Every finding on record at Transition Care Telemetry, Inc.

Upon patient record review 1 of 14 (Patient #1) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #1 had spiritual screen by admission RN on 6/1/24. SCP had made a note on 6/2 that the caregiver did not want to meet until 6/8, however; there was not a spiritual comprehensive assessment performed by the SCP until 6/11/24.

Upon patient record review, 4 of 14 (Patient #9,10,11,13) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery. Patient #9 Passed on 06/08/24 no evidence of a Bereavement Plan of Care. There was evidence of Bereavement letters mailed on 07/02/24 and 09/03/24, per policy. Patient #10 Passed on 06/09/24 no evidence of a Bereavement Plan of Care. There was evidence of Bereavement letters mailed 7/9/24 and 9/13/24. Patient #11 Passed 10/09/23 no evidence of a Bereavement Plan of Care. However; in-person visits documented for 10/11/23, 10/27/23 where note states, “will visit every other week”, 11/08/23, 12/08/23 and 01/26/24. No further notes for visits of calls, no documentation of reason for discontinuing BC. Mailings sent per agency policy until 07/02/24 with no further mailings noted. Patient #13 Passed on 04/13/23 no evidence of a Bereavement Plan of Care. A Bereavement call was made by SCP 4/13, the note stated, “Will continue to check on wife”. No evidence of any further phone or in person contact. However; evidence of Bereavement letters mailed per agency policy.

Upon patient record review, 3 of 14 (Patient #1,9,10) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patients 1,9,10 had assigned visit frequency of "2-3 visits per week".

Upon patient client record review, 3 of 14 (Patient #7, 8, 13) did not evidence that each patient record contains physician orders. Patients 7 and 8 There was no documented MD order to discharge patient as no longer medically eligible. Patient 13 admitted as continuous care level of care 4/12/23 and was having pain out of control. The admitting RN made multiple calls to MD and noted the calls and orders in her narrative continuous care notes. Symptoms managed, patient comfortable over several hours. She then spoke with MD and obtained order to change level of care to Routine Home Care. This was all documented in continuous care narrative notes, however no evidence of actual MD order for level of care change to Routine Home Care in chart. This patient passed peacefully early morning on 4/13/23.

Upon client record review, 3 of 14 (Patient #6,7,8) did not have evidence that the discharge summary includes all required information. Patients 6,7,8 Summaries were last visit note, and did not include all required information.

Upon patient record review, 1 of 5 (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. Patient #3 Had an order for Oxygen PRN. Oxygen PRN was not included on the Medication Profile.

Upon patient record review, 5 of 5 (Patient's #1, #2, #3, #4 and #5) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1, #2, #3, #4, #5- There was no evidence in the record of an initial bereavement assessment being completed.

Upon patient record review, 1 of 5 (Patient #3) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs Patient #3 The plan of care included a frequency order for the MSW of 1 x evaluation then if needed. The initial evaluation did not establish a frequency to meet the patient/family needs or discontinue services until needed.

Upon patient record review, 2 of 5 (Patient #3 and #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3 The Plan of care dated 8/2/21 included a SC visit frequency of 1x per month. There was no evidence of a SC visit in the month of September. The plan of care also included RN visit frequency of 2x per month. The record contained evidence of 8 RN visits in the month of August (8/2, 8/5, 8/7, 8/10, 8/12, 8/17, 8/19 and 8/24/21) and 3 visits in the month of October (10/5, 10/7 and 10/28/21). The LVN visit frequency was 2x per week. The week week of 9/5/21 and 10/3/21 there was only evidence of 1 LVN visit being made. Patient #4 The LVN visit frequency was 2x week. The week of 8/22/21 there was only evidence of 1 LVN visit being made. The SC visit frequency was 1x month. There was no evidence of SC visit for the months of August or September.

Upon personnel record review, 1 of 1 applicable (Personnel #11) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: The tub and shower bath competencies were verbal verification and not directly observed by the RN.

Upon patient client record review, 4 of 5 (Patient #1, #2, #4, #5) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #1, #2, #4, #5- The signed election indicated that the patient/representative elected to receive the Notice of non-covered items, services and drugs. There was no evidence in the record to demonstrate that the patient/representative was given the requested addendum.