Every finding on record at Pnw Hospice, LLC

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 4 of 14 (29%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 2: The nursing visit note dated 03/21/2024 stated the patient had a 16 French Foley catheter placed with 10 cc balloon. The POC dated 04/02/2024 had a goal for the urinary catheter but lacked the specific about the foley. Clinical Record 3: The initial nursing assessment dated 03/21/2024 stated the patient had bladder incontinence. The POC dated 03/21/2024 lacked evidence of a goal and intervention(s) for bladder incontinence. Clinical Record 4: The certification of terminal illness (CTI) dated 02/02/2024 (Certification period: 02/02/2024 - 05/01/2024) stated the patient was bedbound, was gastrointestinal-tube (G-tube) dependent for feeding and had oxygen and inhalers for shortness of breath (SOB). The POC lacked evidence of goal(s) and intervention(s) for skin integrity since bedbound and nutrition since dependent on g-tube feedings. The POC dated 02/02/2024 had a goal for SOB but lacked intervention specifics for the oxygen and the inhalers. Clinical Record 9: The initial nursing assessment dated 11/13/2024 stated the patient was on a pureed diet, and isolating, not leaving the room over the past several months. The POC dated 11/13/2024 lacked evidence of goal(s) and intervention(s) for diet/nutrition and for social isolation. The Clinical Record Reviewer agreed in an interview while completing joint clinical record reviews on 04/03/2024 that the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions that included specifics based on problems identified in the initial and updated comprehensive assessments. The Administrator, the Alternate Administrator/Clinical Manager, and the Clinical Supervisor stated in an interview on 04/04/2024 did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments.

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 a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed for patients that elected hospice aide services revealed the agency did not ensure the hospice aide care plan prepared by the registered nurse (RN) included the tasks required to meet the problems identified during the nursing assessment. Clinical Record 3: The initial nursing assessment dated 03/21/2024 stated the patient had bladder incontinence. The aide care plan dated 03/21/2024 lacked the task "Pericare" to decrease the patient risk of the development of an infection. The Clinical Record Reviewer stated in an interview while completing joint clinical record reviews on 04/03/2024 that the aide care plan prepared by the RN should have included the task "Pericare" since the patient had bladder incontinence. The Administrator, the Alternate Administrator/Clinical Manager, and the Clinical Supervisor stated in an interview on 04/04/2024 that the agency did not ensure the hospice aide care plan prepared by the RN included the tasks required to meet the problems identified during the nursing assessment.