Every finding on record at Riverview Hospice and Palliative Care, LLC

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure the individualized plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 4: The patient elected the hospice benefit on 01/19/2021 with a terminal diagnosis of senile degeneration of the brain. The patient resided in a skilled nursing facility. The hospice nurse documented instructions to staff on 09/09/2024 to clean area on sacrum with wound cleanser, apply A&D ointment, cover with 6x6 dressing change daily and prn [as needed] for soiling. On 09/09/2024 the nurse documented instructions to clean area on sacrum with wound cleanser, apply A&D ointment, cover with 6x6 dressing change daily and prn for soiling. On 10/02/2024 the nurse documented to change the wound 3xw [three times a week] and when soiled. On 10/04/2024 the nurse documented discontinue zinc and A&D on wound. On 10/07/2024 the nurse documented instructions to staff to keep patient dry and off back and instructed staff to call with any questions or concerns. On 03/24/2025 the hospice nurse documented to discontinue any previous wound orders and begin to cleanse the wound with wound cleanser, apply A&D ointment, and cover with foam dressing. On 03/31/2025 the hospice nurse documented that the wound was healed and that the skin was fragile, and buttocks were light pink. The hospice plan of care dated 09/09/2024 through 04/09/2025 did not include interventions for wound care. CLINICAL RECORD 5: The patient elected the hospice benefit on 08/22/2023 with a terminal diagnosis of senile degeneration of the brain. The Registered Nurse documented on the nursing visit note dated 03/07/2025, that the patient was experiencing agitation. The patient’s medication profile dated 03/07/2025 included an order for Haldol 1 mg 2 times a day and 0.5 mg 1 time a day and if the patient refuses medication Ativan 1 mg with 5 mg of Haldol in 1 ml compounded cream every 6 hours as needed. The plan of care dated 03/07/2025 to 04/09/2025 did not include interventions related to the patient’s documented agitation. During an interview on 04/09/2025, the Administrator stated that she did not see interventions for the wound care or agitation in the patients' plans of care.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed with hospice aide services provided, the agency did not ensure the hospice aide reported changes in the patient’s needs to the registered nurse. CLINICAL RECORD 7: The patient elected the hospice benefit 12/11/2024 with a terminal diagnosis of malignant carcinoma of the sigmoid colon. The hospice aide care plan assignment dated 02/24/2025 directed the hospice aide to provide a partial bed bath or a shower. The hospice aide documented on the aide visit note dated 04/04/2025 that the patient refused the bed bath and shower. During an interview with the hospice aide on 04/09/2025, the hospice aide stated the patient had been refusing the bed bath and shower. There was no documentation in the clinical record that the aide notified the registered nurse that the patient refused the bed bath/shower. During an interview on 04/09/2025, the Administrator stated that the clinical record did not include documentation that the Hospice Aide notified the Registered Nurse that the patient refused care.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The agency did not ensure hospice volunteer hours equal five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. Review of the agency's documented volunteer hours for the year 2024 revealed the percentage of volunteer hours was 3.91%. During an interview on 04/10/2025, the Volunteer Coordinator stated the hospice did not meet the required 5% for 2024. A review of the documentation of the volunteer hours that were provided for 2024 did not equal five percent of the total patient care hours of all paid hospice employees and contract staff. In an interview conducted with the Volunteer Coordinator on 04/10/2025, it was stated that the hospice did not meet the required 5% for 2024. The percentage of volunteer hours was (3.91%) for the year of 2024.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed with patient discharge, the agency did not ensure the patient’s attending physician was provided with a copy of the hospice discharge summary. CLINICAL RECORD 12: The patient elected the hospice benefit 05/30/2024 with a terminal diagnosis of Alzheimer's disease. The patient revoked hospice care on 06/19/2024 to seek aggressive therapy. Clinical record review revealed no documented evidence that the patient’s attending physician was provided with a copy of the hospice discharge summary. During an interview on 04/09/2025, the Administrator stated the agency did not have documentation that a hospice discharge summary was sent to the attending physician.

It is required that medical social services are provided based on a psychosocial assessment, according to the patient’s and family’s needs and acceptance of these services, per the plan of care and under the direction of a physician. The psychosocial assessment is revised as new information is acquired and as progress toward goals is made. This standard was not met as evidenced by clinical record review and interviews. 1 of 11 (9%) records reviewed revealed the hospice did not ensure that the patient received medical social services.. Clinical Record 1: The RN completed the Initial Comprehensive Assessment dated 5/4/22, which stated "Social Worker once monthly but chaplain and HHA were declined." The social worker's comprehensive assessment was not completed during the episode of care. There was no documentation of a social worker visit refusal. The patient expired on 5/14/22. The Director of Nursing confirmed this finding during an interview and a joint review of the record.