Every finding on record at Sunshine Hospice, LP

Observed in Record Review. In 2 of 14 patient records reviewed, it was noted that the initial comprehensive assessment was not completed within five calendar days of the patient electing the hospice benefit. For example in record RRHV#2 the social work assessment was completed on day 8 and there had been no documentation of why the assessment was delayed. In record RRHV#4 there was no social work visit documented in the first month of service with no documentation of why the assessment had not been completed. This was confirmed and discussed with the DPCS and Regional Administrator present.

Observed in Record Review. In 2 of 14 patient records reviewed, it was noted that the hospice nurse conducted a medication assessment but failed to identify all medications. For example in record RRHV#3 three medications were identified at the medication reassessment that the patient stated she had been using for a long time and they had not been identified at the initial medication assessment. For example in record RRHV#1 two eye drop medications were identified at the medication reassessment that the patient stated she had been using for years and her son stated she had been using for 15 years and they had not been identified at the initial medication assessment. This was confirmed and discussed with the DPCS and Regional Administrator present.

Observed in Record Review. In 11 of 14 patient records reviewed, it was noted that the written plan of care was not individualized with patient goals, time frames, and services required to meet those goals. For example in record RNHV#1 the volunteer and spiritual counselor's goals were not measurable or individualized. Such as, Orders and careplan will continue to be molded to best support pt and cg. and That the pt and family/will feel spiritual supported while being care for on services. This record also included 3 goals for falls that stated in progress however all target dates were in the past. The POC goals for skin integrity only 2 of 3 patient wounds. This patient had a foley catheter and it was changed monthly however there was not goal or intervention related to the foley catheter care. For example in record RRHV#1 the POC goals for Cancer include pain control, but the only interventions were medications, no non-pharmacologic interventions and the patient was actively using non-pharmacologic methods of pain management. Also in the record's POC 6 nursing goals all stated in progress and their target dates were all in the past. For example in record RRHV#3 the POC goals were not individualized or measurable Ms ---- will feel her spiritual needs are being met as she has defined and maintain a high level of spiritual and emotional contentment Patient will demonstrate understanding of appropriate use of meds for pain management. For example, in record RRNHV#3 6 goals were in progress however the target dates were all in the past. In record RRNHV#7 the POC included goals and interventions for a volunteer, however the volunteer service had stopped. Records RRHV#2 and RRNHV#2, 3, 4, 5, 6, 9, and 10 with similar POC issues. This was confirmed and discussed with the DPCS and Regional Administrator present.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the organization had not followed the plan of care. For example in record RRNHV#1 the frequency of volunteer visits was not followed in 3 of the past 6 months, one month the volunteer completed 3 visits when 2 were ordered on POC, another month the volunteer completed 5 visits when the POC order was 3 and another month the POC was for 2 volunteer visits and 1 visit was completed. This was confirmed and discussed with the DPCS and Regional Director present.

Observed in Patient Home. In 1 of 14 patient records reviewed, it was noted that the nurse had not completed an effective supervision of the aide. For example in record RRNHV#3 the nurse documented aide supervision that stated that all areas were good, however for the last 5 weeks of the hospice care the aide only completed 11 of 13 visits ordered on the POC. The aide had documented missed visits. This was confirmed and discussed with the DPCS and Regional Administrator present.

Observed in Individual Tracer. In 7 of 13 patient records reviewed, the plan of care was not updated to specify the hospice care and services needed to meet the patient and family-specific needs. The plan of care was not updated to include the problem, goals, and interventions related to the terminal illness and related conditions as evidenced by: 1. HSRR1 6/27 MOM recommended by nurse, no update to care plan for related constipation, 6/29 Lasix added without update to care plan, 7/6 following patient fall with scalp laceration no update to care plan, Foley catheter added care plan not updated, 7/12 oxygen increased to 5 liters with no update to care plan; 2. HSRR4 patient developed a small stage 2 ulcer behind ear after admission, no care plan was added; HSRR5 patient developed new wound on left medial foot with antibiotic ordered care plan not updated, social worker discussing patient's desire to move, however, there was no care plan to address need; HSRR6 new problem of contractures reported at IDG with no care plan; HSRR7 11/2 IDG update reporting patient on Lexapro and Levaquin, no care planning for infection or depression, 1/16 antibiotic ordered for tooth infection; HSRR9 patient stated hungry and had no food, eventually on Boost, assessed as moderate risk for nutrition on comprehensive assessment 12/13, no care plan for nutrition/hydration; and lastly; HSRR10 patient transitioned from 3 liters of oxygen to 4 liters 11/22, the care plan was not updated until 1/9, and on 1/6 new meds for anxiety and psychosis, no care plan update.

Observed in Individual Tracer. In 3 of 13 patient records reviewed, the interdisciplinary group's review of the care plan did not include information from the updated comprehensive assessment and did not note patient's progress. This was evidenced by: HSRR1 IDG was not updated on addition of Lasix and progress toward goals at next IDG 7/8/22; HSRR6 IDG was not updated 12/23 or 1/6 on progress of wound after return from GIP; and HSRR7 IDG was not updated on response to antibiotics for a tooth infection.

Observed in HR File Review. During review of the hospice aide personnel record the organization was unable to demonstrate that a registered nurse made an annual on-site visit to the location where a patient was receiving care in order to observe and assess each aide while he or she was performing care during 2021 and 2022. This was verified by the DON.

Observed in Individual Tracer. In 3 of 4 patient records reviewed, of discharged patients a summary of the patient’s stay, including treatments, symptoms, and pain management was not included in the discharge summary. This was evident in the following records: HSRR, HSRR3, and HSRR4. This was verified with the Director of Nursing.