Every finding on record at Rivercross Hospice LLC

Based on interview, record review, and agency policy review, it was determined that the agency failed to effectively monitor patient medications for duplicate drugs for 1 (Patient 5) of 13 patients reviewed. This failure had the potential for Patient 5 to take too much medication and experience unnecessary side effects and health risks. --- Findings Include: Review of an agency policy titled, ";Medication Monitoring," revised April /2017, indicated, ";The Case Manager will assess the effects of medications on the patient. The assessment will identify drug interactions, duplicative drug therapy and noncompliance with drug therapy." Review of Patient 5s ";Hospice Certification Plan of Care," dated 04/14/23, showed the agency admitted Patient 5 on 04/14/23 with diagnoses that included cerebral vascular disease (a term for conditions that affect blood flow to your brain) and atherosclerotic heart disease (damage or disease in the heart's major blood vessels). Review of Patient 5s ";Client Medication Report," dated 05/02/23, showed that on 04/06/23, Patient 5s physician ordered metformin (a medication used to control high blood sugar), 500 milligrams (mg), to be taken by mouth twice a day, every day. Further review indicated a second physician order entered on 04/16/23 for metformin, 500 mg, to be taken by mouth twice a day, every day. Further review indicated that the duplicate metformin orders were on Patient 5s medication profile for 15 days until they were discontinued by the Patient Care Manager (PCM) on 05/01/23, and during that time Registered Nurse (RN) 1 had documented on 04/27/23 that Patient 5s medications had been reviewed for duplicate drugs. During an interview on 05/02/23 at 2:30 PM, the Administrator (ADM) stated that the agency expectation was patient medication lists should be accurate, and nurses should review patient medication lists at every visit and during the care planning meetings. The ADM acknowledged the agency did not follow its policy.

Based on interview, record reviews, and policy review, it was determined that the facility failed to complete an initial bereavement assessment (IBA - an assessment completed within five days of the patients admission to the hospice of 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) for 3 (Patients 5, 6, and 11) of 13 patients reviewed. The failure has the potential for the patients caregivers and family members to not receive needed bereavement services. --- Findings Include: Review of an agency policy titled, ";Bereavement Assessment," revised April 2017, showed, ";On admission the social worker or hospice registered nurse will complete a bereavement risk assessment that is given to the Bereavement Coordinator." Patient 5 Review of Patient 5s ";Hospice Certification Plan of Care," showed the agency admitted Patient #5 on 04/14/23 with diagnoses that included cerebral vascular disease (a term for conditions that affect blood flow to your brain) and atherosclerotic heart disease (damage or disease in the heart's major blood vessels). Review of Patient 5s entire clinical record revealed that an IBA was not completed for Patient 5. Patient 6 Review of Patient 6s ";Hospice IDG [Interdisciplinary Group] Comprehensive Assessment and Plan of Care Update Report," showed the agency admitted Patient 6 on 12/28/22 with diagnoses that included hypertensive heart disease with heart failure (a condition in which the heart muscle cannot pump enough blood to meet the body's needs for blood and oxygen) and personal care needs (day to day activities of living). Review of Patient 6s entire clinical record revealed that an IBA was not completed for Patient 6. Patient 11 Review of Patient 11s ";Hospice Certification and Plan of Care," showed the agency admitted Patient 11 on 01/06/23 with diagnoses that included chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs) and panlobular emphysema (damage to the air sacs within the lungs). Review of Patient 11s entire clinical record revealed that an IBA was not completed for Patient 11. During an interview on 05/02/23 at 2:15 PM, the Administrator (ADM) stated that the agency policy was staff should complete the IBA within five days of a patients admission to the agency. The ADM confirmed that the agency did not complete IBAs for Patients 5, 6, and 11, and acknowledged that the facility did not follow its policy.

