Every finding on record at United Hospice Inc

Based on record reviews, interviews, and review of hospice policy and procedure, the hospice failed to ensure the Interdisciplinary Team (IDT) completed the patient's comprehensive assessment within 5 days of the patient's notice of election (NOE) of hospice care for 5 of 11 patient charts reviewed. (Patient 3, 4, 5, 9, and 13) --- The findings include: Record review on 05/22/23 at 12:08 PM of P 3 revealed P 3 was admitted to the hospice on 01/11/23 for Neurocognitive Disorder with Lewy Bodies. Review of the chart revealed no IDT comprehensive assessment within 5 days of admission. The first IDT meeting for the patient was on 01/17/23, 6 days after the NOE. During an interview on 05/25/23 at 1:07 PM, the Director of Nursing verified the findings. Record review on 05/22/23 at 1:00 PM of P 4 revealed P 4 was admitted to the hospice on 06/09/22 for Atherosclerotic heart disease with unstable angina. Review of the chart revealed no IDT comprehensive assessment within 5 days of admission as the first IDT meeting for the patient was on 06/10/22 which was prior to the initial assessment by the Masters Social Worker on 06/13/22 and the chaplain on 06/13/22. During an interview on 05/25/23 at 1:18 PM, the DON verified the findings. Record review on 05/23/23 at 3:50 PM of P 5 revealed P 5 was admitted to the hospice on 09/02/22 for Multiple Sclerosis. Review of the chart revealed no IDT comprehensive assessment within 5 days of admission. The first IDT meeting for the patient was on 09/09/22, 7 days after the NOE. During an interview on 05/25/23 at 1:25 PM, the DON verified the findings. Record review on 05/23/23 at 10:35 AM of P 9 revealed P 9 was admitted to the hospice on 03/06/23 for Chronic myeloid leukemia. Review of the chart revealed no IDT comprehensive assessment within 5 days of admission as the first IDT meeting for the patient was on 03/07/23 which was prior to the initial assessment by the chaplain on 03/08/23. During an interview on 05/25/23 at 1:30 PM, the DON verified the findings. Facility policy, entitled ";Comprehensive Assessment for Hospice" revealed, ";5. A comprehensive assessment of the patient is completed by designated members of the IDG (interdisciplinary group), in consultation with the patients attending physician, no later than five (5) calendar days after the patient elects the hospice benefit...". On 5/23/23, at 3:00 PM Patient 13's record was reviewed. Patient 13 elected hospice care on 3/1/23 with a diagnosis of Amyotrophic Lateral Sclerosis (ALS). The record review revealed the first interdisciplinary group (IDG) meeting was on 3/7/23 (6 days after election of hospice care). Review of the Hospice Initial Assessment Medical Social Worker (MSW) Visit Note dated 3/3/23 revealed there was no documented evidence the MSW communicated with the Chaplain or the Physician. During an interview with the Director of Nurses (DON) on 5/25/23, at 12:55 PM, she/he confirmed there was no documented evidence all core members of the IDG completed the comprehensive assessment within five days of the election of hospice care. On 5/25/23, the hospice's policy titled, "...A comprehensive assessment of the patient is completed by designated members of the IDG, in consultation with the patient's attending physician, no later than five (5) calendar days after the patient elects the hospice benefit..."

