Every finding on record at Total Care Hospice & Palliative

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. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the organization did not ensure that the individualized written plan of care (POC) identified planned interventions based on problems identified in the initial assessments. Clinical Record 5: The patient elected hospice services on 7/19/2023. An initial nursing assessment dated 7/19/2023 indicated a history of constipation as well as identifying constipation as an ongoing issue. The patient POC dated 7/19/2023 showed no evidence of goals or interventions related to this problem. Clinical Record 6: The patient elected hospice services on 11/12/2023. An initial nursing assessment dated 11/12/2023 indicated a pressure ulcer to the right lower extremity. The current POC dated 11/12/2023 showed no evidence of goals or intervention related to this problem. During joint clinical record review and interview with the Director of Clinical Operations and the Director of Patient Care Services on 12/11/2023, it was reviewed and acknowledged that the patients' POCs were missing goals and interventions related to the identified problems.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 7 of 14 (50%) clinical records reviewed, the organization did not ensure that the individualized written plan of care (POC) included measurable outcomes anticipated from implementing and coordinating the POC. Clinical Record 1: The patient elected hospice care on 5/27/2023. The patient's individualized POC dated 5/27/2023 included documentation of a goal which stated, "Pain will remain at a level acceptable to patient". The goal statement did not include a description of how "a level acceptable to the patient" would be measured. An additional goal (same POC date) stated "Patient demonstrates enhanced neurological function, expression or interaction". This goal statement did not include a description of how achievement of "enhanced neurological function, expression or interaction" would be measured. Clinical Record 4: The patient elected hospice services on 2/2/2023. The patient's individualized POC dated 2/2/2023 included documentation of a goal which stated, "Patient demonstrates enhanced neurological function, expression or interaction". This goal statement did not include a description of how achievement of "enhanced neurological function, expression or interaction" would be measured. Clinical Record 5: The patient elected hospice care on 07/9/2023. The patient's individualized POC dated 07/9/2023 included documentation of a goal which stated, "Pain will remain at a level acceptable to patient". The goal statement did not include a description of how "a level acceptable to the patient" would be measured. Clinical Record 7: The patient elected hospice care on 12/20/2022. The patient's individualized POC dated 12/20/2022 included documentation of a goal which stated, "Pain will remain at a level acceptable to patient". The goal statement did not include a description of how "a level acceptable to the patient" would be measured. Clinical Record 12: The patient elected hospice care on 12/19/2022. The patient's individualized POC dated 12/19/2022 included documentation of a goal which stated, "Pain will remain at a level acceptable to patient". The goal statement did not include a description of how "a level acceptable to the patient" would be measured. Clinical Record 11: The patient elected hospice care on 8/21/2023. The patient's individualized POC dated 8/21/2023 included documentation of a goal which stated, "Pain will remain at a level acceptable to patient". The goal statement did not include a description of how "a level acceptable to the patient" would be measured. Clinical Record 14: The patient elected hospice care on 8/9/2023. The patient's individualized POC dated 8/9/2023 included documentation of a goal which stated, "Pain will remain at a level acceptable to patient". The goal statement did not include a description of how "a level acceptable to the patient" would be measured. During joint clinical record review and interview with the Director of Clinical Operations and the Director of Patient Care Services on 12/11/2023, the POCs were reviewed, and it was acknowledged that the patient's POC goals identified were non-measurable.

It is required that each patient’s individualized written plan of care includes 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 clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the organization did not ensure that the individualized written plan of care (POC) included medical supplies necessary to meet the needs of the patient. Clinical Record 1: The patient elected hospice care on 5/27/2023 and was identified as incontinent by the registered nurse during the initial comprehensive assessment on 5/27/2023. The patient's comprehensive POC dated 5/27/2023 did not include medical supplies. Clinical Record 2: The patient elected hospice care on 8/162023 and was identified as incontinent by the registered nurse during the initial comprehensive assessment on 8/16/2023. The patient's comprehensive POC dated 8/16/2023 did not include medical supplies. It was observed during home visit 2 that the patient was receiving medical supplies including briefs and under-pads. During joint clinical record review and interview with the Director of Clinical Operations and the Director of Patient Care Services on 12/11/2023, the POC was reviewed, and it was acknowledged that the patients' POCs did not include medical supplies.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene and safe handling of soiled items in the patient’s care environment. This standard was not met as evidenced by document review, interview and observation. In 2 of 3 (66%) home visits it was observed that the agency did not ensure clinical staff used standard precautions, including hand hygiene as described in the organization's policies. Document 1: The organizational policy, No. 7-009 (Revised April 2020), stated in part, "Hand washing with soap and water...use a dry disposable towel to turn off faucet." Document 2: The organizational policy, No. 7-007 (Revised April 2020), stated in part, "Gloves are to be changed after removing an old dressing." Home Visit 1: During home visit 1, with staff 1, on 12/11/2023, it was observed during hand washing that the staff member used bare hands to turn off the faucet immediately after washing. They then proceeded to retrieve dry disposable towels to dry the hands. Home Visit 3: It was observed during home visit 3, with staff 3, on 12/12/2023 that the staff member did not change gloves after removing a soiled dressing. Then with the same gloves donned, the staff member reached into a Ziploc baggie to retrieve clean gauze to proceed with cleansing the wound as ordered. During a daily wrap up conference on 12/11/2023 and again on 12/12/2023, the home visit observations were reviewed and acknowledged by the Administrator/CEO, the Executive Director/Administrator designee, the Vice President of Clinical Operations and the Director of Patient Care Services.

is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed revealed the agency did not ensure the hospice election statement was included in the patient's record. Clinical Record 12: The patient elected hospice care on 12/19/2022. The hospice election statement indicated that the patient/family elected to accept the election addendum, "Patient Notification of Hospice Non-Covered Items, Services, and Drugs". The record lacked evidence of the election addendum being furnished to the patient/family. During joint clinical record review and interview with the Vice President of Clinical Operations and the Director of Patient Care Services on 12/12/2023, it was reviewed and acknowledged that the record showed no evidence of the hospice election addendum as requested by the patient/family.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility 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 for patients that were discharged from hospice services and transferred to a Medicare/Medicaid certified facility, revealed the agency failed to forward the receiving facility a copy of the hospice discharge summary. Clinical Record 11: The patient elected hospice care on 8/21/2023, then was discharged on 12/6/2023, for moving out of the service area as they were transported to a non-contracted hospital. The record lacked evidence of the discharge summary being forwarded to the receiving facility (hospital). During joint clinical record review and interview with the Vice President of Clinical Operations and the Director of Patient Care Services on 12/12/2023, it was discussed and acknowledged that the record lacked evidence of the discharge summary being forwarded to the receiving facility.