Valley View Hospice, Inc.

“Observed in Record Review. In 1 of 4 patient records reviewed, During RR#4 it was noted lack of the number of PRN visits established on the POC the middle of January 2025.: BC: 1 - - Initial within 5 days from admission, and As needed for any bereavement needs, MSW: 1 - Initial assessment within 5 days from admission, With every re-certification, and as needed for any psych social needs, RN: 1 - Initial assessment, weekly, Every 14 days sup. Visit, with each recertification and as needed for any COC that require changes to POC, SC: 1 - Initial assessment within 5 days from admission ; With every re-certification and as needed for any spiritual needs. This was discussed with leadership.”

“Observed in Record Review. In 3 of 3 patient records reviewed, it was noted that patient care services were not provided in accordance with the individualized plan of care. For example, a review of the medical record for RRNHV#1, revealed that the Registered Nurse (RN) visit frequency was ordered 1 visit every 2 weeks. There was no documented visit after week 1 of services. At the time of survey the patient was in week 5 of services. The Licensed Vocational Nurse (LVN) frequency was ordered 1 visit weekly. There was one LVN visit documented during week 3 of services. The Hospice Aide frequency was ordered 2 visits weekly. There was no documented evidence that a Hospice Aide visit was completed during the first benefit period. Example #2: A review of the medical records for RRNHV#2, and RRNHV#3, revealed that Hospice Aide frequency was ordered 2 visits weekly. There was no documented evidence that a Hospice Aide visit was completed during the first benefit period. This observation was reviewed with agency leadership.”

“Observed in Record Review. In 1 of 3 patient records reviewed, for patients receiving Hospice Aide services, it was noted that the organization did not ensure Hospice Aide supervision was effective. For example, during the review of the medical record for RRNHV#1, it was noted that a Hospice Aide supervision visit was not documented by the Registered Nurse every 14 days during the first benefit period. The patient was on Hospice services for 5 weeks and there was no documented evidence that a Hospice Aide supervision visit was performed. This observation was reviewed with agency leadership.”

“Observed in Record Review. In 8 of 10 patient records reviewed, for active records, the organization failed to ensure the physician review the clinical information for each hospice patient and provide written certification that the patient’s life expectancy is six months or less if the illness runs its normal course. For example: on review of RRNHV#10 the physician utilized a template for the Certificate of Terminal Illness that read Per LCD guidelines, and supporting information from nursing assessment; Patient continues with slow steady declining and poor prognosis. With this, Patient currently meets the guidelines and criteria for Hospice care for Pt _2nd_certification period with Primary diagnosis of _Athscl heart disease of native coronary artery w/o ang pctrs (I25.10)_ for sign and symptoms management and comfort measures. I attest/confirm that I composed this narrative based on my review of patient’s medical records, team assessment and/or examination of the patient. The documentation lacked current subjective and objective findings. Additional examples could be found on RRHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, and RRNHV#9. These observations were reviewed with the Administrator, and Compliance Officer.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to conduct and document a patient-specific comprehensive assessment and reassessment that identifies the patient’s need for hospice care and services. On review of RRHV#1 the admitting RN documented the patient with a stage 3 wound to the left buttocks however there was no documentation of an assessment of the wound to include all required elements such as size, color, drainage, or odor. In RRNHV#5 the patient was diabetic yet on the initial comprehensive assessment there was no documentation of an assessment of the endocrine system as the section on the visit note was left blank. These observations were reviewed with the Administrator.”

“Observed in Record Review. In 8 of 10 patient records reviewed, the organization failed to ensure the plan of care included goals that were individualized, specific, measurable, and time-bound. For example: through the records there was trend of goals not being specific, and measurable. In RRNHV#2 and example was Pt/Family/PCG will verbalize having urinary elimination needs met at an acceptable level within next 2 weeks and will be reevaluated on the next IDG meeting. In RRNHV#4 the spiritual goals read like interventions such as Assess spiritual needs and preferences -Facilitate articulations of spiritual concerns -Provide non-judgmental listening -Assist in life review -Facilitate relaxation response -Spiritual and emotional needs to be addressed within 7 days -Re-evaluation at IDG meeting. In RRHV#3 an example was --Promote optimal rest status for Pt/Family/PCG within next 2 weeks and will be re-evaluated on the next IDG meeting. In RRNHV#7 there were interventions for nutrition yet no goal established. Similar examples of goals that were not specific, or measurable could be found in RRHV#1, RRNHV#5, RRNHV#6, and RRNHV#8. These observations were reviewed with the Administrator and DON.”

“Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRNHV#6 there was documentation of g-tube feedings and site care yet the issues were not reflected on the plan of care (POC). In RRNHV#7 there was mention of use of a purewick drain yet the device was not reflected in the POC. In RRNHV#8 the patient had an ileostomy but the device was not reflected in the care plans to guide its care. In RRHV#3, RRNHV#6, RRNHV#7, RRNHV#8 the MSW was seeing the patient yet there was no psychosocial care plan established. In RRNHV#6, RRNHV#7, RRNHV#8 the spiritual counselor was visiting the patient but no spiritual care plan to guide the care. These observations were reviewed with the Administrator, and DON.”

“Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#1 there was documentation of an oxygen concentrator in the home yet there were no physicians orders for the oxygen included on the plan of care. There was also documentation on the initial assessment that the patient had a stage 3 wound to the buttocks and wound care was done yet there were no treatment orders for wound care included on plan of care. In RRNHV#5 there was documentation of the patient with diabetes, and interventions on teaching the patient caregiver blood glucose monitoring, yet there were no physicians orders for the monitoring. In RRNHV#8 the patient had an ileostomy yet there were no specific physicians orders for ileostomy management. In RRNHV#9 there was an order on the medication profile for insulin 30 units subcutaneous daily every evening, yet the order did not specify what type of insulin was to be used. There were also no orders for blood glucose monitoring even though there was an intervention on teaching the importance of blood glucose monitoring. These observations were reviewed with the Administrator, Compliance Officer, and Office Manager.”

“Observed in Record Review. In 8 of 10 patient records reviewed, the organization failed to ensure the updated comprehensive assessment included information about the patient’s progress toward goals and desired outcomes. Throughout the records reviewed there was a trend noted of a lack of documented progress toward goals and desired outcomes. The care plans remained the same IDG to IDG with no indication when or if goals had been achieved. This can be seen in RRHV#1, RRHV#2, RRHV#3, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9 and RRNHV#10. These observations were reviewed with the DON, and Administrator.”

“Observed in Record Review. In 5 of 10 patient records reviewed, for active records, the organization failed to ensure the patient’s care, treatment, and services were provided in accordance to the patient’s individualized plan of care. For example: on review RRHV#2 the plan of care (POC) specified the RN visit every recert, yet the visits were documented weekly. In RRNHV#6 the RN was ordered a frequency of weekly yet the weeks 3 & 5 of October no RN visit was documented. In RRNHV#7 the RN per the plan of care was ordered weekly yet documented visits every other week. In RRNHV#9 the LVN was documenting weekly visit to the patient, yet there was no order LVN frequency per the POC. In RRNHV#10 the RN was ordered weekly yet documentation showed visits every other week. The MSW documented services were declined yet the POC noted social service visits every certification period. These observations were reviewed with the Administrator, DON, and Compliance Officer.”

“Observed in Leadership Session. During the Data Management session the surveyor noted the HCO did not analyze and compare data over time to identify levels of performance, patterns, trends and variations as evidenced by there was no documentation of data analysis as the data collected stood alone and not compared over time for trends, patterns, and variations. In the annual review for 2024 example of documentation for analysis was vague for example for infection analysis it read the number of infection were relatively low to active census during the time. There were no trends noted. This observation was reviewed with the Administrator and Compliance Officer.”

“Observed in Record Review. In 2 of 10 patient records reviewed, for active records, the organization failed to ensure the RN provide written patient care instructions for the hospice aide. For example: on review of RRNHV#6 the patient had a g-tube and was ordered a shower yet there were no specific instructions to instruct the aide on how to handle the g-tube while providing care. In RRNHV#7 the patient had an ileostomy, yet there were no instruction for the aide on how to handle the ostomy while bathing the patient. These observations were reviewed with the Administrator, and DON.”

“Observed in Record Review. In 2 of 14 patient records reviewed, the organization failed to ensure the patient record reflected the patient’s care, treatment, and services. On review of RRBR#1 there was no documentation of the death visit. The RN interviewed stated she attended the patient death and produced a route sheet to verify yet there was no documentation of the visit made. In RRBR#2 there was also no documentation of a visit made at the time of the patient’s death. These observations were reviewed with the Administrator and DON. Observed in Record Review. In 2 of 10 patient records reviewed, The organization failed to ensure the record contain information that reflect the patient’s care, treatment and services. For example: on review of RRHV#1 there was documentation in the record that the patient had a wound to the left buttocks and wound care was done and taught to patient caregiver (PCG), yet there was no documentation of what type and steps taken for the wound care performed nor what was taught to the PCG. In RRHV#3 there was a primary terminal diagnosis changed from Alzheimer’s on admission to Cardiac yet there was no documentation noted in the record of what prompted the change. These observations were reviewed with the Office Manager, and Administrator.”