Every finding on record at Texas Elite Hospice, LLC

It is required that the patient’s pain is assessed as part of a comprehensive assessment. The documented assessment of the patient’s pain includes history of pain and its treatment, both pharmacological and non-pharmacological. Use of a standardized pain assessment tool appropriate to the patient’s developmental and cognitive status. Characteristics of the pain, including location, frequency, and intensity and how pain impacts the patient’s ability to engage in usual activities and function (e.g., appetite, sleeping). This standard was not met as evidenced by a review of clinical records and interviews. 7 of 13 (54%) records reviewed revealed that the hospice did not ensure that the comprehensive pain assessment included all required components. Clinical Record #2 was reviewed and identified the patient elected hospice care on 10/28/2021. The initial comprehensive assessment documented that pain was an active problem for the patient. The pain assessment completed during the initial comprehensive assessment did not document how pain impacted the patient’s ability to engage in usual activities and function. Clinical Record #5: was reviewed and identified the patient elected hospice care on 7/30/2022. The pain assessment completed during the initial comprehensive assessment did not document the patient's pain frequency, intensity, and how the pain impacted the patient’s ability to engage in usual activities and function. Clinical Record #1: was reviewed and identified the patient elected hospice care on 4/4/2021. The initial comprehensive assessment documented that pain was an active problem for the patient. There was no documented evidence that a comprehensive pain assessment was completed. Clinical Record #7: was reviewed and identified the patient elected hospice care on 6/22/2022. The initial comprehensive assessment did not document if pain was an active problem for the patient. The pain assessment completed during the comprehensive assessment documented observations of the patient's non-verbal expressions of pain that included irritability and moaning. The pain assessment did not document how pain impacted the patient’s ability to engage in usual activities and function. Clinical Record #9: was reviewed and identified the patient elected hospice care on 6/22/2022. The initial comprehensive assessment documented that pain was an active problem for the patient. There was no documented evidence that a comprehensive pain assessment was completed. Clinical Record #8 was reviewed and identified the patient elected hospice care on 7/1/2022. The initial comprehensive assessment documented that pain was an active problem for the patient. The pain assessment completed during the initial comprehensive assessment did not document the patient's pain frequency, intensity, and how the pain impacted the patient’s ability to engage in usual activities and function. Clinical Record #10: was reviewed and identified the patient elected hospice care on 8/25/2022. The initial comprehensive assessment documented that pain was an active problem for patient. The pain assessment completed during the initial comprehensive assessment did not document the patient's pain frequency, intensity, and how the pain impacted the patient’s ability to engage in usual activities and function. During an interview, the Director or Nursing confirmed that the expectation of clinicians is to perform a complete initial comprehensive pain assessment on every patient. In an interview with the Director or Nursing it was clarified that the expectation of clinicians is to perform a complete initial comprehensive pain assessment on every patient. The pain assessment should address if pain is or is not an active problem for a patient. It should also include location, characteristics, duration, frequency, what makes the pain worse or better and what effects pain has on function or quality of life.

It is required that each patient’s individualized written plan of care reflects patient and family goals, identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. It should include all services necessary for the palliation and management of the terminal illness, including 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, interviews and observations. 6 of 13 (46%) records reviewed revealed the hospice did not ensure that medical supplies and appliances used by the patient were listed on the patient's plan of care (POC). Clinical Record #13 was reviewed and identified the patient elected hospice care on 9/30/2022. The joint review of the clinical record with the Director of Nursing, revealed the patient received medical supplies such as: gloves; wipes; and under pads from the hospice. The medical supplies were not included on the plan of care. Clinical Record #11 was reviewed and identified the patient elected hospice care on 8/21/2022. The review of the clinical record and observation during the home visited (HV#1), revealed that the patient had a hospital bed. The plan of care did not include medical supplies and appliances provided by the hospice. During an interview, the Director of Nursing confirmed that the hospital bed was not included on the plan of care. Clinical Record #5 was reviewed and identified the patient elected hospice care on 7/30/2022. The review of the clinical record revealed that the patient used oxygen and received nebulizer treatments. The hospice supplied the patient with the oxygen and nebulizer. The oxygen and nebulizer were not included on the plan of care. During an interview, the Director of Nursing confirmed that the oxygen and nebulizer were not included on the plan of care. Clinical Record #2 was reviewed and identified the patient elected hospice care on 10/28/2021. The review of the clinical record revealed that the patient used oxygen. In addition, the patient had wounds that required wound supplies. The oxygen and wound care supplies were not included on the plan of care. During an interview, the Director of Nursing confirmed that the hospice supplied the oxygen and wound supplies, but they were not included on the plan of care. Clinical Record #1 was reviewed and identified the patient elected hospice care on 4/24/2021. A review of the clinical record and an interview with the Director of Nursing revealed, that the patient used oxygen. The oxygen was not included on the plan of care. There was no evidence documenting that the oxygen was being provided by the hospice. Clinical Record #4 was reviewed and identified the patient elected hospice care on 1/21/2022. The review of the clinical record revealed that the patient used oxygen as needed. The oxygen was not included on the plan of care. During an interview, the Director of Nursing confirmed that the agency's practice is to supply all patients with the needed medical supplies and durable medical equipment needed to successfully care for the patient and meet the patient's individual needs. In an interview conducted with the Director of Nursing, it was confirmed that the agency's practice is to supply all patients with the needed medical supplies and durable medical equipment needed to successfully care for the patient and meet the patient's individual needs. According to the Director of Nursing these supplies include but are not limited to items such as, gloves, briefs, under pads, diapers, wound supplies, beds, oxygen, over bed tables, wheelchairs and shower chairs.