Every finding on record at Rmce Utah Home Health and Hospice LLC

Based on interview and record review, it was determined that for 1 of 1 sample deceased patients and for 1 of 6 supplemental deceased patients, the agency did not follow the bereavement plan of care. (Patient identifiers: 8 and 15) --- Findings Include: A review of the agencys bereavement policy and procedure was conducted. The following was documented: ";... initial bereavement assessment 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 with the patient's death. Information gathered from the initial bereavement assessment must be incorporated into the plan of care and considered in the bereavement plan of care. Although a bereavement plan is initiated after the death of the patient, prior to the death, the hospice must assess any grief/loss issues of the patients family through an initial bereavement risk assessment that is incorporated in the plan of care. Bereavement issues continue to be part of the ongoing assessments, and the bereavement plan of care after death is based on all these assessments. Bereavement services may be offered prior to the death when the initial assessment, comprehensive assessment, or updates to the assessment identifies the need for the patient/family. Social, spiritual and cultural factors that may impact a family member or other individuals ability to cope with the patients death would include, but not be limited to: History of previous losses; Family problems; Financial concerns; Communication issues; Drug and alcohol abuse; Health concerns; Legal and financial concerns; Mental health issues; Presence or absence of a support system; and Feelings of despair, anger, guilt or abandonment. These issues may not be readily apparent during the initial bereavement risk assessment, but should be incorporated into the hospice plan of care if they become evident, and must be considered in the bereavement plan of care..." The bereavement plan of care had that a sympathy card or letter (mailed after the interdisciplinary team following death; a phone call or personal contact after the date of death; phone call within 1 month; 2nd letter of information approximately 3 months after the date of death; 3rd letter and information approximately 6 month after the date of death; 4th letter and information approximately 9 months after the date of death; 5th letter and information between 12-13 months after the date of death; and a holiday letter approximately 2nd week of November. 1. Patient 8s date of death was 3/15/2023. The first contact to the primary bereaved was 5/30/2023, approximately 1 ½ months after the date of death. 2. Patient 15s date of death was 12/12/2022. The first contact with the bereaved was on 3/16/2023, almost 3 months after the date of death. The agency documented on the bereavement plan of care, ";The Blanding Bereavement provider had left her position and no one in the office had been assined (sic) to do bereavement follow up. I told Blanding office manager that I would make the follow up call. I spoke to [patients husband] on 3/16/23 as soon as I was made aware that he had not received any bereavement. [The patients husband] said, ";Well she died three months ago and I never heard from anyone." He was not happy with this. I tried to explain that due to staffing changes, I was the one contacting him now. He said he did not want anything and hung up. This is a prime case of the issues we face when we do not do timely bereavement follow up. [The patients husband] would not let me offer him anything. I suspect he is grieving and could use some support, but because there as no on (sic) available to provide it when he was receptive, he would not allow me to offer the many resources Rocky Mountain Hospice has. I feel a two month letter would only make things worse in this situation and one will not be sent out." On 8/9/2023 at 4:10 PM, an email was sent to the agency asking for clarification as to why the deceased plan of care was not followed. The agency responded on 8/9/2023 at 4:16 PM and wrote, ";For this patient with this being a (sic)outlier office our employee that did bereavement in price/ vernal was out on leave with family death... When she returned she began catching up on these. We now have our own bereavement person in vernal who is taking over these starting this month currently in training for this. Our bereavement coordinator has been filling in the gaps as she can. With this we are changing how our bereavement is being done and moving it into [the electronic medical record system] where it can be closely monitored by office and admin level with reports..."

Based on interview and record review, it was determined that the agency did not assess skills and competencies for all individuals furnishing cares. Specifically, for 17 out of 20 sampled staff members, there was no documented evidence of skills or competency assessments. (Staff identifiers: 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 18, and 19) --- Findings include: During survey, staff skills and competency evaluations were requested. The agency provided a generic new hire agenda and an attendance record with staff names. There was no evidence of specific skills that were assessed for each discipline. There was no documented evidence that each individual staff member had been assessed for their skills and or competency. In an email from the administrator (ADM) dated 8/9/23 and timed 12:15 PM, the ADM stated, ";Each clinician is individually assessed at orientation by our education department nurse and they do not graduate from orientation until they have successfully passed off basic skills identified in the orientation agenda. This is the only record we have of these assessments." The agency was not able to provide documented evidence that all staff had been assessed for skills and/or competency prior to providing services to patients.