Every finding on record at Unicare Palliative & Hospice Care, LLC

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals for up to one (1) year following the death of the patient. Bereavement counseling extends to residents of an SNF/NF (skilled nursing facility/nursing facility) or ICF/IDF (intermediate care facility/intellectual disability facility) when appropriate and identified in the bereavement plan of care. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed for patients who expired while on services revealed that the hospice did not ensure that the bereavement services reflected the needs of the bereaved per a bereavement plan of care that included the types of services to be offered and the frequency of the service delivery. Document 1: Agency policy (PC.26) [Last Reviewed:100121] stated in part: that the bereavement risk assessment will be performed on admission and after death. Following death, the agency will develop and implement the bereavement plan of care based on the post-death risk assessment. Clinical Record 13: The patient expired on 04/06/2023 and there was no documented evidence of a completed post-death bereavement risk assessment or developed bereavement plan of care. Clinical Record 14: The patient expired on 03/04/2023 and there was no documented evidence of a completed post-death bereavement risk assessment or developed bereavement plan of care. During a phone interview with the Bereavement Coordinator (BC), when asked where the bereavement plan of care could be located in the electronic medical record, the BC stated she was not sure because she had not used the electronic medical record for a few months and stated she did have some notes on paper but would have to look for them. During a joint clinical record review on 02/09/2024, the Assistant Director of Nursing (ADON) agreed the hospice did not ensure that the bereavement services reflected the needs of the bereaved per a bereavement plan of care.

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 described in HCDT 40.I and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for patients who were live discharges while on services revealed that the hospice did not ensure that a copy of the hospice discharge summary was forwarded to the receiving Medicare/Medicaid-certified facility where the patient was transferred. Clinical Record 11: The patient was admitted to the hospital on 05/30/2023. There was no documented evidence that the discharge summary was forwarded to the hospital receiving the hospice patient for care. A live discharge note was documented by the registered nurse on 05/30/2023 stating the patient was discharged due to admission to a hospital and non-contracted facility. During an interview and joint clinical record review with the Assistant Director of Nursing (ADON) on 2/09/2024, the ADON agreed that a discharge summary was not completed or sent to the Medicare/Medicaid-certified facility that received the hospice patient for care.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician 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 who were live discharges while on services revealed that the hospice did not ensure that a copy of the hospice discharge summary was forwarded to the attending physician. Clinical Record 12: The patient was discharged on 09/22/2023 due to being no longer terminally ill. There was no documented evidence that the discharge summary was completed and forwarded to the attending physician. A live discharge visit note documented by the registered nurse on 09/22/2023 stated the patient had no decline during the current benefit period. The Assistant Director of Nursing (ADON) on 2/09/2024 agreed that a discharge summary was not completed or sent to the patient's attending upon discharge.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician 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 who were live discharges while on services revealed that the hospice did not ensure that a copy of the hospice discharge summary was forwarded to the attending physician. Clinical Record 12: The patient was discharged on 09/22/2023 due to being no longer terminally ill. There was no documented evidence that the discharge summary was completed and forwarded to the attending physician. A live discharge visit note documented by the registered nurse on 09/22/2023 stated the patient had no decline during the current benefit period. The Assistant Director of Nursing (ADON) on 2/09/2024 agreed that a discharge summary was not completed or sent to the patient's attending upon discharge.

