Every finding on record at Uvalde County Hospital Authority

Observed in Tracer Visit. In 1 of 4 home visits conducted, The surveyor observed that the medication profile of hospice had not matched the nursing home medication profile. For example Ativan and Aspirin had been listed on hospice profile, but not on nursing home profile and Lumigan drops, and microbid had been on nursing home profile , but had not been included on hospice profile. This issue was observed and confirmed with hospice RN on visit and hospice leadership.

Observed in Record Review. In 2 of 3 patient records reviewed, of patients that had been discharged/Revoked to another Medicare/Medicaid-certified facility, the surveyor observed that the organization had not provided the receiving facility with a copy of the hospice discharge summary. The issue was discussed and confirmed with organization leadership.

Observed in Record Review. The surveyor also observed at the nursing facility that the hospice had left an incomplete copy of the patients signed certification(CTI). The surveyor observed that the CTI had not been completed fully to include the narrative required. The narrative had been part of the hospice record, but had not been added to the nursing facility copy. This issue was discussed and confirmed with both RN on visit and hospice leadership.

Observed in Patient Home. In 2 of 3 home visits conducted, there was no evidence that the organization had informed the patient of their rights both orally and in writing. In review of the home folder for HOS 1 there was no evidence that the patient/family had been informed of their financial responsibility. The surveyor noted that the Admission Consent and Consent for Election of Medicare Hospice Benefit forms were blank and the patient/family had not received the completed forms. Also, for HOS 3 there was no home folder in the patient's home or evidence that the patient/family had been informed of their rights both orally and in writing. This was discussed and validated with the Hospice Director. Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not provided information in a format that the patient/caregiver could understand. For HOS 3 both the patient and the wife who manages the patient's medications read and speak Spanish, however the medication list from the Hospice program was in English. This was discussed and validated with the Hospice Director.

Observed in Leadership Session. the organization had not documented the quality assessment and performance improvement (QAPI) plan for the hospice program. The organization's Performance Improvement Plan 9846346 was a hospital specific plan and did not include hospice. The plan stated that it applied to all polices, procedures and processes in the hospital. Additionally, the identified sources of data collection included the laboratory system, radiology system, operating room log, etc. and failed to include data sources specific to the hospice program demonstrating the complexity of its services such as volunteer services, bereavement program and contracted services. This was discussed and validated with the Hospice Director.

Observed in Record Review. In 3 of 3 patient records reviewed, Bereavement care plans did not include specific, individualized interventions, and the timing and frequency were exactly the same for all levels of bereavement risk. For example, for BR 1 who had been assessed with a moderate bereavement risk, and BR 2 who had been assessed with a high bereavement risk and for BR 3 who had been assessed with a low bereavement risk the bereavement plan of care was the same for each survivor, which was to provide phone calls and mailings 1x every 3 months x 10 months.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not have an updated and accurate medication list. For HOS 1, the surveyor noted that the medication profile was not accurate when it included a erythromycin topical gel which had been completed but was still on the medication profile and failed to include a clindamycin topical ointment and milk thistle tablets that the wife was giving to the patient regularly. This was validated by the visiting RN and discussed with the Hospice Director.