Every finding on record at Quality Life Healthcare Inc

Condition of Participation: Initial and Comprehensive Assessment of the Patient.

Upon patient record review 1 of 7 records reviewed (Patient #1) did not have evidence that the hospice Registered Nurse must complete an initial assessment within 48 hours after the election of hospice care in accordance with §418.24 Patient #1: The record indicated the initial assessment by the RN was completed on 02/20/24. The Start of Care was on 11/24/23. There was no evidence of this initial assessment at the time of the chart review. Corrected on site.

Upon patient record review 4 of 7 record reviews (Patient #1, #5, #6, #7) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #1: The record indicated there was an initiation of the psychosocial comprehensive assessment. There was no evidence of this comprehensive assessment being completed. Patient #5: The record indicated the spiritual component of the comprehensive assessment was logged on 12/1/23. There was no evidence of this assessment being completed. Patient #6: The record indicated the spiritual and psychosocial comprehensive assessments were logged on 10/06/23. There was no evidence of these assessments being complete. Patient #7: The record indicated "a place holder" per the Administrator and chart review for the spiritual comprehensive assessments although the place holder was dated within the 5 calendar days from the start of care date. There was no evidence of this comprehensive assessments being completed.

Upon patient record review 1 of 7 (Patient #1) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #1: The Start of Care was on 11/24/23. There was no evidence of comprehensive assessment that included the physical, psychosocial, emotional, and spiritual needs related to the terminal illness at the time of record review during survey. Corrected on site.

Upon patient record review, 2 of 7 records reviewed (Patient #3, #5) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #3: The record indicated oxygen concentrator 5L stationary 2-4 LPM NC prn daily. There was no evidence on medication profile of what the liter flow should be for mild SOB/wheezes and or moderate to severe SOB/wheezes. Corrected on site. Patient #5: The record indicated Azelastine 0.05% Hydrochloride 0.05% Ophthalmic solution daily prn itchy eyes. There was no evidence on medication profile of which eye or eyes to put the drops in. Corrected on site.

Upon patient record review, 6 of 7 (Patient #1, #2, #3, #4, #6, #7 ) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1: The record indicted the bereavement risk assessment of the comprehensive assessment was logged on 11/24/23. There was no evidence of the bereavement risk assessment being completed. Patient #2: The record indicated the bereavement risk assessment of the comprehensive assessment was logged on 11/17/23. There was no evidence of the bereavement risk assessment being completed. Patient #3: The record indicated the bereavement risk assessment of the comprehensive assessment was logged on 10/28/23. There was no evidence of this assessment being completed, sections 3 - 6 were blank. Patient #4: The record indicated the bereavement risk assessment of the comprehensive assessment was logged on 10/02/23. There was no last name listed of the bereaved and the assessment was not complete. Patient #6: The record indicated the bereavement risk assessment of the comprehensive assessment was logged on 10/06/23. There was no evidence of this assessments being complete. Patient #7: The record indicated "a place holder" per the Administrator for the bereavement risk assessment of the comprehensive assessment although the place holder was dated within the 5 calendar days from the start of care date. There was no evidence of this comprehensive assessments being completed.

Upon patient record review, 1 of 7 records reviewed (Patient #7) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #7: The record indicated the patient was admitted with malignant left breast cancer. The patient was prescribed OTC Tylenol and Ibuprofen. The record did not indicate a care plan for monitoring her pain level. In addition, there was only one care plan addressing neurological issues from the start of care to the time of discharge. Corrected on site.

Upon patient record review, 2 of 7 records reviewed (Patient #3, #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #3: The record indicated an order for oxygen concentrator 5L stationary 2-4 LPM NC prn daily. There was no evidence in order of what the liter flow should be for mild SOB/wheezes and or moderate to severe SOB/wheezes. Corrected on site. Patient #5: The record indicated Azelastine 0.05% Hydrochloride 0.05% Ophthalmic solution daily prn itchy eyes. There was no evidence in order of which eye or eyes to put the drops in. Corrected on site.

Upon patient record review, 2 of 7 (Patient #1, #3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #1: The record indicated in the interventions on the care plan that the patient was using a Trapeze Bar. There was no evidence of the trapeze in the DME order set. Corrected on site. Patient #3: The record indicated the social worker on visit date 4/23/24 documented the patient needed wipes, an aide went on 4/26/24 and 4/29/24. There was no evidence care plan was updated and no evidence of wipes being delivered.

Upon patient record review, 2 of 7 records reviewed (Patient #2, #3) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #2: The record indicated during the SW assessment on 11/21/23 the patient complained of back pain. There was no evidence of a care plan addressing pain. Corrected on site. In addition, The record indicated there is a care plan for funeral planning and financial issues, the last two visits by the SW were on 12/21/23 and 1/21/24. There was no evidence of progress towards the interventions and goals for this problem. Patient #3: The record indicated the patient was on Tramadol 50mg po BID. Patients diagnosis is malignant neoplasm of the endometrium. There was no evidence of a care plan addressing the pain issue. Corrected on site.

Upon client record review, 2 of 7 records reviews (Patient #4, #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: The record indicated an order for an LVN 1 X W. There was no evidence of an LVN visit. Corrected on site. Patient #7: The record indicated an order for an LVN 1 X W. There was no evidence of an LVN visit. In addition, the record indicated an MD order for a Volunteer 1 W 3. There was no evidence of a volunteer visit.

Upon personnel record review, 1 of 15 (Personnel #13) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel Record #13: The record contained a form signed by RN however, the form was incomplete as the RN did not sign and date each individual hospice aide competency line. Corrected on site.

Upon patient record review, 1 of 7 (Patient #1) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1: The record indicated a hoyer/mechanical lift was placed in the home. There was no evidence of the hospice aide care plan being updated for fall precautions and or for the aide to use the hoyer/mechanical lift. In addition: The record indicated the patient was having difficulty swallowing. There was no evidence of the hospice aide care plan being updated to include aspiration precautions. Corrected on site.

Upon patient record review 1 of 7 records reviewed (Patient #2) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #2: The record indicated an Aide supervisory was due on 1/22/24. There was no evidence this supervisory visit was completed on by the 14th day from the last supervisory visit. The next supervisory after the due date was completed on 1/25/24.

Upon patient record review, 1 of 7 (Patient #3) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient #3: The record indicated the physician wrote bullet points in the narrative. There was no evidence in the CTI narrative that the Physician indicated why the patient has a prognosis of 6 months or less.

Upon patient record review, 1 of 7 (Patient #3) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient #3: The record indicated the physician wrote bullet points in the narrative. There was no evidence in the CTI narrative that the Physician indicated why the patient has a prognosis of 6 months or less.

Upon patient client record review, 1 of 7 records reviewed (Patient #7) did not evidence that each patient record contains physician orders. Patient #7 The record indicated the patient was discharged from hospice for no longer meeting hospice medical criteria. There was no evidence in the record of MD order for the discharge. In addition they have a written policy an ACHC standard (HSP-5-8B) that states, "The process for obtaining a written discharge order prior to discharging a patient for any reason." was specifically defined.

Upon the opening of the survey it was determine there were 5 records reviewed at their last survey and these records were not available which were necessary to review due to a low census. There is no evidence of these 5 records being available for review and or maintained for a minimum of six years.