Every finding on record at United Plus Hospice, Inc

It is required that the comprehensive assessment includes consideration of the following factors of symptoms and symptom severity, including dyspnea, nausea, vomiting, constipation, restlessness, anxiety, emotional distress, sleep disorders, skin integrity, and confusion. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed for patients with wounds revealed that the agency did not ensure that the comprehensive assessment included consideration of skin integrity. Clinical Record 8: The initial comprehensive assessment dated 06/12/2023 revealed in the narrative summary that the patient had bilateral pressure wounds to the heels. There were no documented measurements or treatment orders. The next documented nurse visit was on 06/22/23 and had no documented wound measurements or treatment orders for the bilateral pressure wounds to the heels or the additional left lateral leg wound. During a joint clinical record review on 03/08/2024, the Director of Nursing (DON) agreed there were no documented physician orders for wound treatment and no weekly documented measurements of the patient's wounds to the heels or the left lateral leg. The DON stated that the process for wound assessments is to weekly assess, measure, and document in the electronic medical record on the wound assessment tool.

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 document review and observation. In 2 of 3 (67%) medication profiles for active hospice patients reviewed revealed that the hospice agency did not ensure that the patient's drug profile contained the patient's current prescription and over-the-counter drugs. The hospice agency did not ensure the patient's drug profile was updated per the hospice policy and procedure. Agency Policy: HCL/17, revised 050110; stated in part that the agency will maintain a current, accurate list of all prescription and over-the-counter (OTC) medications taken by the patient. (Medication Profile). Home Visit 1/Clinical Record 1: During the home visit (Home Visit 1) with the hospice aide (Personnel Record 7) on 03/07/2024 to the assisted living facility (ALF) where the patient resided, a review of the facility medication profile listed morphine sulfate 100mg/5ml, give 1ml every hour as needed for pain, the order was dated 12/15/2023. The hospice agency's medication profile listed morphine 20mg/5ml, give 1ml every 2 hours as needed for pain, the order was dated 5/19/2023. Home Visit 2/Clinical Record 3: During the home visit (Home Visit 2) with the registered nurse (RN) (Personnel Record 4) on 03/07/2024 to the skilled nursing SNF) where the patient resided, a review of the facility's medication profile listed three medications that the hospice agency's medication file did not include. The first medication listed was Acetaminophen 325mg, given two tablets by mouth twice a day for pain. The order was dated 04/06/2023. The next medication listed was Senna 8.6mg, take one capsule by mouth twice a day for constipation. The order was dated 04/06/2023. The third medication listed was Acetaminophen 325mg, given two tablets every six hours as needed for pain or fever. The order was dated 04/06/2023.

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care; continuous assessment of each patient’s and family’s needs; and to ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed for patients with IDG meeting notes revealed that the agency did not ensure that the IDG comprehensive assessment included consideration of skin integrity. Clinical Record 8: The initial comprehensive assessment dated 06/12/2023 revealed in the narrative summary that the patient had bilateral pressure wounds to the heels. There were no documented measurements or treatment orders. The next documented nurse visit was on 06/22/23 and had no documented wound measurements or treatment orders for the bilateral pressure wounds to the heels or the additional left lateral leg wound. The IDG notes did not include any additional documentation about the patient's heel wounds. During a joint clinical record review on 03/08/2024, the Director of Nursing (DON) agreed there were no documented physician orders for wound treatment and no weekly documented measurements of the patient's wounds to the heels or the left lateral leg. The DON stated that the process for wound assessments is to weekly assess, measure, and document in the electronic medical record on the wound assessment tool.

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, document review and interview. In 1 of 2 (50%) clinical records reviewed for live discharged patients revealed that the hospice did not ensure that a copy of the hospice discharge summary was forwarded to the attending physician. Agency Policy: HCL/PE.1 CH, revised 110113, stated in part that if a patient revokes the hospice election, a copy of the hospice discharge summary is sent to the attending physician. Clinical Record 11: The patient chose to revoke their election of hospice benefit on 01/22/2024 to seek aggressive treatment. There was no documented evidence that the discharge summary was completed and forwarded to the attending physician. There was not a documented and signed revocation form in the clinical record. The Director of Nursing (DON) on 03/08/2024 agreed that a discharge summary had not been completed or forwarded to the patient's community attending upon discharge.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident the most recent hospice plan of care. This standard was not met as evidenced by interview and observation. In 1 of 1 (100%) skilled nursing facility visits observed where hospice patients resided revealed the agency did not ensure the IDG members provided the SNF/NF or ICF/IDF with the most recent hospice plan of care. Home Visit 2/Clinical Record 3: During a home visit (Home Visit 2) to the SNF with the registered nurse (Personnel Record 4), the Assistant Director of Nursing, observed hospice facility binder did not contain the hospice's most recent plan of care. The hospice plan of care in the binder was dated 05/16/2022. The Assistant Director of Nursing agreed on 03/07/2024 that the skilled nursing facility binder did not have a copy of the most recent hospice plan of care.