Based on interview, record reviews, and policy review, it was determined that the agency failed to provide services as ordered in the Interdisciplinary Group (IDG) Plan of Care Update (IDG POCU - a comprehensive plan developed by nurses, social workers, chaplains and medical directors that includes the frequency of staff visits and interventions that guide the staff in providing patient care) for 4 (Patients 3, 6, 8, and 11) of 13 patients reviewed. The failure resulted in these four patients not receiving necessary assessments and services. --- Findings Include: Review of an agency policy titled, ";The Plan of Care," revised April 2017, showed, ";The care provided to the patient must be in accordance with the plan of care." Patient 3 Review of Patient 3s ";Hospice IDG Comprehensive Assessment and Plan of Care Update," showed the agency admitted Patient 3 on 07/07/21 with diagnoses that included chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs) and allergic rhinitis (seasonal allergies). Further review showed that starting 04/28/23, the agency was to provide Patient 3 with 2 social work (SW) visits in the month of April 2023. Review of Patient 3s entire clinical record revealed no evidence the agency provided one SW visit to Patient 3 in April 2023. The agency did not provide any additional documentation of SW visits completed in April 2023. Patient 6 Review of Patient 6s ";Hospice IDG Comprehensive Assessment and Plan of Care Update," showed the agency admitted Patient 6 on 12/28/22 with diagnoses that included hypertensive heart disease with heart failure (a condition in which the heart muscle cannot pump enough blood to meet the body's needs for blood and oxygen) and personal care needs (day to day activities of living). Review of Patient 6s ";Order Number: 230689," showed on 03/21/23 there was an update to Patient 6s plan of care, and the agency was to provide two skilled nursing visits to Patient 6 during the week of 03/28/23. Review of Patient 6s entire clinical record revealed no evidence the agency provided one skilled nursing visit to Patient 6 during the week of 03/28/23. The agency did not provide any additional documentation that showed both nursing visits were completed that week. Patient 8 Review of Patient 8s ";Hospice IDG Comprehensive Assessment and Plan of Care Update," showed the agency admitted Patient 8 on 08/02/22 with diagnoses that included senile dementia of the brain (a general term for a decline in mental ability severe enough to interfere with daily life). Review of Patient 8s ";Order Number: 230772," showed on 03/21/23 there was an update to Patient 8s plan of care, and the agency was to provide two home health aide (HHA) visits to Patient 8 during the week of 04/02/23. Review of Patient 8s entire clinical record revealed no evidence the agency provided two HHA visits to Patient 8 during the week of 04/02/23. The agency did not provide any additional documentation that showed both HHA visits were completed that week. Patient 11 Review of Patient 11s ";Hospice Certification and Plan of Care," showed the agency admitted Patient 11 on 01/06/23 with diagnoses that included chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs) and panlobular emphysema (damage to the air sacs within the lungs). Further review showed the agency was to provide two HHA visits to Patient 11 the week of 01/15/23. Review of Patient 11s entire clinical record revealed no evidence the agency provided two HHA visits to Patient 11 during the week of 01/15/23. The agency did not provide any additional documentation that showed both HHA visits were completed that week. During an interview on 05/02/23 at 2:15 PM, the Administrator (ADM) confirmed the agency was to provide Patient 6 two skilled nursing visits during the week of 03/28/23, Patient 8, two HHA visits during the week of 04/02/22, Patient 11, two HHA visits during the week 01/15/23, and that the agency did not provide these visits as ordered in the patients POCs. The ADM stated that Patient 3s order for 2 SW visits to be completed in April 2023 was a software order entry error that had not been corrected. The ADM confirmed the agency did not provide 2 SW visits in April 2023 as ordered in the Patient 3s POC. The ADM acknowledged the agency did not follow its policy.

Based on interview, agency document reviews, and agency policy review, it was determined that the agency failed to ensure all registered nurses (RNs) and licensed nurses (LNs) maintained current cardiopulmonary resuscitation (CPR) certification consistent with facility policy for 3 (RN 2, RN 3, and LN 4) of 4 nursing staff reviewed for current CPR certification. This failure had the potential for patients to not receive necessary care and interventions. --- Findings Include: Review of an agency policy titled, ";Hospice Administrator," revised April 2017, revealed ";The hospice Executive Director/Administrator position will be responsible for the overall direction, coordination, and general supervision of all hospice services." Per the policy responsibilities of the position would include, ";Staff development including orientation, in-service, continuing education, competency testing, and performance improvement." Review of an agency "Job Description Summary" for a RN Case Manager, revised in August 2021, specified the position qualification included ";Current CPR certification." Review of an agency "Job Description Summary" for the Weekday/Weekend LPN (licensed practical nurse) On-Call, revised in August 2021, specified the position qualification included ";Current CPR certification." Review of RN 2, RN 3, and LN 4's personnel file revealed no documentation of CPR certification. The agency did not provide documentation of current CPR certification for RN 2, RN 3, or LN 4. During an interview on 05/02/23 at 11:48 AM, the Human Resources (HR) Director stated the agency expectation was RNs and LNs should have current CPR certification. The HR Director confirmed the agency did not have documentation of current CPR certifications for RN 2, RN 3, and LN 4, and acknowledged the agency did not follow its policy.

Based on interview, document reviews, and policy review, it was determined that the agency failed to ensure the agency obtained criminal background checks for 2 (Registered Nurse [RN] 2 and Advanced Practice Nurse [APN] 5) of 11 employees reviewed. This failure had the potential to put patient and their caregivers at risk for harm. --- Findings Include: Review of an agency policy titled, ";Internal Control Systems/Accountabilities," revised in April 2017, directed the human resources department to ";2. Criminal background completed on all new employees." Review of RN 2 and APN 5's personnel files revealed the agency did not complete background checks. The agency did not provide any additional documentation of background checks for RN 2 or APN 5. Review of the facility staff roster revealed RN 2 was hired on 12/01/21 and APN 5 was hired on 07/14/22. During an interview on 05/02/23 at 11:30 AM, the Human Resources (HR) Director stated the agency expectation was that background checks were to be completed before new employees were hired. The HR Director confirmed the agency did not have documentation of completed background check for RN 2 or APN 5, and acknowledged the agency did not follow its policy.