Based on record review, interview, and review of hospice policy, the hospice failed to ensure the comprehensive assessment included all relevant assessment data that the nurse identified on admission that the patient was a Veteran, and the Medical Social Worker (MSW) did not complete an assessment of the patient's veteran status and possible veteran benefits or burial arrangement needs for one of 11 patient records reviewed. (Patient 7) --- On 5/24/23 at 9:54 AM, review of Patient 7's record revealed Patient 7 was admitted on 2/24/23 with a diagnosis of kidney cancer. Review of the Nursing Visit Note Hospice Initial Assessment dated 2/24/23 revealed Patient 7 served in the military from 8/5/64 to 5/7/75 on active duty. Review of the Medical Social Worker (MSW) Visit Note Hospice Initial Assessment, dated 2/28/23, revealed, "...Veteran Status...Did patient...serve in the military?...Not assessed..." There was no documented evidence of assessment of veteran benefits or burial arrangements. The corresponding "Prep Notes Communication" by the MSW revealed no documented evidence the MSW assessed Patient 7's veteran status, possible veteran benefits, or burial arrangement needs. During an interview with the Director of Nurses (DON) on 5/25/23 at 12:00 PM, she/he confirmed the findings. Hospice's policy, titled, "Social Work Services for Hospice", revealed, "...The comprehensive assessment of the patient includes a psychosocial assessment conducted by the Social Worker to evaluate the patient/caregiver's emotional, social, financial, and environmental resources and identify appropriate psychosocial problems, interventions and goals for the patient's plan of care...". On 5/24/23 at 11:04 AM, review of Patient 8's record revealed Patient 8 was admitted on 10/19/21 with a diagnosis of heart failure. The patient's record revealed the patient's diagnosis was changed on 4/11/23 to chronic obstructive pulmonary disease. The narrative notes dated 5/1/23 revealed, "...Patient...has complaints of nausea...". The "Prep Notes Communication" dated 5/10/23 revealed, "...Patient...reports that she vomited all night long...". The "Prep Notes Communication" dated 5/17/23 revealed, "...Patient reports she is a little nauseous...". Review of all of the nursing assessment visit notes from 5/1/23 to 5/17/23 (5/1/23, 5/8/23, 5/10/23, 5/15/23 and 5/17/23) revealed the nurse did not complete a gastrointestinal/abdominal assessment for the patient on any of these visits. On 5/25/23 at 11:43 AM, the Director of Nurses (DON) during a concurrent review of Patient 8's record confirmed Patient 8 had ongoing complaints of nausea from 5/1/23 to 5/17/23 and the hospice nurse did not complete a gastrointestinal/abdominal physical assessment on any of her nursing visits during these same dates. The DON confirmed the nurse should have completed a gastrointestinal/abdominal physical assessment. On 5/25/23, a policy on nursing assessment was requested. The hospice was unable to provide a policy on nursing physical assessment.

Based on record reviews, interviews, and review of the hospice's policy and procedure, the hospice failed to ensure reconciliation of the patient's hospice medication profile with the assisted living facility's medication administration record (MAR) for 2 of 2 patients in a nursing care facility. (Patient 9 and 10) --- On 5/23/23, at 10:00 AM a visit was made to Patient 10 with the hospice aide (HA). After observing the HA visit to Patient 10, a review of Patient 10's hospice medication profile and the facility's MAR were conducted. The following discrepancies were identified: The hospice medication profile indicated, "...Acetaminophen 325 mg oral tablet; Take 1 tab(s) oral every 6 hours as needed.." The facility's MAR indicated, "ACETAMIN TAB 325 MG TAKE 2 TABLETS BY MOUTH EVERY 6 HOURS AS NEEDED...21-Dec-2022..."; The hospice medication profile indicated, "Promethazine Hydrochloride 25 mg oral tablet; Take 1 tab(s) oral 2 times a day..." The facility's MAR indicated, "PROMETHAZINE HCL 25 MG TABS TAKE 1 TABLET EVERY 6 HOURS AS NEEDED...4-Jan-2023..."; The facility's MAR indicated, "...ATORVASTATIN TAB 20 MG TAKE 1 TABLET BY MOUTH AT BEDTIME...25-Jan-2021..." Atorvastatin was not on the hospice medication profile; The facility's MAR indicated, "NYAMYC POW (nystatin powder) 100000...PLACE AS DIRECTED TWICE DAILY...3-Feb-2023..." NYAMYC/Nystatin powder was not on the hospice medication profile; The facility's MAR indicated, "...ARTIFICIAL...TEARS INSTILL 2 DROPS INTO RIGHT EYE ONCE DAILY...27-Mar-2023..."; Artificial tears was not on the hospice medication profile. During an interview with the Director of Nurses (DON) she/he confirmed the findings.

