Every finding on record at Pruitthealth Hospice, Inc.

Based on record reviews and staff interviews, it was determined the agency failed to include a qualified Chaplain/spiritual counselor, on the hospice care team, in the interdisciplinary group (IDG) meetings for six months (October 2023 through March 2024) of the six months (October 2023 through March 2024) IDG meetings reviewed. --- The findings include: Record review of IDG meetings for the months of October 2023 through March 2024 failed to reveal a qualified Chaplain serving as pastor or spiritual counselor for the agencys patients and their families. On 3/27/24 at 10:00 a.m., during an interview, the agency's Director of Nursing (DON) confirmed that IDG meetings for the months of October 2023 through March 2024 did not include a qualified chaplain serving as pastor or spiritual counselor for the agencys patients and their families.

Based on record reviews, staff interviews, and review of agency policies and procedures, it was determined the facility failed to reveal and implement initial bereavement assessments for two patients (P) (P#14, P#15) of 19 sampled patients reviewed. --- The findings include: Review of policy titled, ";Bereavement Care Planning for Hospice Revised 11/29/2021, reveals the following: Policy Statement: ";It is the policy of (facility) Hospice to make certain that bereavement services are developed for identified family members and other involved individuals after the patients death, including Care Planning, Services Overview, Risk Assessments, Mailings, Tracking and Evaluation, and Files." Procedure: Bereavement Care Planning: 1. During the initial bereavement assessment, which as per regulations must be completed within the first 5 days of a patients care by hospice, the interdisciplinary group (IDG), identifies family members, caregivers, or significant others who may be significantly impacted by the patients death. The initial bereavement assessment is updated during IDG meetings throughout the course of the patients care. 4. The bereavement plan of care reflects the assessed needs of the bereaved and notes the kind of bereavement services to be offered and the frequency of delivery. The local bereavement coordinator (LBC) should be utilizing the bereavement checklist to determine support for the bereaved as per risk level. Review of the clinical records for P#14 and P#15 failed to reveal initial bereavement assessments. On 3/26/2024 at 12:40 p.m., an interview was conducted with Registered Nurse (RN) AA, who said, ";I am not sure if I did the bereavement assessments. I have no reason why I didnt do it. I am sorry." On 3/26/2024 at 12:48 a.m., an interview was conducted with Social Worker (SW) BB, who stated that ";I really dont remember why we did not do the bereavement assessments; maybe because P#14 was confused, and P#15 had no family." On 3/26/2024 at 12:59 a.m., an interview was conducted with RN CC, who said, ";I did not do the bereavement assessments because P#15 had no family." On 3/26/2024 at 2:00 p.m., an interview was conducted with Chaplain DD, who said, ";I will assume that I did the bereavement assessments. I do not know why I didnt. I am sorry that I did not do it." On 3/26/2024 at 2:38 p.m., an interview was conducted with the Administrator, who confirmed that the hospice staff failed to implement initial bereavement assessments for P#14 and P#15.