Based on interview and record review, the hospice failed to provide for an ongoing sharing of information with other non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions for 1 of 2 patients reviewed (patient #1) in that the hospice did not coordinate care with DME1 that provided ventilator to patient #1. This failed practice placed agency patients at risk for negative outcome due to delay in care, or omission of care or duplication of services. Findings include: Patient #1 Review of Patient #1's clinical records revealed SOC date on 3/31/2022 and terminal diagnosis of chronic obstructive pulmonary disease, unspecified. Other comorbidities included chronic respiratory failure, unspecified, and dependence on respirator (ventilator) status. Review of RN initial assessment completed on 3/31/22 by DON showed documentation in narrative that read in part ";Patient has a chronic trach, on home ventilator with preset settings, on 20 lpm continuous oxygen". The assessment did not include specification of the ventilator. Review of CR did not include any coordination of care with DME1. Review of IDG meeting reports for the benefit periods 7/29/22 – 9/26/22 and 9/27/22 – 10/24/22 did not reveal any care coordination with DME1. Patient #1 was discharged to the hospital on 10/24/22. During an interview with Adm/DON and Adm Asst on 11/9/22 at 11:23 am, the DON stated that patient #1s ventilator was provided by DME1. The Adm/DON was asked if she communicated with DME1 regarding the ventilator and to inform DME1 that the agency was providing hospice care to the patient. The Adm/DON stated that she did not call DME1 because the patients husband told her on admission that the ventilator was paid for and owned by the patient. Adm/DON added that the patients husband also said that DME1 provided maintenance services periodically on the machine. Adm/DON further stated that there was instruction posted on the ventilator on the number to call when there was any problem with the ventilator. The Adm/DON was asked how she knew how to operate the ventilator. The Adm/DON explained that the ventilator had preset settings and the patients husband operated the ventilator. The Adm/DON added that agency nurses only performed tracheostomy care. The Adm/DON was asked why she did not contact DME1 to find out if there was any important information about the ventilator that the hospice agency needed to know. DON acknowledged that she should have contacted DME1 when patient #1 was admitted. Staff were asked if DME1 has ever contacted the hospice agency. The Adm Asst stated that she received a call from a representative of DME1 about payment for the ventilator and she did not address the call because she has never heard of DME1 before the call. The Adm Asst was asked why she did not transfer the call to the Adm/DON. The Adm Asst stated that she did not transfer the call because the Adm/DON did not handle billings. The Adm Asst added that she later informed the Adm/DON or Alt Adm about the call from DME1. The Adm/DON stated that DME1 called before patient #1 was discharged to the hospital asking for payment for the ventilator. The Adm Asst also stated that DME1 sent email messages to her. The Adm Asst stated that she received the call from DME1 sometime in August or September 2022. Staff were asked how the issue was handled with DME1. The Adm Asst stated that they did not talk to DME1 because they had no contract with DME1. Adm/DON was asked if she realized that the agency was required to coordinate care with other providers of care regardless of whether they had a contract with the care provider. The Adm/DON acknowledged understanding that the agency was required to coordinate care with other care providers. When staff were asked why the above interaction was not documented in patient #1s clinical record, the Adm/DON stated that she did not know they were supposed to document the interaction in the patients record. The Adm/DON was asked for the type of patients ventilator. The Adm/DON stated that the ventilator was Vent1. When Adm/DON was asked for the brand and version of the Vent1. Adm/DON stated that she would look for the specification of Vent1. During follow-up interview with the Adm/DON and Adm Asst on 11/9/22 at 12:48 pm, the Adm Asst was again asked for the email messages from DME1. Adm Asst stated that she could not find the email messages. The Adm Asst added that the Alt Adm handled the issue with DME1 and there were also email messages between Alt Adm and DME1. Surveyor asked to speak with Alt Adm. The Adm/DON stated that Alt Adm was out of the country. Adm/DON added that she would reach the Alt Adm on the phone. During a follow-up interview with Adm/DON on 11/9/22 at 1:22 pm, she was asked if she found the description of patient #1s ventilator. The Adm/DON, who was searching on her phone, stated that she could not find the picture of the patients ventilator. Surveyor then showed Adm/DON images of Vent1 brought up on surveyors phone by search engine1, and asked Adm/DON if any of the ventilators was the same as patient #1s ventilator. Adm/DON reviewed the images and stated that she could not recall the type of Vent1 the patient was using. Adm/DON was then asked why the description of Vent1 was not documented in the clinical record. The Adm/DON acknowledged that description of the ventilator should have been recorded in the patients record. The Adm/DON was again asked if the Alt Adm could be interviewed over the phone. Adm/DON stated that she could not reach the Alt Adm. The Adm/DON then handed surveyor her business card with Alt Adm phone number handwritten on it, and she stated that surveyor should call Alt Adm after his return from the travel to obtain information from him. The Adm/DON was asked if she knew that the hospice was required to properly document anything pertaining to patient care and make such available upon request. The Adm/DON acknowledged that anything pertaining to patient care should be documented and available upon request. Review of agencys policy titled "Coordination of Care", revised 050119, read in part: ";II. The agency will provide for an ongoing sharing of information with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions." ";VI. An IDG member will contact the outside entities and determine the care that is being provided for the patient." VII. All communications and coordination of care is documented in the clinical record."