Based on record review and interview, the hospice failed to ensure the nurse completed a gastrointestinal/abdominal physical assessment after the patient complained of nausea and vomiting for one of 11 patient records reviewed (Patient 8). --- Findings: On 5/24/23, at 11:04 AM Patient 8's record was reviewed. The record indicated Patient 8 was admitted to hospice care on 10/19/21 with a diagnosis of heart failure. The record indicated the diagnosis was changed on 4/11/23 to chronic obstructive pulmonary disease. The narrative notes dated 5/1/23, indicated, "...Patient...has complaints of nausea..." The "Prep Notes Communication" dated 5/10/23 indicated, "...Patient...reports that she vomited all night long..." The "Prep Notes Communication" dated 5/17/23 indicated, "...Patient reports she is a little nauseous..." Further review of all of the nursing assessment visit notes from 5/1/23 to 5/17/23 (5/1/23, 5/8/23, 5/10/23, 5/15/23 and 5/17/23) revealed the nurse did not complete a gastrointestinal/abdominal assessment on any of these visits. On 5/25/23, at 11:43 AM the Director of Nurses (DON) was interviewed. During a concurrent review of Patient 8's record, the DON confirmed Patient 8 had ongoing complaints of nausea from 5/1/23 to 5/17/23 and the hospice nurse did not complete a gastrointestinal/abdominal physical assessment on any of her nursing visits during these same dates. The DON confirmed the nurse should have completed a gastrointestinal/abdominal physical assessment. On 5/25/23, a policy on nursing physical assessment was requested. The hospice was unable to provide a policy on nursing physical assessment.

Based on interview, record review and review of facility policy and procedure, the hospice failed to ensure the plan of care (POC) was specific to the patients needs for 6 of 11 patient charts reviewed. (Patient 5, 6, 9, 11, 12 and 13). --- On 5/23/23, at 1:00 PM Patient 6's record was reviewed. Patient 6 was admitted to hospice care on 9/13/22 with a diagnosis of Parkinsons. Review of the Hospice Initial Assessment Skilled Nursing Visit Note dated 9/13/22 indicated, "...Braden Scale (Pressure Ulcer Risk Assessment)...Total Score...14" (13-14 = moderate risk). Review of the Hospice Plan of Care for the benefit period 9/13/22 to 11/11/22 revealed there was no documented evidence the hospice interdisciplinary group (IDG) considered the assessment findings of moderate risk for skin breakdown in the development of the plan of care. Review of the nursing narrative note dated 10/10/20 indicated...New Stage 3 pressure wound assessed to sacrum area, 6 cm by 4 cm..." Review of the nursing narrative note dated 10/25/22 indicated, "...Dressing to sacrum changed. Would (sic) remain 7 cm x 4 cm. Covered with allevyn and dressing...Skin to stage three wound..." Review of the Hospice Plan of Care for the benefit period 11/12/22 to 1/10/23 revealed there was no documented evidence the IDG considered the new assessment findings in the development of the comprehensive plan of care. On 5/25/23 at 11:49 AM an interview was conducted with the Director of Nurses (DON). During concurrent record review of Patient 6's record, The DON confirmed there was no documented evidence the IDG considered initial and updated assessment findings in the development of the comprehensive plans of care dated 9/13/22 to 11/11/22 and 11/12/22 to 1/10/23. She/he stated, "It's not on here." The findings include: Record review on 05/23/23 at 3:50 PM of P 5 revealed P 5 was admitted to the hospice for Multiple Sclerosis. Review of P 5s certification period 03/31/23 to 05/29/23 POC revealed no documentation of P 5s stage 2 decubitus to the buttocks, 2-4 liter oxygen usage, edema related to Congestive heart failure, order for foley catheter changes, medication dose increases for Bumex and bowel elimination related to manual dis-impactions by the SN during patient visits. During an interview on 05/25/23 at 1:25 PM, the Director of Nursing verified the findings. Record review on 05/23/23 at 10:35 AM of P 9 revealed P 9 was admitted to the hospice on 03/06/23 for chronic myeloid leukemia. Review of P 9s certification period 03/06/23 to 05/04/23 POC revealed no documentation of the patients deep tissue injury (DTI) to the right foot and/or the order for skin protectant or skin prep spray treatment for the DTI. During an interview on 05/25/23 at 1:30 PM, the DON verified the findings. Record review on 05/23/23 at 2:00 PM of P 11 revealed P 11 was admitted to the hospice on 01/05/21 for congestive heart failure. Review of P 11s certification period 02/24/23 to 04/24/23 POC revealed no documentation of the patients needs related to inability to provide adequate hygiene care. During an interview on 05/25/23 at 1:45 PM, the DON verified the findings. Record review on 05/22/23 at 1:45 PM of P 12 revealed P 12 was admitted to the hospice on 03/20/23 for cirrhosis of the liver. Review of P 12s certification period 03/20/23 to 05/18/23 POC revealed no documentation of the patients incontinence needs and/or oxygen noted on the plan of care/medication administration (MAR). During an interview on 05/25/23 at 2:05 PM, the DON verified the findings. Facility policy, entitled ";Plan of Care for Hospice" revealed, ";6. Revisions to the plan of care are based on information from the patients updated comprehensive assessment and the patients progress toward outcomes specified in the plan. 7. Reviews of and changes to the plan of care are documented and communicated to members of the IDG...Plan of Care Content 1. The patients plan of care includes all services necessary for the palliation and management of the terminal illness and its related conditions...".

