Every finding on record at Willow Ridge Hospice, LLC

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. This standard was not met as evidenced by clinical record review and interview. In 7 of 7 (100%) clinical records reviewed it was revealed that the agency did not ensure that the hospice patients' Plans of Care included a detailed statement specifying and individualizing what specific patient or family needs that the Interdisciplinary Team's PRN visit orders were to be used to address. Additionally, there were PRN Hospice Aide visit orders in five of the seven Plans of Care. Clinical Record 1: The patient elected the hospice benefit on 5/12/2023. The Plan of Care for the dates 8/10/2023 - 11/7/2023 included discipline visit orders for Nursing three times a week, monthly Social Work and Spiritual Counseling visits, and Hospice Aide visits four times a week. Also included were ten PRN Nursing visits, five each PRN visits for Social Work, Spiritual Counseling, and Hospice Aide. The only reason documented for the PRN visits was "if needed." Clinical Record 2: The patient elected the hospice benefit on 8/2/2023. The Initial Plan of Care for the dates 8/2/23 - 10/30/23 included visit orders for Nursing twice weekly, once monthly Social Work and Spiritual Counseling visits, and Hospice Aide visits three times a week. Additionally, there were ten PRN Nursing visits, five each PRN visits for the Social Worker, Spiritual Counselor, and Hospice Aide. The only reason documented for the order for PRN visits was "if needed." All orders were reviewed for 8/2/2023 to 8/16/2023. Clinical Record 3: The patient elected the hospice benefit on 6/24/2023. The Initial Plan of Care for the dates 6/24/23 - 9/21/23 included twice weekly Nursing visits, monthly Spiritual Counseling visits, and Hospice Aide visits three times a week. Also included were 10 PRN Nursing visits, eight PRN Hospice Aide visits, and five PRN Social Work visits. The PRN Nursing visits were documented for "if patient needs," but there were no qualifying statements for the PRN visits for the Social Worker, Spiritual Counselor, or Hospice Aide. A Physician Order dated 6/28/2023 included monthly Social Work visits. All orders were reviewed from 6/24/2023 to 8/16/2023. Clinical Record 4: The patient elected the hospice benefit on 8/11/2023. The Initial Plan of Care for the dates 8/11/2023 - 9/19/2023 included nursing visits three times a week, twice weekly Hospice Aide visits, twice monthly Social Work visits, and five times a week Spiritual Counseling visits. Also included were ten PRN nursing visits, five PRN Social Work visits, five PRN Spiritual Counseling visits, and five PRN Hospice Aide visits, all "as needed." Clinical Record 5: The patient elected the hospice benefit on 5/26/2023. The Initial Plan of Care for the dates 5/26/2023 - 8/23/2023 included Interdisciplinary Team visit orders for twice-a-week nursing visits. A Physician Order dated 5/30/2023 included twice weekly Hospice Aide visits, monthly Social Worker visits, and one Spiritual Care visit. Additionally, the order included four PRN Spiritual Care visits with the qualifying statement, "Pt denied Spiritual Counseling. PRN visits if patient requests." Additionally, there was six PRN Social Worker visits "if pt needs or requests." A Physician Order dated 6/1/2023 included twelve PRN nursing visits "as needed." All orders were reviewed from 5/26/2023 to the patient's death on 7/26/2023. Clinical Record 6: The patient elected the hospice benefit on 5/26/2023. The Initial Plan of Care for the dates 5/26/2023 - 8/23/2023 included Interdisciplinary Team visit orders for weekly visits from the nurse. A Physician Order dated 5/30/2023 included weekly Hospice Aide visits, monthly Social Worker, and Spiritual Care visits. Additionally, the order included twelve PRN nursing visits, six PRN Social Work visits, six PRN Spiritual Care visits, The only reason listed for the PRN visit orders was "as needed." All orders were reviewed from 5/26/2023 to the patient's death on 6/18/2023. Clinical Record 7: The patient elected the hospice benefit on 6/21/2023. The Initial Plan of Care for the dates 6/21/2023 - 9/18/2023 included Interdisciplinary Team visit orders for once-monthly visits for the Social Worker and the Spiritual Counselor and Hospice Aide visits five times a week and weekly nursing visits. The Plan of Care included five PRN visits each for the Social Worker, Spiritual Counselor, and Hospice Aide for dates 6/21/2023 - 9/18/2023. No qualifying statements were included in the PRN visit orders as to what the PRN visit orders would be utilized for, and no indication on the PRN Hospice Aide orders as to who would be making the assessment for a PRN Hospice Aide visit. All orders were reviewed for the dates 6/21/2023 to the patient's death on 7/2/2023. Personnel Record 2: During interviews with the Alternate Administrator/Alternate Clinical Director and the Administrator/Clinical Director on 8/16/2023 and 8/17/2023, both agreed that the PRN orders should have qualifying statements for what the PRN visits would be used for and that PRN Hospice Aide orders could only be used when it was directed and documented by the RN.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed it was revealed that the agency did not ensure that the copy of the hospice election statement and notice of patient rights were appropriately signed and dated with the date that the Power of Attorney signed the document. Clinical Record 2: The patient elected the hospice benefit on 8/2/2023 with the terminal diagnosis of Alzheimer's disease. The patient's son and Power of Attorney (POA) signed the Consent for Election of Medicare/Medicaid Hospice Benefit form and the Admission Consent form. The start of care date was entered as 8/2/2023. The son's signature on both forms was not dated. There was also no signature of the hospice's representatives or date written by the hospice employee. There was no reason on the form why the patient was not signing the Consent and Election form for herself. The only date on the forms was the effective start of care date for hospice services to begin. Personnel Record 2: During an interview on 8/16/2023 with the Alternate Administrator/Alternate Clinical Director, she confirmed that the Consent and Election of the Hospice Benefit forms did not include the date the forms had been signed.