Every finding on record at Russell-Murray Hospice, Inc

Based on record review and interview, the hospice failed to ensure effective pain management was provided for one (Patient #18) of 19 patients. --- Patient #18 A review of the plan of care dated 10/13/21 to 01/10/22 showed a primary diagnosis of cancer of the lung and documented a skilled nurse frequency of five visits per week for 13 weeks. A review of the clinical record showed the following: A skilled nurse assessment dated10/15/21 documented the patient's pain as 9 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. A skilled nurse assessment dated10/16/21 documented the patient's pain as 10 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. A skilled nurse assessment dated10/18/21 documented the patient's pain as 8 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. A skilled nurse assessment dated10/19/21 documented the patient's pain as 9 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. A skilled nurse assessment dated10/20/21 documented the patient's pain as 9 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. A skilled nurse assessment dated10/21/21 documented the patient's pain as 9 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. A skilled nurse assessment dated10/22/21 documented the patient's pain as 9 out of 10 on the classic 1-10 pain scale. Documentation showed medication was administered with no documented follow up to the effectiveness of the pain medication. Documentation showed no other interventions provided and no physician notification of the elevated pain level. On 03/28/22 at 2:40 pm., Staff B stated pain was not managed appropriately for Patient #18.

Based on record review and interview, the hospice failed to ensure 1. hospice aide visits were provided in accordance with the plan of care for two (Patients #1 and 6) of 19 patients and 2. social worker visits were provided in accordance with the plan of care for one (Patient #12) of 19 patients. --- Patient #1 A review of the plan of care dated 12/24/23 to 02/21/24 showed a hospice aide frequency of three visits per week for 10 weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 01/08/24 documented the reason for the missed visit as "Due to being off" for the week of 01/07/24 to 01/13/24 (only two of three completed visits for this week). Documentation showed no patient or family refusal of visits and no change in the ordered frequency. Patient #6 A review of the plan of care dated 12/03/23 to 01/31/24 showed a hospice aide frequency of three visits per week for 10 weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 12/27/23 documented the reason for the missed visit as "Due to being off" for the week of 12/24/23 to 12/30/24 (only one of three completed visits for this week). Documentation showed no patient or family refusal of visits and no change in the ordered frequency. A hospice aide missed visit note dated 01/05/24 documented the reason for the missed visit as "Due to being off" for the week of 12/31/23 to 01/06/24 (only two of three completed visits for this week). Documentation showed no patient or family refusal of visits and no change in the ordered frequency. Patient #12 A review of the plan of care dated 01/27/24 to 03/26/24 showed a social worker frequency of one visit per month. A review of the clinical record showed the following: A social worker visit dated 02/23/24 documented the reason for the missed visit as "not home today" (no visits were completed for the month of February). Documentation showed no patient or family refusal of visits and no change in the ordered frequency. No documentation of attempts to reschedule the missed visit.On 03/28/24 at 2:50 p.m., Staff B stated: 1. the hospice aide frequency was not followed as ordered for Patients #1 and #6 and 2. the social worker frequency was no followed as ordered for Patient #12.

