Every finding on record at Snl Hospice, 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 and interview. In 1 of 14 (7%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 5: The initial nursing assessment dated 07/12/2023 stated the patient was receiving oxygen 2 liters/minute via nasal cannula. The POC dated 07/12/2023 lacked evidence of goal(s) and intervention(s) that included the specifics of the oxygen being administered. The Administrator/Director of Patient Care Services stated in an interview on 03/28/2024 that the agency did not ensure the POC reflected patient and family goals and interventions based on problems identified in the initial comprehensive assessment.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I, and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed for patients that revoked hospice and transferred to a facility revealed the agency did not ensure a copy of the discharge summary was forwarded to the receiving facility. Clinical Record 6: The patient elected the hospice benefit on 06/07/2023. The patient went to the hospital to pursue aggressive treatment and revoked the hospice benefit on 06/22/2023. The record lacked evidence of the discharge summary being forwarded to the receiving facility (hospital). The Administrator/Director of Patient Care Services stated in an interview on 03/28/2024 that the agency did not ensure a copy of the hospice discharge summary was forwarded to the receiving facility for a patient that was transferred to pursue aggressive treatment.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IDF representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 5 of 5 (100%) clinical records reviewed of patients residing in a skilled nursing facility (SNF) revealed the agency did not ensure that the plan of care (POC) specified which provider was responsible for performing the functions that were agreed upon and were included in the POC. Clinical Record 4: The patient elected the hospice benefit on 03/16/2023. The patient resided in a SNF. The record lacked evidence of which provider was responsible for performing the functions that were agreed upon and were included in the POC. Clinical Record 7: The patient elected the hospice benefit on 11/18/2022. The patient resided in a SNF. The record lacked evidence of which provider was responsible for performing the functions that were agreed upon and were included in the POC. Clinical Record 12: The patient elected the hospice benefit on 04/06/2023. The patient resided in a SNF. The record lacked evidence of which provider was responsible for performing the functions that were agreed upon and were included in the POC. Clinical Record 13: The patient elected the hospice benefit on 11/02/2022. The patient resided in a SNF. The record lacked evidence of which provider was responsible for performing the functions that were agreed upon and were included in the POC. Clinical Record 14: The patient elected the hospice benefit on 01/18/2023. The patient resided in a SNF. The record lacked evidence of which provider was responsible for performing the functions that were agreed upon and were included in the POC. The Administrator/Director of Patient Care Services stated in an interview while completing joint clinical record reviews on 03/28/2024 that the agency did not ensure that the POC for the patients receiving routine hospice care at a SNF specified which provider was responsible for performing the functions that were agreed upon based on the needs of the patient.