Every finding on record at Town Center Hospice Care

Upon observation, there was no evidence the agency has conducted exercises to test the emergency plan every two years. The agency confirmed they have not completed an emergency drill or have had an event since new ownership. Leadership was unable to provide information conducted by previous ownership.

Upon observation, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient's Rights and Responsibilities in a language and manner that the patient understands. Patients 1,2,3: During home visits, the patients and caregivers were observed only speaking Armenian and were unable to converse in English. All consents and admission information was written in English and not provided in Armenian.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient 2: The consents stating a copy of the Patient's Rights and Responsibilities was signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence of the appropriate documentation for release of confidential information. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon patient record review, 1 of 10 (Patient #3) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 3: The medication profile contained mometasone furoate topical ointment with no defined area for administration.

Upon patient record review, 2 of 10 (Patients #3,#4) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 3: The medical record contained nursing documentation upon admission identifying patient is a high risk for skin impairment. There was no evidence of problems, goals, and interventions related to risk for skin impairment. Patient 4: The medical record contained nursing documentation upon admission identifying patient issue with dyspnea. There was no evidence of problems, goals, and interventions related to respiratory dysfunction.

Upon patient record review, 1 of 10 (Patient #3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 3: The medical record contained an order for mometasone furoate topical ointment with no defined area for administration.

Upon patient record review, 3 of 10 (Patients #1,#4,#5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 1: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair. There was no evidence of the wheelchair included as DME in the plan of care. Patient 4: The medical record contained nursing documentation upon admission identifying patient use of a shower chair. There was no evidence of the shower chair included as DME in the plan of care. Patient 5: The medical record contained nursing documentation upon admission identifying patient use of a walker and wheelchair. There was no evidence of the walker and wheelchair included as DME in the plan of care.

Upon patient record review, 1 of 10 (Patient #4) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 4: There was no evidence of an RN visit completed between 8/14/23-9/8/23, and 9/20/23-10/6/23, no update to the comprehensive assessment during these dates.

Upon client record review, 1 of 10 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 4: RN frequency ordered as RN 1 every 14 days. There was no evidence of an RN visit completed between 8/14/23-9/8/23, and 9/20/23-10/6/23.

Upon patient client record review, 1 of 10 (Patient #2) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 2: The consents stating a copy of the Patient's Rights and Responsibilities and the election form were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

The agency did not have access to patient records on service during previous ownership at the start of survey. Leadership contacted previous owners to obtain information and received only four patient charts at that time.

Upon client record review, 1 of 10 (Patient #2) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient 2: The consents were signed by the patient who is on service for terminal diagnosis of Alzheimer's Disease.

Upon observation, there was no evidence the hospice provides orientation to personnel of a SNF/NF or ICF/IID regarding the policies and procedures of the provision of care/service including all required content.