Every finding on record at Wiregrass Hospice, LLC

Upon patient record review 3 of 19 (Patient #4,5,10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #4: No evidence that the spiritual assessment was completed within 5 days of admission. The patient was admitted on 6/27/23. The record indicated that the spiritual assessment was not completed until 7/13/23. Patient #5: No evidence that the spiritual assessment was completed within 5 days of admission. The patient was admitted on 2/17/24. The record indicated that the spiritual assessment was not completed until 7/1/24. Patient #10: No evidence that the spiritual assessment was completed within 5 days of admission. The patient was admitted on 5/08/24. The record indicated that the spiritual assessment was not completed until 5/14/24.

Upon patient record review, 1 of 19 (Patient #7) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #7: No evidence that an initial bereavement assessment occurred within 5 days of election. Patient admitted on 03/12/2024, completed on 04/24/2024.

Upon patient record review, 1 of 19 (Patient # 2) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #2: Patient has a wound to right heel. No evidence that the wound was measured between 05/12/2024 and 6/05/2024, and again for the weeks of 06/09/2024, 06/23/2024. Gentiva policy

Upon patient record review, 2 of 19 (Patient #4,6) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #4: The record shows that the patient has a wound to his right heel. There was not evidence that the plan of care included goals and interventions related to impaired skin integrity. Corrected on site. Patient #6: The patient was admitted with Subarachnoid Hemorrhage. The record shows that the patient has difficulty swallowing due to having a dislocated jaw, coughs while drinking liquids, uses thickener. There was no evidence that the plan of care included goals and interventions related to her risk for aspiration. Corrected on site.

Upon client record review, 2 of 19 (Patient #1,13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The volunteer visit frequency was for once a month effective on 04/01/2024. The record shows that the patient received 2 visits from volunteers for the month of April, on 04/2/2024 and 04/4/2024. No evidence that the ordered visits occurred for the month of May or June. Patient #13: Volunteer referral entered on 02/23/2024. No evidence that any follow-up occurred.

Upon patient record review, 1 of 19 (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: The aide plan of care has shampoo hair listed as a task to be completed. No evidence that a frequency was ordered for the aide to complete the task.

Upon patient record review 3 of 19 (Patient #1,3,7) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1:The aide plan of care task list includes change linens, nail care, and shampoo hair weekly. The record shows that the aide completed those task at every visit on the weeks of 5/7/24, 5/21/24, and 6/4/24. Patient #3: The aide plan of care task list includes change linens, nail care, and shampoo hair weekly. The record shows that the aide completed those task at every visit between 04/15/24 and 06/25/24. Patient #7: The aide visit frequency effective 3/12/2024 was twice a week. For the week of 5/26/24-6/1/24, the record indicated only one refused visit for that week on 05/28/24. No evidence that the second visit for the week was performed.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The documented annual usage for the year 2023 was 2.19%.

Upon client record review, 1 of 19 (Patient #4) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #4: The volunteer visit frequency was for once every 2 weeks effective on 04/18/2024. No evidence that those visits occurred. The record indicated that only one visit occurred.

Upon client record review, 1 of 19 (Patient #4) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 4: The record shows that the patient has a wound to the right heel. The order states that betadine swab is be applied Q shift. No evidence that a specific provider (hospice or facility nurse) was identified as being responsible for performing the wound care.