Based on record review and interview, the hospice failed to ensure the Skilled Nurses (SN), Master of Social Worker (MSW), Volunteer and Chaplain completed home visits per the ordered frequency on the patient's plan of care for 4 of 11 patient charts reviewed. (Patient 9, 11, and 14) --- The findings include: Record review on 05/23/23 at 10:35 AM of P 9 revealed P 9 was admitted to the hospice on 03/06/23 for chronic myeloid leukemia. Review of certification period 03/06/23 to 05/04/23, volunteer visit frequency was 2 times a month. Review of patient 9s visits revealed 1 missed volunteer visit for the month of 04/23. During an interview on 05/25/23 at 1:30 PM, the DON verified the findings. Record review on 05/23/23 at 2:00 PM of P 11 revealed P 11 was admitted to the hospice on 01/05/21 for congestive heart failure. Review of certification period 02/24/23 to 04/24/23, SN visit frequency was 2 times a week for 8 weeks, chaplain visit frequency was 1 time a month for 2 months, and MSW visit frequency was 1 time a month for 2 months. Review of P 11s visits revealed 1 missed SN visit the week of 03/05/23, 1 missed Chaplain visit the month of 03/23 and 1 missed MSW visit the month of 03/23. During an interview on 05/25/23 at 1:45 PM, the DON verified the findings. Record review on 05/22/23 at 2:20 PM of P 14 revealed P 14 was admitted to the hospice on 01/06/23 for Alzheimer. Review of certification period 01/06/23 to 04/05/23, volunteer visit frequency was 1 time a month for 85 days. Review of P 14s visits revealed 1 missed visit the month of 02/23. During an interview on 05/25/23 at 2:13 PM, the DON verified the findings.

Based on record review and interview, the hospice failed to ensure information was shared with the Assisted Living Facility (ALF) for 2 of 3 patient visits observed (Patients 9 and 10). --- On 5/23/23, at 10:00 AM a visit was made to Patient 10 with the hospice aide (HA). Patient 10 lived in an ALF. After observing the patient visit, Patient 10's hospice chart in the ALF was reviewed for hospice documents. There were no hospice consents, hospice plan of care, hospice certification of terminal illness or hospice medication profile. During a concurrent interview with the facility staff nurse, she/he confirmed the findings and stated there was no other place in the facility these documents would be. The findings include: Observation on 05/23/23 at 12:13 PM to 1:19 PM of P 9s (facility) electronic medical record revealed no current medication profile and/or hospice or attending physician orders. During an interview on 05/25/23 at 1:30 PM, the Director of Nursing verified the findings.

Based on record review, interview, and review of hospice policy and procedure, the hospice failed to ensure the Quality Assessment and Performance Improvement (QAPI) program analyzed causes and implemented preventative actions for tracked adverse events. --- The findings include: Review of the QAPI program on 05/25/23 at 1:00 PM revealed the QAPI program contained adverse events with no documentation of analysis and/or implementation of preventative actions for the adverse events. During an interview on 05/25/23 at 2:00 PM, the Administrator verified the findings.

Based on record review, interview, and review of the hospice's policy, the hospice failed to ensure bereavement services were provided for one of two patients reviewed. (Patient 2) --- On 5/22/23 at 2:15 PM, review of Patient 2's record revealed Patient 2 was admitted on 11/16/22 and died on 11/16/22. Review of the patient's record including the bereavement notes revealed the first and only bereavement note was dated 4/14/23. There was no documentation after the patients death on 11/16/22 indicating any bereavement contact or any reason for no bereavement services from 11/16/22 to 4/14/23. There was also no bereavement plan of care. On 5/25/23 at 11:40 AM, the Director of Nurses (DON) confirmed the findings. Hospice's policy, titled, "Bereavement Care Planning for Hospice", revealed "...The Bereavement Coordinator...initiates the bereavement discussion and care planning at the first IDG meeting following the patient's death...Within 72 hours of the death the local chaplain or designee will make the initial condolence call...A sympathy card will also be mailed...".

