Every finding on record at Savannah Hospice and Palliative Care Inc

It is required that each patient’s individualized written plan of care reflects patient and family goals and 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, document review and interview. 5 of 5 (100%) clinical records reviewed revealed the agency did not ensure plan of care POC) reflected patient and family goals and identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Document 3: The Policy #PC.6, "Care Planning Process (Revised 2015)," stated in part, "Policy: The plan of care must reflect client and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments." Clinical Record 1: The patient elected the hospice benefit on 8/4/23. The medication list dated 8/4/23 stated the patient was on Imodium. The POC dated 8/4/23 lacked evidence of a goal and intervention(s) for diarrhea. Clinical Record 2: The patient elected the hospice benefit on 6/26/23. The medication list dated 6/26/23 stated the patient was on Lorazepam and Docusate Sodium. The POC dated 6/26/23 lacked evidence of goals and interventions for anxiety and constipation. Clinical Record 3: The patient elected the hospice benefit on 8/25/23. The initial nursing assessment dated 8/25/23 had documentation in the narrative that stated the patient reported he was hard of hearing in both ears. The POC dated 8/25/23 lacked evidence of goal(s) and interventions for hard of hearing. Also, the initial nursing assessment had documentation in the narrative that stated the patient was educated to elevate the head of the bed to assist with breathing. The POC dated 8/25/23 had a goal for respiratory but lacked an intervention related to the education completed by the nurse that instructed the patient to elevate the head of the bed to assist with breathing. Clinical Record 4: The patient elected the hospice benefit on 10/7/22. The medication list dated 10/7/22 stated the patient was on Trazadone. The POC dated 10/7/22 lacked evidence of a goal and intervention(s) for depression. Clinical Record 5: The patient elected the hospice benefit 10/31/22. The medication list dated 10/31/22 stated the patient was on Trazadone, Lorazepam, and Lactulose. The POC dated 10/31/2022 lacked evidence of goals and interventions for depression, anxiety, and constipation. Upon interview on 10/26/23, the Administrator/Director of Nursing/Volunteer Coordinator/Nurse Practitioner/Registered Nurse and the Office Manager reviewed and agreed the agency did not ensure the POC reflected patient and family goals and identified planned interventions based on problems identified in the initial and updated comprehensive assessments.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: Medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 5 (40%) clinical records reviewed revealed the agency did not ensure the plan of care included medical supplies and appliances necessary to meet the needs of the patient. Document 3: The policy #PC.6, "Care Planning Process (Revised 2015)," stated in part, "Procedure: 1. Initial Plan of Care: The following will be included on the initial plan of care: Medical supplies and equipment needed to meet patient's needs. 2. Updated Interdisciplinary Team Plan of Care: Content of the updated IDT Plan of Care will include: Medical supplies and appliances to meet identified patient/family need(s)." Clinical Record 2: The patient elected the hospice benefit on 6/26/23. The initial nursing assessment dated 6/26/23 stated the patient required incontinence briefs, chux, and wipes. The POC dated 6/26/2023 lacked evidence that the agency had provided incontinence supplies (i.e. briefs, chux, and wipes). Clinical Record 1: The patient elected the hospice benefit on 8/4/23. The initial nursing assessment dated 8/4/23 stated the patient had incontinence and required incontinence briefs. The POC dated 8/4/23 lacked evidence that the agency had provided incontinence supplies (i.e. briefs). Per a physician order dated 8/15/23, a sling was ordered for right-hand pain. The IDG POC dated 8/17/2023 lacked evidence that the agency had provided DME (i.e. sling) for the patient's right-hand pain. Upon interview on 10/26/23, the Administrator/Director of Nursing/Volunteer Coordinator/Nurse Practitioner/Registered Nurse and the Office Manager reviewed and agreed the agency did not ensure the plan of care included medical supplies and appliances necessary to meet the needs of the patient.

