Every finding on record at Pruitthealth Hospice, Inc.

Based on clinical record review, it was determined that the hospice failed to ensure that the plan of care included complete physician's order for five of 13 patients (P) (P#4, P#5, P#6, P#9 and P#13) sampled. The findings include: 1. Patient #4 was admitted to hospice on 5/17/21, with the hospice diagnosis of hypertensive heart disease. The clinical record was reviewed for certification period 1/15/22 to 3/15/22. The plan of care dated 1/22/22, indicated the patient was on oxygen precautions and had an oxygen concentrator listed as part of the equipment provided by the hospice agency. The clinical record did not contain a physician's order for oxygen. P#4's clinical record also contained a physician's order for Keflex 500 mg (milligrams) twice daily for ten days for wound infection. The clinical record did not contain a physician's order for treatment of a wound. 2. Patient #5 was admitted to hospice on 1/4/22, with the hospice diagnosis of cerebral infarction. The clinical record was reviewed for certification period 1/15/22 to 4/3/22. The plan of care dated 1/4/22, contained the following physician's order: "Dakins Quarter Strength Solution 0.125% topical solution; Apply 0.125% topical once a day; use once a day to clean wounds". The physician's order did not contain the following requirements: location of the wound or wounds, products to be used to cover the wounds, products to be used to secure the covering for the wounds, and designation of who was responsible for the treatment of the wound or wounds. 3. Patient #6 was admitted to hospice on 1/5/22, with the hospice diagnosis of cerebral infarction. The clinical record was reviewed for certification period 1/5/22 to 4/4/22. The plan of care dated 1/5/22, contained the following physician's order: "Dakins Quarter Strength Solution 0.125% topical solution; Apply 0.125% topical once daily; cleanse wound on right lateral ankle daily". However, physician's order did not contain the following requirements: product to be used to cover the wound, product to be used to secure the covering for the wound and designation of who was responsible for the treatment of the wound. The plan of care date 1/5/22, also contained the following physician's order: "Santyl 250 units/g (gram) topical ointment; Apply 1 application applied topically once a day to right ankle". The physician's order did not contain the following requirements: product to be used to clean the wound, product to be used to cover the wound, product to be used to secure the covering for the wound and designation of who was responsible for the treatment of the wound. 4. Patient #9 was admitted to hospice on 1/6/22, with the hospice diagnosis of Alzheimer's disease. The clinical record was reviewed for certification period 1/6/22 to 4/5/22. The clinical record contained a physician's verbal order dated 1/13/22 documented : "Treat wound care cleanse with wound cleanser; every 7 days using clean technique cleanse wound with wound cleanser, pat dry, cover with Optifoam dressing, change every 7 days and prn (as needed) for soiling, hospice nurse each visit caregiver other times." However, the physician's order did not contain the location of the wound. 5. Patient #13 was admitted to hospice on 11/30/20, with the hospice diagnosis of atherosclerotic heart disease. The clinical record was reviewed for certification period 7/28/21 to 9/25/21. The clinical record contained a physician's verbal order dated 7/29/21, with the following: "cleanse with wound cleanser/ NS (normal saline) apply calcium alginate with silver and cover with foam dressing every other day." The physician's order did not contain the location of the wound and designation of who was responsible for the treatment of the wound. During interview at the agency at 11:30 a.m. on 2/9/22, the Administrator was made aware of the presence of incomplete physician's order for five of 13 sampled patients (P#4, P#5, P#6, P#9 and P#13).

Based on clinical record review, it was revealed that the hospice failed to ensure that bereavement services were provided after the patient's death in one of two patients (P) bereavement records (P#11) reviewed. The findings include: Documentation in clinical record for patient #11 reflected that the patient's death was 8/3/21. Review of the bereavement record revealed the record lacked documentation of bereavement follow up as as outlined in the post death bereavement plan of care for P#11 as established by the hospice interdisciplinary team. During an interview at the agency with the Administrator at 11:30 a.m. on 1/27/21, the Administrator was made aware of the findings.

Based on clinical record review, it was determined the Registered Nurse (RN) failed to make an on-site supervisory visit to patient's home at least every 14 days to assess the quality of the care the hospice aide provides and assess if the services adequately meet the patient's needs for four of 13 patient (P) records reviewed (P#1, P#2, P#3 and P#4). The findings include: 1. Patient #1 was admitted on 10/11/21, with the hospice diagnosis of Alzheimer's disease. The clinical record was reviewed for certification period 1/9/22 to 3/9/22, and revealed P#1 had a physician's order for hospice aide care three times per week. The clinical record review also revealed that the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to the patient. 2. Patient #2 was admitted on 6/16/21, with the hospice diagnosis of Alzheimer's disease. The clinical record was reviewed for certification period 1/21/22 to 3/21/22, and revealed P#2 had a physician's order for hospice aide care five times per week. The clinical record review also revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to the patient. RN visits made on 1/5/22 and 1/20/22, were coded in the agency electronic medical record (EMR) as supervisory visits yet lacked the required documentation in the visits for supervision of the hospice aide. 3. Patient #3 was admitted on 5/17/21, with the hospice diagnosis of hypertensive heart disease. The clinical record was reviewed for certification period 1/12/22 to 3/12/22, and revealed P#3 had a physician's order for hospice aide care two times per week. The clinical record review also revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to P#3. RN visits made on 1/4/22 and 1/21/22, were coded in the agency EMR as supervisory visits yet lacked the required documentation in the visits for supervision of the hospice aide. 4. Patient #4 was admitted on 1/15/21, with the hospice diagnosis of hypertensive heart disease. The clinical record was reviewed for certification period 1/15/22 to 3/15/22, and revealed P#4 had a physician's order for hospice aide care five times per week. The clinical record review also revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to the patient. In an interview at the agency at 11:30 a.m. on 2/9/22, the Administrator was made aware that the RN failed to make an on-site supervisory visit to the patient's home at least every 14 days to assess the quality of the care the hospice aide provides and assess if the services adequately meet the patient's needs for four of 13 patient (P) records reviewed (P#1, P#2, P#3 and P#4).

