Every finding on record at Sunset 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 duplicate drug therapy. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed, it was revealed that the agency did not ensure that the medication review process addressed duplicate drug therapy. Clinical Record 3: A review of the clinical record revealed that the patient elected the hospice benefit on 10/28/2024. The patient's medication profile, on the plan of care dated 10/28/2024-01/25/2025, included "Acetaminophen Oral Tablet 325mg, 2 tabs BID PO (twice a day, by mouth) for pain or fever" and "Acetaminophen Oral Tablet 325mg 2 tabs every 4 hours as needed (PRN) for pain or fever." It also included "Loratadine Oral Tablets 10mg 1 tab daily as needed PO for allergic rhinitis" and "Loratadine Oral Tablet 10mg, 1-tab daily PO for allergic rhinitis." The clinical record did not include documentation of a medication review that addressed the duplicate drug therapy for the Acetaminophen or loratadine medicines. The Director of Nursing (Personnel Record 2) was interviewed on 11/19/2024 and stated, "The medicines were accidentally entered two times. There should only be one of each medicine in the medication profile."

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care, ensure continuous assessment of each patient’s and family’s needs, and 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), the patient or patient representative if any of them so desire, and he primary caregiver in accordance with the patient’s needs if any of them so desire. This standard was not met as evidenced by clinical record review and interview. In 7 of 7 (100%) clinical records reviewed, the agency did not ensure that services were provided as ordered on the patient's individualized plan of care. Clinical Record 1: The patient elected the hospice benefit and was admitted on 09/28/2024. The plan of care (POC) dated 09/28/2024 included orders for the Spiritual Counselor (SC) two times each month. There were no documented SC visits in October 2024. The record lacked evidence of interim orders or documentation to support why there were missed visits. Clinical Record 2: The patient elected the hospice benefit and was admitted on 09/03/2024. The plan of care (POC) dated 09/03/2024 included orders for Skilled Nursing (SN) weekly and Spiritual Counselor (SC) two times each month. There were three documented SN visits made during the week of 09/03/2024 and two documented visits during the week of 09/22/2024. There was only one documented SC visit in September 2024 (09/09/2024) and no documented SC visits in October 2024. The record lacked evidence of interim orders or documentation to support why there were missed visits or additional visits made. Clinical Record 3: The patient elected the hospice benefit and was admitted on 10/28/2024. The plan of care (POC) dated 10/28/2024 included orders for Skilled Nursing (SN) weekly, Medical Social Work (MSW) biweekly (one visit every other week), and Spiritual Counselor (SC) biweekly (one visit every other week). There were two documented SN visits week of 10/28/2024. The SC documented an extra visit on 11/05/2024, and the MSW documented an extra visit on 11/06/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits or additional visits made. Clinical Record 4: The patient elected the hospice benefit and was admitted on 06/24/2024. The plan of care (POC) dated 06/24/2024 included orders for Skilled Nursing (SN) twice weekly, Medical Social Work (MSW) biweekly (one visit every other week), and Spiritual Counselor (SC) biweekly (one visit every other week). There were missed SN visits during the weeks of 06/30/2024, 08/04/2024, 08/11/2024, 08/18/2024, 09/01/2024, and 09/08/2024. Extra SN visits were documented on 09/24/2024, 09/25/2024, and 09/26/2024. Extra documented MSW visits were present on 07/11/2024, and 08/07/2024. An extra SC visit was documented on 07/07/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits or additional visits made. Clinical Record 5: The patient elected the hospice benefit and was admitted on 07/30/2024. The plan of care (POC) dated 07/30/2024 included orders for Skilled Nursing (SN) weekly and Medical Social Work (MSW) two times each month. Extra SN visits were documented on 08/06/2024, 08/08/2024, and 08/29/2024. There was a missed SN visit the week of 09/02/2024. There was an extra documented MSW visit on 09/18/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits or additional visits made. Clinical Record 6: The patient elected the hospice benefit and was admitted on 09/03/2024. The patient was recertified for the second benefit period and the plan of care (POC) dated 10/28/2024 included orders for Skilled Nursing (SN) weekly. Extra SN visits were documented on 10/29/2024, 11/05/2024, 11/06/2024, and 11/07/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits or additional visits made. Clinical Record 7: The patient elected the hospice benefit and was admitted on 08/20/2024. The plan of care (POC) dated 08/20/2024 included orders for Skilled Nursing (SN) weekly and Medical Social Work (MSW) biweekly (one visit every other week). Extra SN visits were documented on 08/22/2024, 08/29/2024, and 09/19/2024. No documented MSW visit was made the week of 09/01/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits or additional visits made. The Administrator and Director of Nursing (DON) were interviewed on 11/20/2024. The Administrator stated, "We didn't completely understand visit frequencies and how to put them in the electronic medical record (EMR). We just started a quality project on visit frequencies and now understand how to enter the correctly in [the EMR]." The DON stated, "We just had a mock survey and found out we weren't using frequencies correctly. We've already started working on a quality project."

It is required that a hospice aide provides services: ordered by the Interdisciplinary Group. This standard was not met as evidenced by clinical record review and interview. In 3 of 3 (100%) clinical records reviewed, in which aide services were accepted, it was revealed that the agency did not ensure that aide services were provided as ordered by the Interdisciplinary Group (IDG). Clinical Record 2: The patient elected the hospice benefit and was admitted on 09/03/2024. The plan of care (POC) dated 09/03/2024 included visit frequency orders for the Hospice Aide (HA) weekly. There were no documented HA visits during the weeks of 09/03/2024, 09/22/2024, 10/06/2024, 10/13/2024, 10/20/2024, 10/27/2024, or 11/03/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits. Clinical Record 3: The patient elected the hospice benefit and was admitted on 10/28/2024. The plan of care (POC) dated 10/28/2024 included visit frequency orders for the Hospice Aide (HA) weekly. There was a missed HA visit during the week of 10/28/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits. Clinical Record 5: The patient elected the hospice benefit and was admitted on 07/30/2024. The plan of care (POC) dated 07/30/2024 included visit frequency orders for the Hospice Aide (HA) weekly. There was a missed HA visit the week of 08/04/2024. The record lacked evidence of interim orders or documentation to support why there were missed visits. The Administrator and Director of Nursing (DON) were interviewed on 11/20/2024. The Administrator stated, "We didn't completely understand visit frequencies and how to put them in [electronic medical record (EMR)]. We just started a quality project on visit frequencies and now understand how to enter the correctly in [the EMR]." The DON stated, "We just had a mock survey and found out we weren't using frequencies correctly. We've already started working on a quality project."

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 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, where the patient revoked the hospice benefit, it was revealed that the agency did not ensure the discharge summary was provided to the patient's attending physician. Clinical Record 5: The patient elected the hospice benefit on 07/30/2024. Documentation was present in the record that the patient no longer wanted to receive hospice services and signed a revocation on 09/21/2024. The patient was discharged from hospice service and a discharge summary was created by the discharging clinician. The clinical record lacked documentation that the discharge summary was provided to the patient's attending physician. The Administrator and Director of Nursing were interviewed on 11/20/2024 and stated that they were unaware the discharge summary needed to be sent to the patient's primary (attending) physician.