Every finding on record at Premier Hospice, LLC

Based on record review, and interview, the hospice agency failed to ensure patient with wounds had documented weekly wound assessments for 1 (#1) of 3 (#1-#3) 3 patients reviewed for wound care. --- Findings: Patient #1 Review of the agency's policy with a revision date of 04/09/2024 titled, "Wound Care", Section titled ";Assessment and evaluation", revealed in part: · "Documentation: Detailed documentation of wound assessments, treatments, and patient responses should be maintained in the medical record" Record review revealed patient#1 was admitted to the provider on 03/19/2024 with a primary diagnosis of malignant neoplasm of meninges along with diagnoses of aphasia following cerebral infarction, epilepsy, dependence on wheelchair, neoplasm related pain, nausea, shortness of breath, and hemiplegia affecting dominant side. Review of the initial skin assessment revealed there were multiple cancerous nodules to the scalp. The most recent certification period was from 06/13/2024 to 09/10/2024. The plan of care for the certification period called for the following home visits: Skilled Nurse- 2 times weekly with 10 as needed (prn) visits Hospice Aide- 3 times weekly Record review revealed skilled nurse visits had been made twice weekly as directed by the plan of care (POC). S2RegisteredNurse (RN) provided the skilled nurse visits documentation from 06/13/2024-07/30/2024. Each skilled nurse visit showed a record of wound care being provided as directed by the POC with a brief description of the wound in the narrative section of the notes. The narrative notes revealed S2RN recorded the nodules had an odor with oozing but did not have any details of wound care provided. Review of the ";skin assessment" section of the nurses visit note had no record of the wound or nodules to the scalp of patient#1. On 09/03/2024 at 1:25 p.m. an interview with S2RN confirmed she performed skilled nurse visits for the month of July 2024. S2RN reported the nodules were all over the scalp of patient #1 and along the front of her forehead. She described them as being raised, with a foul odor and oozing blood at times. S2RN could not confirm she recorded a detailed wound assessment on each skilled nurse visit. On 09/04/2024 at 08:25a.m., an interview with S1DON confirmed detailed weekly skin assessments were not documented in the skin assessment section for patient #1. S1DON confirmed the documentation in the narrative section of the skilled nurse`s notes was not sufficient. S1DON reported the wound assessment should have been recorded in the skin assessment section of the skilled nurse`s notes for each visit the skilled nurse completed for patient#1.

Based on record review and interview, the hospice agency failed to ensure that the care and services were provided in accordance with the plan of care for 1 (#9) of 11 (#1 - #11) patients reviewed for care and services. Findings: Record review revealed patient #9's start of care date was 07/05/2023 with a documented terminal diagnosis of malignant neoplasm of unspecified ovary. Further review revealed the benefit period was dated 07/05/2023 through 10/02/2023. Review revealed patient #9 was to receive service types that included in part, skilled nursing: 1 visit daily, medical social worker: 1 visit weekly, and chaplain: 1 visit weekly. Record review revealed documentation of patient #9 receiving a skilled nursing visit on the following dates: 07/05/2023, 07/06/2023, 07/07/2023, 07/10/2023, 07/12/2023, 07/17/2023, 07/19/2023, 07/24/2023, 07/26/2023, 07/31/2023, 08/02/2023, 08/09/2023, 08/11/2023, 08/16/2023, 08/18/2023, 08/23/2023, and 08/25/2023. Record further review revealed documentation of patient #9 receiving hospice aide visits on the following dates: 07/12/2023, 07/17/2023, 07/19/2023, 07/20/2023, 07/24/2023, 07/26/2023, 07/27/2023, 07/31/2023, 08/02/2023, 08/03/2023, 08/07/2023, 08/09/2023, 08/10/2023, 08/14/2023, 08/16/2023, 07/17/2023, 08/21/2023. 08/23/2023, and 08/24/2023. On 08/29/2023 at 4:00 p.m., S1DON (Director of Nursing) / Administrator was notified of the findings regarding the plan of care service type orders, skilled nursing, and hospice aide visits. After completing a review of the electronic healthcare records with S1DON/Administrator confirmed there was no physician orders for skilled nursing visits 2 times per week and no physician order for a hospice aide 3 times per week. S1DON/Administrator confirmed services were not being provided in accordance with patient #9's written plan of care.

Based on personnel record review and staff interview, the Hospice Agency failed to ensure all Hospice Aides received at least 12 hours of in-service training during each 12 month period for 1 (S5Hospice Aide) of 3 (S3Hospice Aide, S4Hospice Aide, S5Hospice Aide) Hospice Aides currently employed by the agency. --- Review of the personnel record for S5Hospice Aide revealed the date of hire as 10/26/2011. Review of the Agencies documented in-service training for 2022 revealed S5Hospice Aide did not have the required 12 hours of in-service training, Interview on 08/30/2023 at 10:40am, with S1Director of Nursing/Administrator confirmed S5Hospice Aide did not have documentation of 12 hours of in-services during the 12 month period of 2022.

Based on review of the volunteer records and interviews, the hospice agency failed to maintain, document, and provide volunteer orientation and training that is consistent with hospice industry standards for 7 (S6Volunteer - S12Volunteer) volunteer records reviewed. The hospice provider failed to ensure all volunteers received volunteer training prior to providing services for the agency. --- Findings: Review of the Hospice (8217 Q.3. a-p) Volunteer Training Policy included the following topics: introduction to hospice, role of the volunteer, concepts of death and dying, communication skills, care and comfor measures, disease and medical conditions, psychosocial and spiritual issues with death and dying, concept of hospice family, stress management, berevement, infection control, safety, confidentiality, patient rights, role of the IDG (Interdisciplinary Group), and specialized training (nursing homes and acquired immunodeficiency syndrome facilities). Review of S6Volunteer, S7Volunteer, and S8Volunteer's record revealed a hire date of 09/15/2021. Further review revealed there was no documentation of volunteer training to include all topics noted in the volunteer training policy. Review of S9Volunteer and S10 Volunteer's records revealed a hire date of 09/16/2021. Further review revealed there was no documentation of volunteer training to include all topics noted in the volunteer training policy. Review of S11Volunteer's record revealed a hire date of 09/17/2021. Further review revealed there was no documentation of volunteer training to include all topics noted in the volunteer training policy. Review of S12Volunteer's record revealed a hire date of 09/29/2021. Further review revealed there was no documentation of volunteer training to include all topics noted in the volunteer training policy. On 08/30/2023 S2Compliance reported that all volunteers were required to have volunteer training prior to providing services for the agency.