Every finding on record at Unity Family Healthcare

Observed in Patient Home. In 1 of 2 Hospice Home Visits conducted with skilled nurses, the hospice did not conduct and document a patient-specific comprehensive reassessment in accordance with organizational policy #83.00, Comprehensive and Ongoing Assessment - page 2 Assessment to include, but not limited to . . . Head to toe assessment, Body System assessment . . .. Observed in HOSRRHV#1, the Registered Nurse did not complete a thorough skin assessment on a chair bound patient, assessing only her bilateral feet. This was reviewed and validated with the Director of Home Care and Hospice.

Observed in Record Review. In 1 of 9 active patient records reviewed, the organization did not conduct and document a comprehensive assessment that included Survivor risk factors. Identified in the review for HOSRRNHV#1, there was no initial Bereavement Risk Assessment documented in the patient's record. This was reviewed and validated with the Director of Home Health and Hospice. Observed in Record Review. In 2 of 2 Bereavement Records reviewed, the organization did not conduct and document a Bereavement Risk Assessment (BRA) post patient death in accordance with organizational policy Bereavement Services-Hospice Procedure 4. Following the hospice client death, utilizing a standardized tool, the bereavement coordinator or designee will complete a bereavement risk assessment with the bereaved. Identified in the review of HOSRRBR#1 and in discussion with the Bereavement Coordinator, the BRA was not completed with the bereaved, but, was created by reviewing the initial BRA and the Registered Nurse notes from the death event visit documentation. In review of HOSRRBR#2, there was no BRA completed post death. This was reviewed and validated with the Regional Director of Home Care and Hospice.

Observed in Record Review. In 9 of 9 active hospice patient records reviewed, the organization did not ensure that the written plan of care was based on the patient's goals and time frames required to meet those goals. Identified in the record review of all active hospice records reviewed: HOSHV#1, HOSHV#2, HOSHV#3, HOSNHV#1, HOSNHV#2, HOSNHV#3, HOSNHV#4, HOSNHV#5, and HOSNHV#6, the individual plans of care did not specify the timeframes required to meet the patients' goals. In 5 of 5 active hospice patient records reviewed where Music Therapy was included in the plan of care, there were no goals identified. Reviewed in HOSRRHV1, HOSRRHV2, HOSRRHV3, HOSRRNHV1, and HOSRRNHV2, there were no goals for Music Therapy included in the plans of care. In 7 of 7 active hospice patient records reviewed where Massage Therapy was included in the plan of care, there were no goals identified. Reviewed in HOSRRHV#1, HOSRRNHV#2, HOSRRNHV#1, HOSRRNHV#2, HOSRRNHV#4, HOSRRNHV#5, and HOSRRNHV#6 there were no goals for Massage Therapy included in the plans of care. This was reviewed and validated with the Director of Home Health and Hospice.

Observed in Tracer Activities. The organization did not provide education and training to their hospice patients/families/caregivers that included basic health practices and safety. Identified during the review of the organization's Hospice Start of Care packet, there was no education or training included on Respiratory Hygiene. This was reviewed and validated with the Regional Director of Home Care and Hospice.

Observed in Record Review. In 1 of 2 bereavement records reviewed, the organization did not make bereavement services available for one year following the death of a patient. Identified in the review of BR#2 there was no bereavement care plan and no documentation of bereavement services offered or provided. This was reviewed with the Regional Director of Home Health and Hospice.

Observed in Tracer Activities. Identified during the Contract Review session, the organization did not ensure that a physician was designated by the hospice to assume the same responsibilities as the medical director when the medical director was not available. This was reviewed with the Director of Home Health and Hospice

Observed in Record Review. In 2 of 2 Live Discharge Charts reviewed there was no evidence that a written discharge summary was created and/or offered to the patients' physicians or other licensed practitioners after discharge from the organization in accordance with organizational policy 86.07, Transfer and Discharge - Hospice. Identified in the record review for HOSLiveDC#1, and HOSLiveDC#2, there were no Discharge Summaries created and/or offered to the patients' physicians or other health care professional who were responsible for providing care and services to the patients after discharge from hospice services. This was validated with the Director of Home Health and Hospice.