehensive assessment dated 04/03/2023 included documentation that blood sugar checks were completed daily. During interview on 10/19/2023, the DPCS reviewed the associated records and stated that the missing aide goals and the interventions related to DM had since been added to the plan of care.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 3 of 8 (38%) records reviewed it was revealed that the agency did not ensure the patient’s individualized written plan of care included all the drugs and treatments necessary to meet the needs of the patient. Clinical Record 3: The election of benefit form was dated 08/24/2023. The plan of care (POC) dated 08/24/2023 read, "insert 18Fr 10cc silicone foley catheter and change prn" with no prn qualifiers. Clinical Record 5: The election of benefit form was dated 04/26/2023. During the home visit performed on 10/18/2023 the caregiver informed the nurse that she had given the patient Tylenol for pain. Tylenol was not included on the plan of care dated 07/25/2023 at the time of the review on 10/18/2023. Clinical Record 8: The election of benefit form was dated 08/04/2023. The POC dated 08/04/2023 read "Biliary drain-instruct caregiver on how to flush drain every 6-8hrs for optimal functioning," There was no specification of what solution to use for the flush. During interview on10/19/2023, the DPCS reviewed the associated records and stated that the orders had since been updated with missing components.

It is required that the hospice’s policies and procedures define a system of communication and integration that sustains coordination of services and provides documentation of exchange of information. The policies and procedures ensure that care and services provided are in accordance with the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 8 (25%) records reviewed the agency did not ensure that care and services were provided in accordance with the plan of care. Clinical Record 4: The election of benefit form was dated 08/30/2023. The plan of care (POC) dated 08/30/2023 included a social work visit frequency of '1xweek effective 09/10/23.' There was no documented evidence of a social work visit the week of 09/10/2023 and no explanation of why services were not provided as ordered. Clinical Record 8: The election of benefit form was dated 08/4/2023. The POC dated 08/04/2023 included a nurse frequency of '1xweek1, 2week13.' There was evidence of a single nursing visit the week of 08/06/2023 dated 08/10/2023 and no documented explanation of why services were not provided as ordered. During interview on10/19/2023, the DPCS reviewed the associated records and stated that missed visit documentation had been entered.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 7 (57%) records reviewed with the provision of aide services the agency did not ensure that the hospice aide provided services as ordered. Clinical Record 3: The hospice election of benefit was dated 08/24/2023. The 08/24/2023 Hospice plan of care included an aide frequency of '1week1, 3week11.' There were only 2 aide visits documented for the week of 08/30/2023 and the week of 09/04/2023 dated 08/30/2023, 09/01/2023, 09/06/2023 and 09/08/2023. There was no evidence of documentation stating why the aide visits were not completed as per the frequency ordered at the time of the review on 10/18/2023 Clinical Record 4: The hospice election of benefit was dated 08/30/2023. The 08/30/2023 Hospice plan of care included an aide frequency of '1xweek.' There were no aide visits documented for the week of 08/30/2023 and there was no evidence of documentation stating why the aide visits were not completed as per the frequency ordered at the time of the review on 10/18/2023 Clinical Record 5: The hospice election of benefit was dated 04/26/2023. The 07/25/2023 Hospice plan of care for the 07/25/2023 episode of care included an aide frequency of '2xweek.' There was only 1 aide visits documented for the week of 07/25/2023 and 08/28/2023 dated 07/28/2023 and 08/28/2023. There was no evidence of documentation stating why the aide visits were not completed as per the frequency ordered at the time of the review on 10/18/2023 Clinical Record 7: The hospice election of benefit was dated 09/07/2023. The 09/07/2023 Hospice plan of care included an aide frequency of '1week1, 3week12.' There were no visits documented for the week of 09/07/2023 only 2 aide visits documented for the week of 09/11/2023 dated 09/13/2023 and 09/15/2023. There was no evidence of documentation stating why the aide visits were not completed as per the frequency ordered at the time of the review on 10/18/2023 During interview on10/19/2023, the DPCS reviewed the associated records and stated visits were not completed per ordered frequency and missed visit documentation had since been entered.