Every finding on record at Suncrest Hospice Utah, 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, and other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when a new medication is added or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records and interviews. 2 of 13 (15)% clinical records reviewed, the agency did not ensure that the medication profile was updated to include oxygen. Clinical Record 10: Skilled Nurse (SN) recertification assessment dated 9/7/2022 revealed that the patient is utilizing oxygen almost full time. The medication profile does not include oxygen. Clinical Record 8: SN assessment on 6/11/2022 reveals that the patient is using oxygen 2L/min per nasal cannula. Medication profile dated 6/16/2022 does not include oxygen. In an interview on 9/14/2022, the VP of clinical services stated, in part, that we will get those updated and educate the staff. 2 of 13 (15)% of clinical records revealed that the agency did not ensure that the medication profile was updated to include oxygen.

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. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 13 (7%) clinical records reviewed, the agency did not ensure that the Registered Nurse implemented the individualized plan of care. Clinical Record 2: Physician orders obtained on 6/27/2022 read, "Abrasion/right anterior leg shin: Remove old dressing, clean with NS or wound cleanser, pat dry with gauze or 4x4's, apply xeroform gauze or Adaptic, cover with a non-adherent pad or Telfa pad. Secure with bi-layer compression wraps. Abrasion/Right Dorsal leg calf: pat dry with gauze or 4x4 apply xeroform gauze or Adaptic, and cover with a nonadherent pad or Telfa pad. Secure with bilayer compression wraps." Skilled Nurse visit on 6/28/2022 documents in part, "RN cleaned the wound and changed the dressing. RN left the dressing off so the wound could heal better." As of 9/13/2022, the wound care orders dated 6/27/2022 remain inactive. In an interview on 9/13/2022, the VP of Clinical Services stated in part, "there should be an order to leave the bandage off if appropriate. Again, another education opportunity." 1 of 13 (7%) of clinical records reveal that the agency did not ensure that the registered nurse implemented the individualized plan of care.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments and includes all services necessary for the palliation and management of the terminal illness, including intervention to manage pain and symptoms, drugs and treatment necessary to meet the needs of the patient and medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records and interviews. 3 of 13 (23%) clinical records reviewed, the agency did not ensure that the patient's individualized written plan of care included all the required elements. Clinical Record 10: Skilled Nurse (SN) initial assessment on 3/20/2021 notes in part that there is a small wound on his left shin. Treated with antibiotic ointment and covered with a bandage by the nurse. The plan of care dated 3/20/2022 does not include any orders or interventions for wound care. SN recertification assessment dated 9/7/2022 notes in part that the patient is now on O2 almost full time. He will not wear it when he leaves his room for meals, but other than that, he is on it full time. The patient’s SPo2 is dropping below 90% at rest without O2, and if he walks, it drops into the low to mid 80’s on Room Air. He is Short of Breath (SOB) at rest with talking and extremely SOB with exertion just going short distances. The patient has to sleep in his recliner with his O2 on so he can breathe at nighttime. Plan of care dated 9/11/2022-11/9/2022 does not include orders for oxygen. Clinical Record 8: SN Assessment on 6/11/2022 reveals that the patient had an abdominal surgical wound with a wound vac and a wound on the arm due to a fall. SN assessment also reveals that the patient is oxygen dependent on 2L/min via Nasal Cannula (NC). Plan of care dated 6/11/2022 -9/8/2022 does not include oxygen or wound care orders. The medication profile dated 6/16/2022 reveals sixteen medications but no medications are included on the plan of care dated 6/11/2022-9/8/2022. Plan of care signed by the physician on 7/3/2022. A recertification assessment completed on 8/31/2022 reveals that patient use of oxygen has increased to 3L/min via NC. Plan of care dated 9/9/2022 – 12/7/2022 does not include oxygen. The plan of care dated 6/11/2022 does not include nursing interventions and a medication list. The clinical record contains signed physician orders for skilled nursing interventions and medications dated 6/11/2022 but did not get transferred to the plan of care. Clinical Record 2: Plan of care dated 6/27/2022 to 9/24/2022 lists Foley insertion tray and Foley catheter under supplies but does not contain orders for a catheter. There is no indication of the size of the Foley or how often the Foley catheter should be changed. SN assessment dated 6/27/2022 notes that the patient has a Foley catheter with a leg bag. Interview with VP of Clinical Services: VP of Clinical Services, in an interview stated on 9/14/2022 you are right, the nursing interventions and medications are not on the Plan of Care (POC). I don't know how that happened because we audit 100% of our POC's. VP of Clinical services stated in part in interview on 9/15/2022, "I don't know how that could have happened and how it could have gotten past our QI reviews." Later discovered that if orders are signed prior to the generation of the plan of care, the signed orders do not flow to plan of care. 3 of 13 (23%) of clinical records revealed that the agency did not ensure that the patient's individualized written plan of care included all the required elements.

It is required that hospice aides are assigned to a specific patient by a Registered Nurse who is a member of the Interdisciplinary Group. 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 a review of clinical records and interviews. 5 of 7 (71%) clinical records for patients receiving hospice aide services were reviewed, and the agency did not ensure that the aide care plan provided clear direction to the aide related to the patient's individual needs. Clinical Record 12: Skilled Nursing (SN) assessment and plan of care dated 9/9/2022 notes that the patient was utilizing oxygen 4-5L continuous via Nasal Cannula (NC). Aide care plan dated 9/9/2022 does not include oxygen use or directions to the aide related to the use of oxygen. Clinical Record 8: SN assessment on 6/11/2022 reveals that the patient utilizes oxygen and has a wound vac. Aide care plan dated 6/11/2022 does not include direction to the aide related to oxygen or wound dressing during personnel care. An aide care plan was updated on 9/13/2022 to have the directions to the aide about wound care, "keep dressing intact, notify RN if the dressing is soiled or removed on wound each visit." Clinical Record 6: Orders written on 9/6/2022 to perform wound care to abrasion on right forearm, to cleanse with Normal Saline, apply medihoney to wound bed, and apply bandage twice weekly. Apply bordered foam to the coccyx. Aide care plan dated 8/11/2022 was not updated to reflect changes to patient needs on 9/6/2022. The aide has no direction regarding wound care areas during personnel care. Clinical Record 3: Start of care assessment and plan of care dated 5/12/2022 revealed that the patient is dependent on oxygen 3L/min via nasal cannula continuous. Aide care plan dated 5/12/2022 does not address oxygen or instructions to the aide related to oxygen. Clinical Record 2: Start of care assessment 6/27/2022 reveals that the patient has a Foley catheter. Plan of care orders dated 6/27/2022 include charges for wound care with dressings, left calf/shin, and a Foley catheter. Aide care plan dated 6/27/2022 does not have any information or direction to the aide related to Foley catheter or dressing during personnel care . In an interview on 9/14/2022, the VP of Clinical Services stated in part, "we will have to do more education on developing the aide care plan." 5 of 7 (71%) relevant clinical records the agency did not ensure that the aide care plan provided clear direction to the aide related to patient's individual needs.