Every finding on record at Trina Patterson Dba Landing Hospice

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over the counter (OTC) drugs. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 3 of 5 (60%) records reviewed it was revealed that the agency did not ensure that the drug profile was updated with the addition of new prescription medications. Clinical Record 2: The hospice election of benefits was dated 09/09/2022. The medication profile included Lispro 100U/ml sliding scale 0-110=0U, 111-150=1U, 151-200=3U, 201-250=6U, 251-300=9U, 301-350=12U, 351-400=15U, >400 notify MD. There was no frequency or route documented. Clinical Record 4: The hospice election of benefits was dated 05/15/2022. The plan of care dated 05/15/2022 included an order for Oxygen 2-4L via nasal cannula as needed (PRN) dyspnea. Oxygen was not included on the medication profile. A physician order dated 06/04/2022 included OxyContin 50mg ER tablets 1 oral every 4 hours PRN pain and Ativan 1 mg tablet 1 oral every 4 hours PRN agitation. The medications were not included on the medication profile. Clinical Record 5: The hospice election of benefits was dated 10/07/2022. The medication profile read as follows: Tylenol 325mg every 4 hours PRN with no route or prn qualifier, Colace 100 mg cap bid with no route, Allopurinol 100mg with no dosage, route, or frequency, MiraLAX 1 pack tid with no route, Eliquis 5 mg 1 tab daily with no route, Clonazepam 0.5mg tab bid with no route, Plavix 75mg 1 tab oral with no frequency, Vitamin B12 Intramuscular 1xmonth with no dosage, Voltaren cream with no location, or frequency, Levalbuterol 0.63/ml every 4 hours PRN with no route or prn qualifier, Nitroglycerin 0.4 Sublingual dissolve under tongue as needed with no frequency or prn qualifier, Prednisone 5 mg 1 tablet oral with no frequency, Lantus 100u/ml 25Units at bedtime with no route, Percocet 5mg/325mg 1 tab oral every 6 hours PRN with no prn qualifier, and Oxygen continuous with no rate or route. During interview on 09/08/2023, the Administrator reviewed the associated records and stated the medications profiles were incomplete.

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 the drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) records reviewed it was revealed that the agency did not ensure that each patient’s individualized written plan of care included all services necessary for the palliation and management of the terminal illness, including the treatments necessary to meet the needs of the patient. Clinical Record 4: The hospice election of benefits was dated 05/15/2022. The comprehensive assessment dated 05/15/2022 included the use of a pure wick external catheter. There was no documentation on the plan of care dated 05/15/2022 ordering the use of the pure wick external catheter. During interview 09/08/2023, Administrator reviewed the associated record and stated catheter care had been inadvertently omitted.

It is required that the hospice’s policies and procedures define a system of communication and integration that sustains coordination of services and provides documentation of exchange of information. The policies and procedures ensure that care and services provided are in accordance with the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) records reviewed it was revealed that the agency did not ensure that the care and services provided were in accordance with the plan of care. Clinical Record 4: The hospice election of benefits was dated 05/15/2022. The 05/15/2022 hospice plan of care included a frequency of '1xmo' for the medical social worker (MSW). There was documentation of two visits made for the month of May dated 05/19/2022 and 05/31/2022. The 05/23/2022 interdisciplinary team meeting did not show evidence of a MSW change in visit frequency at the time of the review. During interview 09/08/2023, Administrator reviewed the associated record and stated that the MSW had made a PRN (as needed) visit and that the standard additional prn visit for assessment of patient needs had inadvertently been omitted form the hospice plan of care.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 4 (25%) records reviewed of patients that were receiving aide services, it was revealed that the agency did not ensure that the hospice aide provided services that were ordered by the Interdisciplinary Group and included in the plan of care. Clinical Record 4: The hospice election of benefits was dated 05/15/2022. The aide care plan created on 05/15/2022 included the following tasks to be performed every visit: Record urinary output (U.O.)/BM, comb/brush hair, peri care, oral care, and shampoo 2xweek. The aide visit note dated 05/16/2022 contained no evidence of the completion of a bed bath, peri care, or record of U.O./ BM and there was documentation that catheter care was provided. The aide visit note dated 05/17/2022 contained no evidence of the completion of peri care, oral care, record of U.O./BM and there was documentation that catheter care was provided. The aide visit note dated 05/19/2022 contained no evidence of the completion of hair care, record of U.O./BM and there was documentation that catheter care was provided. The aide visit note dated 05/20/2022 contained no evidence of the completion of record of U.O./BM and there was documentation that catheter care was provided. The aide visit notes dated 05/21/2022, 05/22/2022, 05/23/2022, 05/25/2022, 05/26/2022, 05/27/2022, 05/29/2022, 05/30/2022, 05/31/2022, and 06/11/2022 contained no evidence of the completion of bath, hair care, record of U.O./BM and there was documentation that catheter care was provided. The aide visit notes dated 06/02/2022, 06/07/2022, 06/09/2022 contained no evidence of the completion of bath, or record of U.O./BM. The aide visit note dated 06/03/2022 contained no evidence of the completion of record of U.O./BM and there was documentation that catheter care was provided. The aide visit note dated 06/08/2022 contained no evidence of the completion of bath, hair care or record of U.O./BM. The aide visit note dated 06/10/2022 contained no evidence of the completion of bath or record of U.O./BM and there was documentation that catheter care was provided. The aide visit note dated 05/18/2022, 06/05/2022 and 06/12/2022 contained no evidence that any task was completed as ordered on the aide plan of care. The aide visit documentation dated 05/16/2022 through 06/13/2022 contained no evidence of the completion of shampoo as per the aide plan of care. The aide care plan did not include catheter care. During an interview on 09/08/2023, the Administrator reviewed the records and stated that the care plans had not been followed.

It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. This standard was not met as evidenced by clinical record review and interview. In 3 of 5 (60%) records reviewed it was revealed that the agency did not ensure that all entries in the patient record were legible, appropriately authenticated, and dated by the person performing the care/service. Clinical Record 1: The comprehensive assessment completed 09/09/2022 by the registered nurse did not have a date with the associated signature and credentials. The initial social work assessment completed 09/13/2022did not contain a date with the associated signature and credentials. Clinical Record 4: The aide visit notes for the dates 05/16/2022 through 06/13/2022 did not include the aide's credentials with the associated signature and date. The social worker assessment dated 05/19/2022 did not contain a date with the associated signature and credentials. The comprehensive assessment completed by the registered nurse on 05/15/2022 did not include a date with the associated signature and credentials. Clinical Record 5: The comprehensive assessment completed 10/07/2022 by the registered nurse did not have a date with the associated signature and credentials. The medication profile created 10/07/2022 did not contain a date with the associate signature and credentials on page 1 of 2 and page 2 of 2 had no signature, date or credentials. The bereavement clinical note dated 02/05/2023 did not have credentials with the associated Chaplain's signature and date. During an interview on 09/08/2023, the Administrator reviewed the associated records and stated that the signatures had been corrected to contain signature, date and credentials.