Every finding on record at Select Hospice, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 14 (7%) clinical records reviewed it was revealed that the agency did not ensure that the drug profile included the patient's current prescription and over the counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. Clinical Record 3: During home visit 3 on 12/28/2023, a review of the assisted living medication record included medications Multivitamin daily, Nystatin as needed, Nitrostat as needed, precision daily, non-aerosol nasal spray daily, and ferrous sulfate daily. The hospice clinical record did not include orders for these medications, and they were not listed on the hospice medication profile effective 12/1/2023. In an interview on 12/28/2023, the Executive Director confirmed that medications listed on the assisted living medication record were not consistent with hospice orders and stated that the Multivitamin, Nystatin, Nitrostat, Prevision, Non-aerosol nasal spray, and Ferrous Sulfate should have been discontinued at the assisted living as they were discontinued upon admission to hospice on 12/1/2023.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group and written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed of a patient that received hospice aide services, it was revealed that the agency did not ensure that the RN prepared written patient care instructions that provided clear individualized instruction to the aide. Clinical Record 2: The medication profile and plan of care dated 11/29/23 listed Oxygen 2L/min as needed. A review of the hospice aide care plan created on 11/29/23 revealed that oxygen was not listed as a precaution and no other directions related to oxygen were documented. In a joint review of clinical record 2 and the hospice aide care plan on 12/28/23, the executive director confirmed findings and stated, "I didn't think that needed to be on the care plan since the patient is not using the oxygen right now".

It is required that a hospice aide provides services ordered by the interdisciplinary group and included in the plan of care. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 14 (7%) clinical records reviewed of a patient that received hospice aide services, it was revealed that the agency did not ensure that hospice aide services were provided according to the plan of care. Clinical Record 3: During home visit on 12/28/23, the hospice aide provided a sponge bath. The current hospice aide plan of care orders effective 12/1/2023 included the aide task of a shower weekly. No sponge bath was included in the aide care plan. There was no documentation in the clinical record that there was communication to the RN about changes and direction to change the plan of care. Personnel Record 7: During the home visit for clinical record 3, the hospice aide stated, "I haven't been able to give the patient a shower because she is weaker and the entry into the shower is raised". In an interview on 12/28/23, the Executive Director stated, "The aide gives me a report every day, but I don't know how to update the hospice plan of care on the computer". The Executive Director confirmed on 12/28/2023 that the plan of care did not reflect the care provided to the patient and stated, " I just didn't realize I needed to be that specific and make those changes."

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge includes a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient's current plan of care, the patient's latest physician orders and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 2 of 4 (50%) clinical records reviewed of patients that were discharged, it was revealed that the agency did not ensure that a discharge summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient's current plan of care, the patient's latest physician orders, and any other documentation was provided upon discharge to assist in the post-discharge continuity of care. Clinical Record 4: The clinical record did not contain evidence of a written discharge summary. The Election of Beneit form was dated 6/6/23 and the discharge was dated 6/28/23. Clinical Record 11: The clinical record did not contain evidence of a written discharge summary. The Election of Benefit form was dated 5/11/23 and the discharge was dated 8/2/23. The Executive Director confirmed in a joint record review on 12/28/23 that the records did not include discharge summaries.

It is required that hospice contracts require that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. This standard was not met as evidenced by document review and interview. In 3 of 4 (75%) contracts reviewed that included contracted direct patient care providers, it was revealed that the agency did not ensure that the contracts included language requiring criminal background checks. Contract 1: The agreement for contracted therapy services dated 3/17/2023 did not include language requiring therapists who will provide direct care to obtain a criminal background check. Contract 3: The agreement for durable medical equipment dated 9/28/23, which included delivery services to patient homes, did not include language requiring contracted employees with direct patient contact or access to patient records to obtain criminal background checks. Contract 5: The Medical Director Agreement dated 9/11/2023 did not include language requiring the medical director to obtain a criminal background check. The executive director confirmed in an interview on 12/28/2023, that the Agreement for Therapy Services, Agreement for Durable Medical Equipment and Related Supplies and Services and Medical Director Agreement did not include language requiring criminal background checks.