It is required that the hospice is primarily engaged in providing the following care and services in a manner consistent with accepted standards of practice: Medical supplies (including drugs and biologicals) and medical appliances related to the palliation and management of the terminal illness and related conditions as identified in the care plan. This standard was not met as evidenced by document review, interview and observation. 1 of 5 (20%) clinical records reviewed that the patient required medications related to the hospice diagnosis revealed the agency did not ensure medications were provided in a manner consistent with accepted standards of practice. Document 4: Per the agency, "Consent for Treatment/Acknowledgement/Financial Responsibility Form," the Financial Responsibility/Assignment of Benefits section, stated in part, "Consolidated billing for supplies, equipment and drugs under Medicare - I understand that I will be informed which supplies, equipment and drugs Medicare covers while I am under a physician's home health care plan. I understand that when Hospice provides these types of supplies, I have no financial liability,.. Hospice services provided for the patient will be covered at no charge to patient and family." Clinical Record 1: The patient elected the hospice benefit on 8/4/23. The medication list dated 8/4/23 stated the patient was on Dilaudid and using a Fentanyl patch for pain related to his primary hospice diagnosis. Home Visit 1: During an interview with the patient at home visit 1 (clinical record 1) on 10/25/23, the site visitor questioned who had been providing the Dilaudid and the Fentanyl patches thus far? The patient stated, "No, I'm getting those from the pain doctor from the hospital." The patient went on to say, "Yes, I was just on the phone with my pain doctor that I get those medications from." The licensed vocational nurse was present for this interview. Upon interview on 10/25/23, the Administrator/Director of Nursing (DON)/Volunteer Coordinator (VC)/Nurse Practitioner (NP)/Registered Nurse (RN) was asked who had been providing the Dilaudid and the Fentanyl patches thus far the patient at home visit 1 (clinical record 1)? The Administrator/DON/VC/NP/RN stated, "We have not provided the Dilaudid or the Fentanyl patches." The site visitor reviewed during conversation that the hospice is responsible for medications related to the hospice diagnosis. Upon interview on 10/26/23, the Administrator/DON/VC/NP/RN and the Office Manager, reviewed and and again agreed that the hospice, between the dates of 8/4/23 and 10/26/23, had not provided the Dilaudid or the Fentany patches for the patient home visit 1 (clinical record 1). Prior to exiting the agency, the Administrator/DON/VC/NP/RN had a plan to begin the coverage of medications related to the patient's hospice diagnosis.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: Signed copies of the hospice election statement. This standard was not met as evidenced by clinical record review, document review and interview. 1 of 5 (20%) clinical records reviewed revealed the agency did not ensure the election statement included the "Signature of Beneficiary/Representative" and the "Date Signed". Document 7: The policy #PE.3, "Initial Patient Assessments/Patient Admission," stated in part, "Procedure: 2. Upon admission, a member of the interdisciplinary team, will discuss and obtain signatures indicating receipt of information of the following documents: Consent form, Hospice election form...." Clinical Record 1: The patient elected the hospice benefit on 8/3/23. The election statement had evidence of the Effective Date of Election: 8/3/23. The record lacked evidence of the "Signature of Beneficiary/Representative" and "Date Signed".; both lines were blank on the election statement. Upon interview on 10/26/23, the Administrator/Director of Nursing/Volunteer Coordinator/Nurse Practitioner/Registered Nurse and the Office Manager reviewed and agreed the agency did not ensure the election statement included the "Signature of Beneficiary/Representative" and the "Date Signed".

It is required that hospice staff, in coordination with SNF/NF or ICF/IDF staff, ensures orientation and training of staff providing care to hospice patients. At a minimum, the orientation and training include: Introduction to hospice philosophy; Hospice policies and procedures regarding methods of comfort, pain control, and symptom management; Principles about death and dying, and individual responses to death; Patient rights; and Appropriate forms and record keeping requirements. This standard was not met as evidenced by document review and interview. The agency did not ensure orientation and training of the contracted skilled nursing facility staff that would provide respite and general inpatient care if the agency patients require such care. Document 5: The policy #PC.25, "Hospice Care in a SNF/NF or ICF/IID (Dated: 2015)," stated in part, "Procedure: 5. Coordination/Continuity of Care: 5.1 The Hospice will perform the following: Assure the orientation of staff who provide that care, in the hospice philosophy, including hospice policies and procedures regarding methods of comfort, pain control, symptom management, as well as principles about death, patient rights, appropriate forms, and record keeping requirements." Document 6: The "Nursing Facility Services Agreement," stated in part, "Responsibilities of the Hospice: Hospice shall provide orientation and ongoing hospice care training to Facility's personnel . . . Such orientation must include hospice policies and procedures regarding methods of comfort, pain control and symptom management as well as principles about death and dying, individual responses to death, patient rights, appropriate forms and recordkeeping requirements." Upon interview on 10/26/23, the Administrator/Director of Nursing (DON)/Volunteer Coordinator (VC)/Nurse Practitioner (NP)/Registered Nurse (RN) when asked about the orientation of the facility staff when the Respite/GIP agreement was signed, she reported that the agency did not provide the required hospice orientation to the facility. The components of the orientation requirement were reviewed with understanding verbalized. Upon interview on 10/26/23, the Administrator/DON/VC/NP/RN and the Office Manager reviewed and agreed the agency did not ensure the required orientation and training of staff at the contracted facility that would be providing care to hospice patients that are transferred to receive either respite care or general inpatient care. The agency did not ensure orientation and training of the contracted skilled nursing facility staff that would provide respite and general inpatient care if the agency patients require such care.