Rite Care Hospice, Inc.

“Upon patient record review 3 of 16 (Patient #2, 3, 5) 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 #2: There was no evidence of an initial psychosocial assessment completed within 5 days. Patient #3: There was no evidence of an initial psychosocial or spiritual assessment completed within 5 days. Patient #5: There was no evidence of an initial psychosocial assessment completed within 5 days.”

“Upon patient record review, 4 of 16 (Patients #2, 3, 5, 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. Patients 2, 3, 5, and 7 had no evidence of an initial bereavement assessment being completed within 5 days.”

“Upon patient record review, 1 of 16 (Patient #2) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #2: There is no evidence of an IDG being held after 09/27/24. The patient was on service until his death on 02/16/25.”

“Upon observation, there was no evidence the hospice has an interdisciplinary group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. Interdisciplinary group members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. Patients 1-16: There was no evidence on any chart that an IDG meeting was signed by all core services, aside from the MD and nurse.”

“Upon patient record review, 2 of 16 (Patient #6, 15) 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 #6: The POC includes interventions for wound assessment and treatment at each visit. The patient was admitted on 05/16/24. The wound was assessed on admission. After the initial assessment there is no further documentation of new wound assessments. No measurements obtained with full assessment after initial visit. Patient #15: The patient had 2 severe wounds on admission. Orders were give for wound care and the POC included interventions for wound assessment and wound care at each nursing visit. There is no further documentation of wound assessments.”

“Upon patient record review, 9 of 16 (Patients #2, 3, 5, 6, 9, 12, 13, 15, 16) 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 #2: The patient was on an anticoagulant. There are no interventions or goals for use of anticoagulants or bleeding precautions on the POC. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #3: The patient was on an anticoagulant. There are no interventions or goals for use of anticoagulants or bleeding precautions on the POC. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #5: The patient is on service with Cancer. There is no evidence of interventions or goals for the primary diagnosis. There are no goals or interventions for pain, respiratory, oxygen, neuro (for depression medication), or for constipation. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #6: The patient was on an anticoagulant. There are no interventions or goals for use of anticoagulants or bleeding precautions on the POC. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #9: The patient was on an anticoagulant. There are no interventions or goals for use of anticoagulants or bleeding precautions on the POC. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #12: The patient has a history of seizures and is prescribed Depakote. There are no interventions or goals for seizures on the POC. The patient was on an anticoagulant. There are no interventions or goals for anticoagulants or bleeding precautions on the POC. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #13: The patient is on service for colon cancer. there are no interventions or goals on the POC for the primary diagnosis. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #15: The patient has DME of suction ordered, however, there are no interventions or goals for suctioning on the POC. The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home. Patient #16: The patient has interventions listed under ADL, Mobility, and Environmental/Safety that state: “ use of side rails, trapeze, and Hoyer” The patient does not have this DME in the home.”

“Upon patient record review, 2 of 16 (Patient #6, 15) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #6: Patient has a Stage 4 sacral ulcer. The order is to cleanse with NS. Pat dry, apply mupirocin and calcium alginate to wound bed and cover with bordered gauze. Change dressing every 2 days and prn for loss of integrity/soilage. The order does not specify when the hospice nurse will change dressing and when the care giver will change dressing, if at all. Patient #15: The patient has 2 wounds. The first is a stage 4 sacral ulcer the order is to cleans wound with Dakins solution. Apply Santyl, Bactroban ointment and fill with Calcium alginate. Cover with border gauze. Change dressing daily. The second wound is a DTI on the right lateral foot. The order reads, Apply betadine soaked gauze and cover with ABD pad, wrap with Kerlix every 3 days. Neither dressing specifies who will be changing the dressings.”

“Upon patient record review, 4 of 16 (Patients #6, 9, 11, 12) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #6: There is no DME or supplies listed on the POC. Patient #9: There is no DME listed on the POC. Patient #11: The patient has an order for suctioning. There is no evidence on the POC that the patient was provided with a suction machine or suction supplies. Patient #12: The initial assessment documented the need for an Air Mattress, Bed, OBT, Walker, Wheelchair, Shower Chair, and Hoyer that were not listed on the POC. The POC lists only oxygen concentrator, nebulizer and E Tank.”

“Upon client record review, 2 of 16 (Patients #6, 15) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6: The POC includes interventions for wound assessment and treatment at each visit. The narratives on every visit by an LVN states that the RN provided dressing care, however an RN was not present. Patient #15: The patient had 2 severe wounds on admission. Orders were give for wound care and the POC included interventions for wound assessment and wound care at each nursing visit. There is no further documentation of wound care being provided.”

“Upon patient record review, 9 of 16 (Patient #2, 3, 6, 10, 11, 13, 14, 15, 16) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #2: There was no evidence of any bereavement follow up after death. Patient #3: There was no evidence of any bereavement follow up after death. Patient #6: There was no evidence of any bereavement follow up after death. Patient #10: There was a post death bereavement assessment that recommended follow up with letter mailings. There is no evidence that any bereavement follow up was completed. Patient #11: There was a post death bereavement assessment that recommended follow up with letter mailings. There is no evidence that any bereavement follow up was completed. Patient #13: There was no evidence of a post death bereavement assessment of any bereavement follow up after death. Patient #14: The patient had a post death bereavement assessment with documentation that family was “open to bereavement services”. There is no evidence of any bereavement services or letters after that assessment. Patient #15: There was a post death bereavement assessment with recommendation for follow up letters, however there is no evidence of letters or additional bereavement follow up. Patient #16: There was a post death bereavement assessment with recommendation for follow up letters, however there is no evidence of letters or additional bereavement follow up.”

“Upon patient record review 5 of 16 (Patients #2, 6, 8, 12, 15) 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 #2: The patient was admitted on 06/28/24. There was a verbal order entered for aide services twice weekly. There is no evidence that a hospice aide ever saw the patient. Patient #6: The patient was admitted on 05/16/24. There was an order for aide services twice weekly. There are interventions in the POC for aide services. There is no evidence in the record that an aide ever saw the patient. Patient #8: The patient was admitted 11/03/23. The initial assessment assesses for the need of hospice aide services. The RN completed a hospice aide assignment. There is no evidence in the record that the aide provided services. Patient #12: The patient was admitted 01/28/22. The initial assessment assessed the need for hospice aide services for grooming and linen changes. A hospice aide assignment was written by the RN, however there is no evidence that the aide ever provided services to the patient. Patient #15: The patient was admitted on 06/16/22. The initial assessment included the hospice aide twice weekly. A hospice aide assignment was created by the RN, however, there is no evidence that the aide ever provided services to the patient.”

“Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. Documentation must include the following: • The identification of each position that is occupied by a volunteer • The work time spent by volunteers occupying those positions • Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of CFR 418.78 for the amount of time specified in paragraph (d)(2) of CFR 418.78 There was no documentation of Volunteer hours or cost savings records since 2023.”

“Upon patient client record review, 5 of 16 (Patients #8, 11, 12, 13, 14) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #8 The election statement did not include an effective date. Patient #11: During admission, the patient/caregiver elected to receive a Hospice Election Addendum. There is no evidence that this was provided to the patient/caregiver. Patient #12: During admission, the patient/caregiver elected to receive a Hospice Election Addendum. There is no evidence that this was provided to the patient/caregiver. Patient #13: During admission, the patient/caregiver elected to receive a Hospice Election Addendum. There is no evidence that this was provided to the patient/caregiver. Patient #14: During admission, the patient/caregiver elected to receive a Hospice Election Addendum. There is no evidence that this was provided to the patient/caregiver.”