Every finding on record at Riverview Hospice Care Inc

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 8 (12%) Clinical records reviewed, it was revealed that the agency did not ensure that the pre-bereavement assessment was completed within five days of the election of the Hospice Benefit. CLINICAL RECORD 4: The hospice election of benefit was dated 05/13/2025. The pre-Bereavement assessment was completed on 06/02/2025. This was 20 days and 15 days late. During the interview with the Director of Nursing, who reviewed the record, stated that the chaplain was refused on the initial call, and that was why it was late.

It is required that the comprehensive assessment includes consideration of the following factors: The nature and condition causing admission, including the presence, or lack of, objective data and subjective complaints. This standard was not met as evidenced by clinical record review and interview. In 1 of 8 (13%) clinical records reviewed it was revealed that the agency did not ensure that an assessment of the infusion line was documented on the initial comprehensive assessment. CLINICAL RECORD 4: The initial comprehensive assessment was completed on 05/13/2025. The nurse documented that an infusion device was present on the comprehensive assessment. There was no description of the location, site appearance, or dressing in place. The nurse called the medical director and received an order to pull the line, which was completed on 05/15/2025. During the interview with the Director of Nursing, who had completed the visit, she stated that she had assessed the line and called the doctor. She stated the rehab had not notified her in their paperwork or calls that the line was in place. She had been unsure where in the record to document the information on the site.

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 1 of 8 (13%) clinical records reviewed, it was revealed that the agency did not ensure that all interventions were documented for problems identified in the initial or updated comprehensive assessments. CLINICAL RECORD 2: The hospice election of benefit form was dated 11/05/2024. The initial comprehensive assessment and updated assessments documented that the patient was using a Purwick external catheter, and the canister and tubing required changing. There were no interventions documented on the initial plan of care or any of the updated plans of care as of review 06/18/2025. During the interview with the Director of Nursing, who reviewed the record, and agreed that the interventions were not documented at the time of review.

It is required that a hospice aide provide services: Ordered by the Interdisciplinary Group; Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 8 (13%) clinical records reviewed in which a Hospice Aide was accepted, it was revealed that the agency did not ensure that the aide delivered care according to the tasks ordered on the plan of care. CLINICAL RECORD 1: The hospice aide's plan of care was documented on 06/07/2025, with tasks assigned for every visit, 3 times a week, that included dangle at bedside, incontinent care, bed bath, and passive ROM (range of motion). On 06/10/2025, the aide did not document the tasks, dangle at the bedside and incontinent care, but provided active ROM. The visit performed on 6/12/2025 documented NA to bed bath, provided active ROM, not passive, and no dangle from bed or incontinent care. This did not follow the ordered tasks on the aide plan. During the interview with the Director of Nursing, who reviewed the record, it was agreed that the tasks were not followed as ordered.

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. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 1 of 8 (13%) clinical records reviewed in which a hospice aide provided care, it was revealed that the agency did not ensure that the registered nurse was notified when tasks were not completed as ordered. CLINICAL RECORD 1: The hospice aide's plan of care was documented on 06/07/2025, with tasks assigned for every visit, 3 times a week, including dangle at bedside, incontinent care, bed bath, and passive ROM (range of motion). On 06/10/2025. The aide did not document dangle at the bedside or incontinent care was performed, and provided active ROM. The visit performed on 6/12/2025 documented NA to bed bath, provided active ROM, not passive, and no dangle from bed or incontinent care was provided. There was no documentation in the record that the aide had notified the nurse of the care changed during the visits. During the interview with the Director of Nursing, it was stated that the aide did not call the nurse with the changed tasks.