Every finding on record at True Care Hospice, Inc.

Observed in Record Review. In 8 of 14 patient records reviewed, the organization failed to assess and reassess its patient's. During record review for RRHV#1, RRHV#2, RRHV#3, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, and RRNHV#6, the Hospice Nurse Surveyor observed the initial assessments were not completed according to regulation. For example: all records listed had the bereavement assessment completed over the phone with no documentation as to it being offered in person. For RRHV#2, RRHV#3, RRNHV#2, RRNHV#3, RRNHV#4 and RRNHV#5, the spiritual care assessment was completed on the phone with no documentation as to it being offered in person. This was discussed and reviewed with the DON.

Observed in Record Review. the organization failed to assess and reassess its patient's. During record review for all records, the Hospice Nurse Surveyor observed lack of documentation related to progress towards goal outcomes. This was discussed and reviewed with the DON.

Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for all records, the Hospice Nurse Surveyor observed all goals were expected to be achieved on the last day of certification. This was discussed and reviewed with the DON.

Observed in Record Review. In 4 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRNHV#4 and RRNHV#5, the Hospice Nurse Surveyor observed the Plan of Care lacked documentation of all needed services for palliation and management of the terminal illness and related conditions. For example in RRNHV#5, the patient had a new wound with new orders on 7/11 and a new change in status to daily nursing visits due to impending death ( 7/17) but neither were addressed on the Plan of Care. In RRHV#1, the patient notes stated a Stage 1 pressure ulcer but there was no documentation on the Plan of Care. In RRHV#2, the patient notes state questions about psychosocial issues such as issues with caregiving, the house and food and the SW addressed these needs at the visit but there was no goals or interventions on the Plan of Care. And for RRNHV#4, the patient had a recent seizure and on-going issues with nausea but there was no documentation on the Plan of Care. This was discussed and reviewed with the DON.

Observed in Record Review. In 9 of 9 patient records reviewed, the organization failed to plan the patient's care. During record review for records with aide service and oxygen, RRHV#1, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5,RRHNV#6, and RRNHV#7, the Hospice Nurse Surveyor observed the aide care plan did not state whether the aide could remove the oxygen during bathing. Also for RRNHV#2, RRNHV#5, RRNHV#6, the aide care plan was not updated to reflect the newest oxygen orders. For RRNHV#2, the orders were changed to 5-20L and for RRNHV#5 the orders were changed to 2-10 L but neither changes were reflected on the aide care plan. For RRNHV#6, the oxygen orders were changed to 5 L continuous on 6/12 but the aide care plan was not updated. This was discussed and reviewed with the DON.