Every finding on record at Viva Hospice Care

It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, the agency did not ensure the plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 6: The initial nursing assessment dated 11/28/2023 included documentation that the patient was receiving "Continuous tube feeding - Jevity 1.2 60/ml/hr. - 24 hr. a day/7 day a week" per a percutaneous endoscopic gastrostomy (PEG) tube. The plan of care dated 11/28/2023 included a goal for "Nutrition" but did not include intervention(s) for PEG tube management and tube feeding specifics. Clinical Record 7: The initial nursing assessment dated 11/20/2023 included documentation that the patient was receiving "A breathing treatment of Albuterol 2.5mg/3ml bottle via nebulizer every 4 hrs. as needed." The plan of care dated 11/20/2023 included a goal for "Respiratory: SOB [shortness of breath]" but did not include intervention(s) related to nebulizer treatment(s). Clinical Record 8: The plan of care dated 01/16/2024 included an order for Medical Social Worker (MSW) frequency as once a month for three months and two as needed visits for social crisis. The MSW documented visits were completed on 01/22/2024, 02/27/2024, and 03/15/2024. The plan of care dated 01/16/2024 did not include goals and interventions for the MSW. Clinical Record 12: The plan of care dated 06/28/2024 included an order for Chaplain frequency as once a month for 3 months. The Chaplain documented visits were completed on 07/11/2024 and 08/27/2024. The plan of care dated 06/28/2024 did not include goals and interventions for the Chaplain. The Chief Executive Officer/Volunteer Coordinator and the Registered Nurse Supervisor stated in an interview while performing joint clinical record reviews on 09/05/2024 that the agency did not ensure the plan of care reflected interventions based on problems identified in the initial and updated comprehensive assessments.

It is required that hospice aides are assigned to a specific patient by a Registered Nurse (RN) who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 13 (8%) clinical records reviewed for patients with hospice aide services provided, the agency did not ensure the Registered Nurse (RN) provided the aide with patient-specific written care instructions. Clinical Record 6: The initial nursing assessment dated 11/28/2023 included documentation that the patient was receiving a continuous tube feeding per a percutaneous endoscopic gastrostomy (PEG) tube. The plan of care dated 11/28/2023 included an order for "Continuous tube feeding - Jevity 1.2 60/ml/hr. - 24 hr. a day/7 day a week." Review of the aide care plan assignment dated 12/22/2023 revealed the aide was assigned a bed bath for the patient. The aide care plan did not include specific care instructions for providing a bed bath to a patient with a PEG tube and continuous tube feedings. The Chief Executive Officer/Volunteer Coordinator and Registered Nurse Supervisor stated in an interview while performing clinical record reviews on 09/05/2024 that the agency did not ensure the RN provided the aide with patient-specific written care instructions regarding the PEG tube.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The agency did not ensure volunteers provided care and services that equaled, at a minimum, five percent of the total patient care hours of all paid hospice employees and contract staff. Review of the agency’s 2024 Volunteer Hours Compared to Direct Patient Care Employee Hours Report revealed the volunteer percentage of hours worked for January 2024 through August 2024 was 1.14%. The Chief Executive Officer/Volunteer Coordinator stated in an interview on 09/06/2024 that the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent of the total patient care hours of all paid hospice employees and contract staff. The review of the "Volunteer Hours Compared to Direct Patient Care Employee Hours Report revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IID representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 3 (100%) clinical records reviewed in which the patient resided in a SNF [skilled nursing facility]/NF [nursing facility], the agency did not ensure the hospice plan of care identified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 3: The patient elected the hospice benefit 07/17/2024 and resided in a skilled nursing facility (SNF). The plan of care did not include documentation of which provider was responsible for performing the functions that were agreed upon and listed on the plan of care. Clinical Record 5: The patient elected the hospice benefit 05/31/2024 and resided in a SNF. The plan of care did not include documentation of which provider was responsible for performing the functions that were agreed upon and listed on the plan of care. Clinical Record 11: The patient elected the hospice benefit 08/26/2024 and resided in a SNF. The plan of care did not include documentation of which provider was responsible for performing the functions that were agreed upon and listed on the plan of care. The Chief Executive Officer/Volunteer Coordinator and Registered Nurse Supervisor stated in an interview on 09/05/2024 that the agency did not ensure the hospice plan of care identified which provider was responsible for performing the functions that were agreed upon and included in the plans of care for patients that resided in a skilled nursing facility.