Every finding on record at Wesley Healthcare LLC

It is required that counseling services include spiritual counseling. The hospice provides an assessment of the patient’s and family’s spiritual needs. The hospice also makes all reasonable efforts to facilitate visits by local clergy, pastoral counselors, or others who can support the patient’s spiritual needs. This standard was not met as evidenced by clinical record review and interview. In 2 of 6 (33%) clinical records reviewed, it was revealed that on-going spiritual counseling was not provided as requested by the patient. Clinical Record 47990 : Evidence of on-going spiritual counseling was not provided as identified in the Chaplain initial assessment dated 10/25/2021, which states "Patient was grateful for the visit and looks forward to the next visit". POC dated 10/25/2021 and 11/24/2021 stated "Chaplain Declined". No documentation of patient refusal of Chaplain visits. Clinical Record 93682 : Evidence of on-going spiritual counseling was not provided as identified in Chaplain initial assessment dated 12/24/2021, which documents continuing care needed, answered yes. POC dated 12/24/2021 stated "Chaplain Declined". No documentation of patient refusal of Chaplain visits. These findings were reviewed and confirmed during joint clinical record review with agency administrator.

It is required that the hospice medical director, physician employees, and contracted physician(s), in conjunction with the patient’s attending physician, are responsible for the palliation and management of the terminal illness as well as conditions related to the terminal illness. If the attending physician is unavailable, the medical director, contracted physician, and/or hospice physician employee is responsible for meeting the medical needs of the patient. This standard was not met as evidenced by document review and interview. The documents reviewed revealed that an alternate medical doctor was not available to meet the medical needs of patients if the medical director was not available. During an interview, this was verified by the alternate administrator and the hospice medical director.