Based on clinical record review, it was determined the Registered Nurse (RN) failed to make an on-site supervisory visit to the patient's home at least every 14 days to assess the quality of the care the hospice aide provides and assess if the services adequately meet the patient's needs for four of 13 patient (P) records reviewed (P#1, P#2, P#3 and P#4). The findings include: 1. Patient #1 was admitted on 10/11/21, with the hospice diagnosis of Alzheimer's disease. The clinical record was reviewed for certification period 1/9/22 to 3/9/22, and revealed P#1 had a physician's order for hospice aide care three times per week. The clinical record review revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to P#1. 2. Patient #2 was admitted on 6/16/21, with the hospice diagnosis of Alzheimer's disease. The clinical record was reviewed for certification period 1/21/22 to 3/21/22, and revealed P#2 had a physician's order for hospice aide care five times per week. The clinical record review revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to the patient. RN visits made on 1/5/22 and 1/20/22, were coded in the agency electronic medical record (EMR) as supervisory visits yet lacked the required documentation in the visits for supervision of the hospice aide. 3. Patient #3 was admitted on 5/17/21, with the hospice diagnosis of hypertensive heart disease. The clinical record was reviewed for certification period 1/12/22 to 3/12/22, and revealed P#3 had a physician's order for hospice aide care two times per week. The clinical record review revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to P#3. RN visits made on 1/4/22 and 1/21/22, were coded in the agency EMR as supervisory visits yet lacked the required documentation in the visits for supervision of the hospice aide. 4. Patient #4 was admitted on 1/15/21, with the hospice diagnosis of hypertensive heart disease. The clinical record was reviewed for certification period 1/15/22 to 3/15/22, and revealed P#4 had a physician's order for hospice aide care five times per week. The clinical record review revealed the hospice agency did not provide documentation of on-site RN supervisory visits at least every 14 days to supervise hospice aide services provided to P#4.. In an interview at the agency at 11:30 a.m. on 2/9/22, the Administrator was made aware that the RN failed to make an on-site supervisory visit to the patient's home at least every 14 days to assess the quality of the care the hospice aide provides and assess if the services adequately meet the patient's needs for four of 13 patient (P) records reviewed (P#1, P#2, P#3 and P#4).

Based on clinical record review, it was determined that the hospice failed to ensure a coordinated plan of care that specifically identified the provider responsible for each intervention included in the plan of care for six of 13 patients (P) (P#1, P#5, P#6, P#7, P#11 and P#13) reviewed. The findings include: 1. Patient #1 was admitted to hospice on 10/11/21, with the diagnosis of Alzheimer's disease. The clinical record for P#1 was reviewed for certification period 1/9/22 to 3/9/22. P#1's clinical record revealed the patient resided at a personal care home. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the personal care home that would be responsible and accountable for each intervention, task, and function related to P#1's care and service. 2. Patient #5 was admitted to hospice on 1/4/22, with the diagnosis of cerebral infarction. The clinical record for P#5 was reviewed for certification period 1/4/22 to 4/3/22. P# 5's clinical record revealed that the patient resided at an assisted living facility. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the assisted living facility that would be responsible and accountable for each intervention, task, and function related to P#5's care and service. 3. Patient #6 was admitted to hospice on 1/5/22, with the diagnosis of cerebral infarction. The clinical record for P#6 was reviewed for certification period 1/5/22 to 4/4/22. P# 6's clinical record revealed that the patient resided at a nursing home. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the nursing home that would be responsible and accountable for each intervention, task, and function related to P#6's care and service. 4. Patient #7 was admitted to hospice on 6/2/21, with the diagnosis of end stage renal disease. The clinical record for P#7 was reviewed for certification period 1/28/22 to 3/28/22. P# 7's clinical record revealed the patient resided at a nursing home. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the nursing home that would be responsible and accountable for each intervention, task, and function related to P#7's care and service. 5. Patient #11 was admitted to hospice on 1/13/22, with the diagnosis of stage five chronic kidney disease. The clinical record for P#11 was reviewed for certification period 1/13/22 to 4/12/22. P# 11's clinical record revealed the patient resided at a nursing home. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the nursing home that would be responsible and accountable for each intervention, task, and function related to P#11's care and service. 6. Patient #13 was admitted to hospice on 11/30/20, with the diagnosis of atherosclerotic heart disease. The clinical record for P#13 was reviewed for certification period 7/28/21 to 9/25/21. P# 13's clinical record revealed that the patient resided at a nursing home. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the nursing home that would be responsible and accountable for each intervention, task, and function related to P#13's care and service. During interview at the agency at 11:30 a.m. on 2/9/22, the Administrator was made aware that the plans of care did not identify the provider responsible for each intervention included in the plans of care for six of 13 (P#1, P#5, P#6, P#7, P#11 and P#13) patients reviewed.