Every finding on record at Promised Hope Hospice,

Observed in Emergency Management Session. The Surveyor identified during the review of the organizations Emergency Operations Plan (EOP) that the organization had not established backup procedures in the event that communications fail during an emergency. For example, in the EOP, it states Staff shall be notified . . . via text messaging, MMS, e-mail and calling their cell phones. There is no backup procedures to address the loss of cellular functions. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 1 live discharge records reviewed, the organization did not respect the patient's right to elect and revoke hospice care. Identified in the review of RR#2, the patient was hospitalized for worsening conditions, but there was no signed revocation form on file. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 3 active patient records reviewed where there were no burial/mortuary plans made, the organization did not complete a reassessment of the needs. For example in the review of the record for HV#3 whose start of care date was approximately 6 weeks prior to the survey date, the Medical Social Worker identified during the initial Psychosocial assessment that the patient had no burial/mortuary plans made, and failed to reassess this in the subsequent visit made 1 month following the start of care date. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 2 inactive records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: - Interventions to manage pain and symptoms - A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs - Measurable outcomes anticipated from implementing and coordinating the plan of care - Medications and treatment necessary to meet the patient’s needs. For example, identified in the review of the record for RR#2, the patient had a change in condition which was documented both in the Registered Nurses Visit Report and Communication Note dated 8 days prior to the patient's hospitalization for aggressive treatment. The visit narrative stated, Blood pressure elevated, c/o headache, dizziness, SOB, fatigue, lung sounds crackles, irregular heart beat. No ER visit reported but sister reported if her condition gets worse she will take her to ER. She does not want to loose her sister . . . ; and, the communication note stated, Patient noted with crackles, reports pressure around the chest area. Swollen hand and feet. Currently on Furosemide 40 mg daily with poor effect. MD updated. New order obtained and instructed patient and PCG on administration and possible s/e. Both verbalized understanding. There was no follow-up visit made, or telephone call documented to address the effectiveness of the new medication or the patient's current and ongoing condition. Eight days following the last visit and communication documented, the patient was taken by EMS to a hospital and admitted for aggressive treatment. This was reviewed and validated with the Director of Patient Care Services and the Administrator.. Observed in Record Review. Identified in 3 of 3 active patient records reviewed, the plans of care did not include all services needed for the palliation and management of the terminal illness and related conditions. For example, in the review for the record of HV#1, who was admitted 30 days prior to the survey, Nutrition was not included in the individual plan of care yet it was identified and documented upon admission and during each subsequent weekly nursing note poor appetite, eats less than 75% of meals; the plan of care included Respiratory as a problem, but did not include oxygen therapy in the intervention yet the patient was on oxygen therapy, 2 LPM via nasal cannula as needed; the Psychosocial plan of care did not include burial/mortuary yet it was identified by the Medical Social Worker in the initial psychosocial assessment that there were no arrangements made or funeral home identified; and, there was no Spiritual plan of care created. In the review of the record for HV#2, Respiratory was identified as a problem in the individual plan of care but did not include oxygen therapy as an intervention yet the patient was on continuous oxygen, 2 LPM via nasal cannula; the Psychosocial plan of care did not include burial/mortuary plans yet it was identified by the Medical Social Worker in the initial psychosocial assessment that there were no arrangements made or funeral home identified; and, there was no Spiritual plan of care created. In the review for the record of HV#3, the Medical Social Worker's (MSW) initial psychosocial assessment identified that the patient had no burial/mortuary plans yet this was not included in the Psychosocial plan of care; the MSW also documented that the patient was grieving the recent loss of his wife, yet this was not included in the Psychosocial or Bereavement plan of care; and, there was no Spiritual plan of care created. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 2 of 3 active records reviewed, it was identified that the signature of the Licensed Vocational Nurse (LVN) was not authenticated. For example in the record for HV#1, the LVN signed the visit documentation with her first initial and last name, but did not include her professional credentials. In the record for HV#2, the LVN visit documentation for visit made 1 week following admission did not include her professional credentials. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 1 live discharge records reviewed, the organization did not provide a written discharge summary to the patient's physician or other care professionals involved in the patient's care, treatment, or services. For example, identified in the review for RR#2, the patient was hospitalized for aggressive treatment and there was no evidence that a discharge summary was created or shared. This was reviewed and validated with the Director of Patient Care Services.