Every finding on record at Wings of Hope Hospice and Palliative Care, Inc.

It is required that the patient’s pain is assessed as part of a comprehensive assessment. The documented assessment of the patient’s pain includes the patient’s/family’s goals for pain management. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) records reviewed revealed the agency did not ensure that the comprehensive pain assessment included documentation of the patient/family goals for pain management. Clinical Record 6: Comprehensive pain assessment, completed on 7/28/23, with a documented pain score of 5 out of 10, pain level "moderate," and stated "yes" that pain was a current problem. The comprehensive pain assessment did not include patient or family goals for pain management. Care plan, effective 4/14/23 to current, listed this intervention: "patient will be pain free or verbalize an acceptable pain level with current pain management regimen," which did not include specific patient/family goals. Clinical Record 8: Comprehensive pain assessment, completed on 1/2/23, with a documented pain score of 3 out of 10, pain level "mild," and stated "yes" that pain was a current problem. The comprehensive pain assessment did not include patient or family goals for pain management. Care plan, effective 1/4/23 to current, listed this intervention: "patient will be pain free or verbalize an acceptable pain level with current pain management regimen," which did not include specific patient/family goals. Personnel Record 1: The medical director completed joint record reviews and confirmed during the interview, on 8/10/23, that the clinical record did not contain documented patient/family goals for pain management.

It is required that each patient’s individualized written plan of care 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, interview and observation. In 2 of 19 (11%) records reviewed revealed that the agency did not ensure the patient's care plans identified all problems identified in observation and comprehensive assessments. Clinical Record 2: Election of benefit 1/12/23 with a terminal diagnosis of senile degeneration of the brain. During the home visit observation, conducted on 8/9/23, the RN performed an assessment of the patient's skin which revealed bilateral heel protectors. The RN verbalized that the patient had healed a pressure ulcer on the heel, and they have been using the heel protectors to prevent further breakdown." Plan of care for current benefit period (7/11/23 to 9/8/23) listed the problem of impaired skin integrity and the following intervention: "assess skin integrity and overall condition of skin including s/s (signs/symptoms) of breakdown, friction, shearing or pressure areas," but did not indicate the utilization of heel protectors. Clinical Record 7: Initial comprehensive nursing assessment, 5/23/23, documented a terminal diagnosis of dysphagia following cerebral infarction with nutrition solely from tube feeding. Plan of care, effective from 5/23/23 to current, did not include any problems, goals, or interventions, specific to dysphagia or tube feedings. Personnel Record 1: The medical director completed joint record reviews and agreed during the interview, on 8/10/23, that the plans of care for these patients were not individualized to meet their specific needs.

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 and interview. In 4 of 14 (29%) records reviewed, in which aide services were accepted, revealed the agency did not ensure that the registered nurse (RN) provided specific instructions to the hospice aide thus leaving the aide to make decisions which is outside the scope of practice. Clinical Record 4: Initial nursing assessment on 7/27/23 documented a terminal diagnosis of hypertensive heart disease with oxygen being administered at 2 liters continuously. Aide care plan, effective from 7/27/23 to current, listed shower as a task without instructions as to if the oxygen may or may not be removed for cares. Clinical Record 7: Initial nursing assessment on 5/23/23 documented a terminal diagnosis of dysphagia following cerebral infarction and listed the following wound dressings: foam dressing on left hip, foam dressing on coccyx, and foam dressing on left outer foot. Aide care plan effective 5/23/23 to current, did not alert the aide to wound dressings or RN notification if dressing is wet or not present. Per initial nursing assessment the patient also had a tube feeding which was not noted on the aide plan. The aide care plan included the following relevant tasks: complete bed bath. Clinical Record 8: Initial nursing assessment on 1/2/23 documented a terminal diagnosis of Chronic Obstructive Pulmonary Disease (COPD) with oxygen being administered at 3 liters continuously. Aide care plan, effective from 1/2/23 to current, listed shower as a task, without instructions as to if the oxygen may or may not be removed for cares. Clinical Record 10: Initial nursing assessment on 6/7/23 documented a terminal diagnosis of hypertensive heart disease with chronic kidney disease, with oxygen being administered at 4 liters continuously. Aide care plan, effective from 6/7/23 to current, listed shower as a task, without instructions as to if the oxygen may or may not be removed for cares. Personnel Record 1: During an interview, on 8/10/23, the Medical Director agreed that the RN should have included these items and stated, "we included oxygen precautions but hadn't thought about saying if it could be removed, but they shouldn't remove it unless told to."