Every finding on record at Specialized Hospice, LLC

It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. Volunteer services are noted in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed, in which the patient accepted a volunteer, revealed that the agency did not ensure that the plan of care included orders for the volunteer. Clinical Record 8: The patient was admitted on 11/01/2024 with a diagnosis of malignant neoplasm of the prostate. The Skilled Nurse (SN) assessment on 11/01/2024 included a volunteer assessment and reported that patient accepted volunteer services. The plan of care for certification period 11/01/2024 - 01/29/2025 documented, “services accepted: RN, Aide, Spiritual, MSW and Volunteer.” The plan of care did not include visit frequency orders for a volunteer. The clinical record did not contain any verbal orders for a volunteer and as of 11/25/2024 the patient had not been seen by a volunteer. In an interview on 11/20/2024, the Director of Operations stated, “there should be orders on the plan of care and we would expect the volunteer coordinator to assess them for needs and frequency within 5 days of the start of care.”

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed, in which a patient revoked hospice services, it was revealed that the agency did not ensure that a discharge summary was sent to the physician. Clinical Record 14: The patient was admitted on 04/05/2024 with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The patient requested revocation on 07/28/2024 and the patient was discharged by request. The clinical record contained no evidence that a discharge summary was sent to the physician. Director of Operations stated in an interview on 11/21/2024, I looked through everything and cannot find that a discharge summary was sent to the physician.

It is required that the hospice designates a Registered Nurse member of the IDG to ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) clinical records revealed the agency failed to follow the written individualized plan of care established by the interdisciplinary group. Record #35071: The Plan of Care, for benefit period 9/3/2021 to 12/1/2021, revealed the spiritual care visit frequency order (effective 9/3/2021) was written as follows: One visit in one week starting on 9/5/2021, one visit in one week starting on 10/10/2021, one visit in one week starting on 10/17/2021, one visit in one week starting on 11/7/2021, and two as needed (PRN) visits for the benefit period. An order, effective 9/18/2021, was written to add an additional six (6) PRN spiritual care visits for the remainder of this benefit period. Completed scheduled visits were documented on the following dates: 9/7/21 and 10/10/21. Completed PRN visits were documented on the following dates: 9/14/21, 9/18/21, 9/19/21, 9/22/21, 9/23/21, 9/28/21, 9/29/21, 10/2/21, 10/3/21, 10/6/21, 10/11/21, 10/13/21, 10/14/21, 11/5/21, and 11/15/21. On 12/21/2021 at 1500 an interview was conducted with the administrator; it was confirmed that eight (8) PRN visits were conducted without a plan of care order and that one scheduled visit for the week starting on 10/17/21 was not made and there was no documentation to support the reason.

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. This standard was not met as evidenced by review of personnel records and interview. In 1 of 12 (8%) personnel records the hospice failed to document assessment of skills and competency. Record #47436 (date of hire: 9/24/2021): The volunteer file was reviewed and revealed there was no documented initial skills/competency checklist. In an interview with the administrator, held on 12/22/21 at 1020, he stated he was aware the volunteers need to have the competencies completed and says he spoke with the volunteer coordinator who thought it had been completed, but they were unable to locate the form.