Based on record review and interview, the hospice failed to ensure an individualized plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for nineteen (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and 19) of 19 patients reviewed. --- Patient #1 A plan of care dated 12/24/23 to 02/21/24 documented a primary diagnosis of Alzheimer's disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #2 A review of the plan of care dated 02/18/24 to 05/17/24 documented a primary diagnosis of cancer of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #3 A plan of care dated 01/27/24 to 03/26/24 documented a primary diagnosis of end stage renal disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #4 A plan of care dated 12/14/23 to 03/12/24 documented a primary diagnosis of Pompe disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #5 A plan of care dated 01/03/24 to 04/01/24 documented a primary diagnosis of congestive heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #6 A plan of care dated 12/03/23 to 01/31/24 documented a primary diagnosis of Parkinson's disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #7 A plan of care dated 01/22/24 to 03/21/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #8 A plan of care dated 03/12/24 to 06/09/24 documented a primary diagnosis of heart disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #9 A plan of care dated 12/25/23 to 02/22/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #10 A plan of care dated 12/04/23 to 03/02/24 documented a primary diagnosis of cancer of the prostate and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #11 A plan of care dated 01/11/24 to 04/09/24 documented a primary diagnosis of abdominal aortic aneurysm and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #12 A plan of care dated 01/27/24 to 03/26/24 documented a primary diagnosis of amyotrophic lateral sclerosis and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #13 A plan of care dated 01/22/24 to 03/21/24 documented a primary diagnosis of congestive heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #14 A plan of care dated 12/25/23 to 02/22/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #15 A plan of care dated 02/16/24 to 05/15/24 documented a primary diagnosis of congestive heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #16 A plan of care dated 01/11/24 to 03/10/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #17 A plan of care dated 03/13/24 to 05/11/24 documented a primary diagnosis of amyotrophic lateral sclerosis and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #18 A plan of care dated 10/13/23 to 01/10/24 documented a primary diagnosis of cancer of the lung and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #19 A plan of care dated 01/27/24 to 03/26/24 documented a primary diagnosis of Alzheimer's disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 03/28/24 at 2:35 pm, Staff B stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and 19 failed to include services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the agency failed to ensure services were coordinated with the physician regarding missed visits for six (Patients #4, 6, 9, 10, 12 and 14) of 19 patients. --- Patient #4 A plan of care dated 12/14/23 to 03/12/24 showed a skilled nurse frequency of two visits per week for 14 weeks and a hospice aide frequency of one visit per week for 14 weeks. A review of the clinical records showed the following: A hospice aide missed visit note dated 12/22/23 documented the physician was not notified of the missed visit. A skilled nurse missed visit note dated 12/22/23 documented the physician was not notified of the missed visit. A skilled nurse missed visit note dated 01/02/24 documented the physician was not notified of the missed visit. A skilled nurse missed visit note dated 01/05/24 documented the physician was not notified of the missed visit. A skilled nurse missed visit note dated 02/02/24 documented the physician was not notified of the missed visit. Patient #6 A plan of care dated 12/03/23 to 01/31/24 showed a hospice aide frequency of three visits per week for 10 weeks. A review of the clinical records showed the following: A hospice aide missed visit note dated 12/25/23 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 12/27/23 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/01/24 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/05/24 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/31/24 documented the physician was not notified of the missed visit. Patient #9 A plan of care dated 12/25/23 to 02/22/24 showed a hospice aide frequency of three visits per week for 10 weeks. A review of the clinical records showed the following: A hospice aide missed visit note dated 12/25/23 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/01/24 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/03/24 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/15/24 documented the physician was not notified of the missed visit. A hospice aide missed visit note dated 01/31/24 documented the physician was not notified of the missed visit. Patient #10 A plan of care dated 12/04/23 to 03/02/24 showed a social worker visit frequency of one visit per month. A review of the clinical record showed the following: A social worker missed visit note dated 01/08/24 documented the physician was not notified of the missed visit. Patient #12 A plan of care dated 01/27/24 to 03/26/24 showed a social worker visit frequency of one visit per month. A review of the clinical record showed the following: A social worker missed visit note dated 02/23/24 documented the physician was not notified of the missed visit. Patient #14 A plan of care dated 12/25/23 to 02/22/24 showed a social worker visit frequency of one visit per month. A review of the clinical record showed the following: A social worker missed visit note dated 02/19/24 documented the physician was not notified of the missed visit. On 03/28/24 at 3:15 pm., Staff stated there was no documentation of the physician notification of missed visits for Patients #4, 6, 9, 10, 12 and 14.

Based on record review and interview, the hospice failed to the ensure plans of care was coordinated with the long-term care facility for four (Patients #1, 6, 7 and 8) of 19 patients reviewed. --- Patient #1 A plan of care dated 12/24/23 to 02/21/24 showed a primary diagnosis of Alzheimer's disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #6 A plan of care dated 12/03/23 to 01/31/24 showed a primary diagnosis of Parkinson's disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #7 A plan of care dated 01/22/24 to 03/21/24 showed a primary diagnosis of senile degeneration of the brain and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #8 A plan of care dated 03/12/24 to 06/09/24 showed a primary diagnosis of heart disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. On 03/28/24 at 2:50 pm, Staff stated the plan of care for Patients #1, 6, 7 and 8 did not outline the patient specific interventions to be to be provided by the nursing home or the hospice for the palliation and management of the terminal illness.