Every finding on record at Serenity Hospice Care, LLC

Observed in Record Review. In 1 of 4 patient records reviewed, the update of the comprehensive assessment did not include changes occurring since the initial assessment. For example, in record RRNHV#2 a nurse documented that the patient had fallen, however the plan of care was not updated and this was not discussed in the following interdisciplinary meeting. This RFI was reviewed and validated with the Administrator and Branch Directors.

Observed in Record Review. In 2 of 4 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. For example, in records RRNHV#1 and RRNHV#4 the patient was provided with fungal cream or powder but there were no orders documented in the plan of care. This RFI was reviewed and validated with the Administrator and Branch Directors.

Observed in Patient Home. In 4 of 4 home visits conducted, the hospice did not inform patients of their rights both orally and in writing. The election of benefits and consent were signed at the start of care. The patient was given a blank template of these that was similar, but not exactly like the signed document. Also, the template did not contain the same patient specific information as the original document. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 2 of 19 patient records reviewed, the hospice did not assess patients according to defined timelines. For example, in record RRNHV#3 the initial bereavement risk assessment was not completed until 20 days after the admission date. And in record RRNHV#4 the initial bereavement risk assessment was not completed until 50 days after the admission date. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 2 of 19 patient records reviewed, the hospice failed to conduct and document a patient-specific comprehensive assessment that identified the patient’s need for hospice care and services. For example, in record RRHV#1 there was documentation that the patient was admitted, revoked for treatment of a fractured hip and then was re-admitted. An initial bereavement assessment was completed in the first benefit period, but not the second. In record RRHV#4 initial comprehensive spiritual, social work, and bereavement assessments were not documented. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 15 of 19 patient records reviewed, where the interdisciplinary group met more than twice, the organization did not update comprehensive assessments to reflect changes that had occurred since the initial assessment. Meeting notes did not consistently document on-going patient decline, progress toward goals, and plans for the next two weeks in the records of RRHV#1, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, RRDC#1, RRDC#2, RRBR#1, and RRBR#3. For example, a patient was injured and went to an emergency department for care; and a patient death was not addressed in the following meeting. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 19 of 19 patient records reviewed, patient goals were generic, few were specific, and most were not measurable. Some were to be met by the end of the benefit period, but most had no identified completion target. Additionally, many goals were not revised during the benefit period. For example: Pain will be managed at a level acceptable to the patient. Patient/caregiver: will verbalize/demonstrate appropriate pain management reduction or relief of cardiopulmonary symptoms; have safety needs met; will follow an effective bowel program to prevent/relieve constipation; will receive assistance with personal care and hygiene and other activities of daily living as needed; will have decreased fear/anxiety regarding death and dying process. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 10 of 19 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions in the plan of care. For example, in record of RRHV#1 diminished breath sounds, shortness of breath, mild dyspnea, and 2+ pitting edema were identified. Similar omissions were found in records RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNVH#10. None of these problems were addressed in the plans of care. This RFI was reviewed with Administrators and Branch Directors.

Observed in Record Review. In 10 of 19 patient records reviewed, the plan pf care did not include all services needed for the palliation and management of the terminal illness and related conditions. For example, in record RRHV#4 a registered nurse documented the presence of an indwelling foley catheter, and the need for a Hoyer lift. There were no orders for these items, nor a catheter change order. In RRNHV#3 a foley catheter was also documented. There was an order to change the catheter every 30 days, but no order for the catheter itself. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 2 of 19 patient records reviewed, hospice failed to provide the patient with care, treatment, or services according to their individualized plan of care. In record RRHV#1 an occupational therapy evaluation was ordered but was not completed. In the records of RRHV#1 and RRHV#4 oxygen and oral suction machines were ordered but not fulfilled. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 4 of 14 patient records reviewed, a registered nurse did not supervise the hospice aide every 14 days or less. In record RRHV#1 there was a span of 18 days. In record RRNHV#1 more than 14 days elapsed seven times in three and a half months. In record RRNHV#3 there were spans of 15 and 24 days. In record RRNHV#4 there were spans of 20 and 23 days. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Leadership Session. Leaders did not manage implementation of patient care policies and procedures governing the provision of care as evidenced by condition level findings at §418.54 and §418.56. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Competency Session. In 2 of 9 HR files reviewed, the hospice did not ensure that staff were oriented to their job duties. In file HR#2 RN and HR#9 MT staff did not receive a description of their job duties as part of orientation. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Competency Session. In 1 of 9 HR files reviewed, the hospice did not assess and document staff competence as part of orientation. There was no competence assessment completed by another physician during the orientation process in the file of HR#1 MD. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Patient Home. In 1 of 2 home visits conducted, where medication reconciliation was performed, the list in one home was inaccurate. For example, at the visit for RRHV#4 Acetaminophen 650 mg rectal suppository was on the list but there were none in the home. Tamsulosin 0.4 mg capsule was to be given once daily on the list, however it was written as twice daily on the label. Chamoxyn with Manuka Honey was being applied to the right hip twice a week and as needed but was not on the medication list. RFI was reviewed with Administrators and Branch Directors.

Observed in Record Review. In 1 of 2 discharge records reviewed, the hospice did not notify the patient’s physician of the availability of a discharge summary. This was found in record RRDC#2 where the patient was discharged for extended prognosis. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Record Review. In 1 of 2 discharge records reviewed, the hospice did not provide a discharge summary and provide a copy to the patient’s physician. In record RRDC#1 the patient revoked for aggressive care following a fall. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.

Observed in Patient Home. In 2 of 4 home visits conducted, the hospice did provide education and training to the patient in the following areas: procedures to follow if care, treatment, or services were disrupted by a natural disaster or emergency. At home visits RRHV#2 and RRHV#4 there were no individualized emergency plans found. The daughter for RRHV#2 confirmed that she did not verbally receive this information. The patient at RRHV#2 lived alone and could not attest to verbally receiving the information. As well at RRHV#2 the daughter stated that she did not receive information on how to set up the oxygen concentrator or tank. This RFI was reviewed with Administrators and Branch Directors.

Observed in Competency Session. In 1 of 9 HR files reviewed, the hospice did not verify and document staff credentials using the primary source when certification is required by law and regulation. In the file HR#9 MT there was a license for her role as a certified occupational therapy aide. However, there was no certification for her role as a massage therapist, which is what she was hired to do. This RFI was reviewed with the Regional Clinical Specialist, Administrator and Branch Director.