Every finding on record at Western Health Resources

It is required that the comprehensive assessment includes the patient’s or family’s need for referrals and further evaluation by appropriate health professionals. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the organization did not ensure that a referral was initiated for further evaluation by speech therapy. Clinical Record 7: The patient elected hospice care on 05/18/2024 in the 12th benefit period with the diagnoses: Parkinson’s Disease, dementia with anxiety, hypertension, bed confinement, and wounds to the lower extremities. The Registered Nurse (RN) initial comprehensive assessment dated 05/18/2024 documented, “Communication Intervention provided: ‘Initiate referral to speech therapy to develop alternate means of communication for the non-verbal patient.” During a joint clinical record review on 09/19/2024, the Administrator confirmed that there was no documentation in the patient record to indicate that a speech therapy referral was physician-ordered or refused by the patient’s family. The Administrator stated, “I’m sure this was marked in error. In an interview, the Clinical Manager [Personnel Record 2], who completed the initial assessment, was asked to clarify the documentation. On 09/20/2024, before the exit conference, the Administrator stated that the Clinical Manager documented a clarification note on 09/19/2024 stating that the 05/18/2024 initial assessment’s documented need for a speech therapy referral was marked in error.

It is required that hospice aides are assigned to a specific patient by a registered nurse 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, interview, and observation. In 1 of 12 (8%) clinical records reviewed in which Hospice Aide (HA) services were provided, the Hospice Aide did not receive written patient care instructions to meet the patient's specific needs. Clinical Record 12/Home Visit 1: The patient elected hospice care on 06/28/2023 with the diagnoses of dysphagia, aphasia, Alzheimer's Disease, dementia, anxiety, chronic obstructive pulmonary disease (COPD), and epilepsy. The patient resided in a skilled nursing facility. During the home visit with the Registered Nurse (RN) [Personnel Record 7] on 09/19/2024, the RN stated that the patient was on seizure and aspiration precautions. The patient had right and left contractures of the hands and needed a brace applied to her right hand and a rolled towel placed in her left hand. Her heels were to be floated on pillows. The HA care plan, effective 06/28/2023 and not updated, did not provide the HA with written instructions regarding the patient's seizure and aspiration precautions and applying the right-hand brace. During the daily wrap-up conference on 09/19/2024, the Administrator stated that the aide care plan had been updated on 09/19/2024 to include the tasks. During a joint clinical record review on 09/19/2024, the Administrator confirmed that the recertification plan of care dated 08/21/2024 included seizure and aspiration precautions, skin monitoring, and using a right-hand brace.

It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 12 (8%) clinical records reviewed in which Hospice Aide services were provided, the agency did not ensure that the Hospice Aide (HA) provided services included in the care plan. Clinical Record 13/Home Visit 2: The patient elected hospice care on 9/20/2023 with the diagnoses: atherosclerotic heart disease, a neurocognitive disorder with Lewy bodies, dementia, delirium, legal blindness, and a history of falls. During the home visit with the Hospice Aide (HA) [Personnel Record 6] on 09/19/2024, the HA stated that they washed the patient's hair "once a week or on special occasions, but not every visit. I won't wash her hair today." The HA care plan, effective 03/19/2024, assigned the HA the relevant task of shampooing the patient's hair every visit. During a joint clinical record review and interview on 09/19/2024, the Administrator, present at the visit, confirmed the finding.

It is required that 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, interview, and observation. In 1 of 1 (100%) home visit observations of a patient residing in a skilled nursing facility (SNF), the organization did not ensure that the hospice plan of care specified which provider was responsible for performing functions agreed upon and included in the integrated plan of care. Home Visit 1/Clinical Record 12: The patient elected hospice care on 06/28/2024 and resided in a skilled nursing facility (SNF). During the home visit with the Registered Nurse (RN) [Personnel Record 7] on 09/19/2024, a review of the SNF record revealed no copy of an integrated plan of care that specified duties to be performed by the SNF and duties to be performed by hospice personnel. The Administrator, present at the visit, reviewed the SNF and confirmed that the patient's clinical record did not include evidence of a plan of care that specified care and services to be performed by each provider. The Administrator stated that the organization used a paper document titled Hospice SNF/Coordination of Care for each SNF resident that was to be completed for each resident of an SNF at the start of care, placed in the facility chart, uploaded into the hospice electronic medical record, and updated in both the facility record and hospice record as needed.

It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: the hospice election form. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 1 (100%) home visit observations of a patient residing in a skilled nursing facility (SNF), the organization did not ensure that the designated IDG member provided the SNF with a copy of the patient's hospice election form. Home Visit 1/Clinical Record 12: The patient elected hospice care on 06/28/2023 and resided in a skilled nursing facility (SNF). During the home visit on 09/19/2024 with the Registered Nurse (RN) [Personnel Record 7], a review of the patient's SNF record revealed no evidence of a copy of the patient's/resident's hospice election form. During a joint record review, the Administrator, who was present for the visit, confirmed that there was no hospice election form in the patient's SNF clinical record. Following the home visit, the Administrator stated that the hospice election form was being delivered to the SNF on 09/19/2024.