Based on observation, interview, and record review, the hospice failed to ensure the hospice aide (HA) plan of care/assignments were specific to the patients for 1 of 3 patient visits observed (Patients 10) and for 2 of 11 patient charts reviewed. (Patient 5 and 11) --- Findings: On 5/23/23, at 10:00 AM a visit was conducted to Patient 10 with the hospice aide (HA). The HA was observed assisting Patient 10 take a shower. Patient 10 did not use a shower chair. The HA was also observed to wash the patient's hair and put clean sheets on the bed. The Interdisciplinary Care Plan HA assignment was reviewed concurrently. The HA assignment indicated, "...Hygiene...Bath - Shower Chair..." The HA assignment did not indicate for Patient 10 to take a shower or to take a shower without a shower chair. The HA assignment also indicated, "...Make patient bed...Hygiene...Shampoo..." There were no frequencies for how often the HA was supposed to make Patient 10's bed, bathe her/him or change the bed sheets. After the HA completed Patient 10's visit, an interview was conducted. The HA confirmed she did not know by the HA assignment how often she was supposed to bathe Patient 10, wash her/his hair or change the bed sheets. The HA stated she visited Patient 10 twice a week. The HA stated she would do these tasks twice a week even if she saw Patient 10 five days week because she thought that's how often Patient 10 needed these services. On 5/25/23, at 9:30 AM, an interview was conducted with the Director of Nurses (DON). During a concurrent review of Patient 10's record, the DON confirmed Patient 10's HA assignment was not specific to Patient 10 and should have contained specific frequencies for the completion of tasks. On 5/25/23, the hospice's policy titled, "Hospice Aide Assignments and Duties," was reviewed. The policy indicated, "...The hospice RN responsible for supervising the hospice aide prepares patient care instructions that are patient-specific and not generic..." Record review on 05/23/23 at 3:50 PM of P 5 revealed P 5 was admitted to the hospice on 09/02/22 for Multiple Sclerosis. Review of certification period 03/31/23 to 05/29/23, the aide plan of care was not specific to the type of bath the aide was to perform for P 5. During an interview on 05/25/23 at 1:25 PM, the DON verified the findings. Record review on 05/23/23 at 2:00 PM of P 11 revealed P 11 was admitted to the hospice on 01/05/21 for congestive heart failure. Review of certification period 02/24/23 to 04/24/23, the aide plan of care was not specific to the type of bath the aide was to perform for P 11. During an interview on 05/25/23 at 1:45 PM, the DON verified the findings.

Based on observation, interview, and review of the hospice policy, the hospice failed to ensure expired supplies were removed from the patient supply room and were not available for patient use. --- On 5/22/23 at 10:30 AM, observations of the hospice's patient supply room revealed four Ready Prep Povidone Iodine 4 oz (ounce) bottles expired 03/23 and one opened box of Secure Safe Syringes with safety needle containing 76 syringes expired 5/13/23. During interview with the Administrator on 5/22/23 at 10:45 AM, she/he confirmed the findings. Hospice policy, titled, "Medical Supplies for Hospice," revealed, "...Outdated medical supplies are discarded..."

Based on record review and interview, the hospice failed to ensure physician orders were included in the patient's record for one of 11 patient charts reviewed. (Patient 6) --- The findings are: On 5/23/23 at 1:00 PM, review of Patient 6's record revealed Patient 6 was admitted on 9/13/22 with a diagnosis of Parkinson. Review of the nursing narrative note dated 10/10/22 at 6:35 PM revealed Patient 6 had a new Stage III wound to the sacrum. Review of the Skilled Nursing Visit Note dated 10/10/22 revealed "...Wound Cleansing/Dressing Change...Gauze...Wound Care Frequency...Daily...". Review of the Skilled Nursing Visit Note dated 10/25/22 revealed "...Wound Cleansing/Dressing Change...Cleansed with...Wound cleanser...Covered with...Allevyn...Wound Care Frequency...Daily...". Review of the physician orders for Patient 6 revealed there were no physician orders for the wound care provided by the nurse on 10/10/22 or 10/25/22. On 5/25/23 at 11:49 AM, the Director of Nurses (DON) during concurrent review of Patient 6's record confirmed there were no physician orders for Patient 6's new Stage III sacral wound for the wound care performed by the nurse on 10/10/22 and 10/25/22.