Absolute Hospice & Palliative Care, Inc.

“Based on observation, interview, and record review, the hospice agency (HA, agency providing care to terminally ill patients who has six months or less to live) failed to ensure patient care plan was developed and completed that included identified problems, interventions, monitoring, and management of the patient’s related condition for one of six sampled patients (Patient 8). This deficient practice had the potential to affect the necessary care and services needed to maintain the highest practicable physical, mental, and psychosocial well-being of Patient 8 certified to receive hospice care services. A review of Patient 8’s demographics (identifying information such as patients name, date of birth and address, along with insurance information) indicated Patient 8 was admitted to the hospice agency on 2/1/2024, with a terminal diagnosis of hepatic failure (loss of liver function). A review of Patient 8s POC (Plan of Care)/IDG (Interdisciplinary Group) Review, indicated an order for visits dated 2/14/2024, for routine level of care (routine visits from a home provided by licensed medical professionals under the direct supervision of a physician) by a skilled nurse (SN) twice a week, Social Worker (MSW) to evaluate and assess for needs within five days of admission, and the Spiritual Care Coordinator (SC) for spiritual assessment within five days of admission to identify spiritual needs. A review of Patient 8’s Physician’s order dated 2/1/24, indicated to administer Sertraline (Zoloft, an anti-depressant medication [any drug that affects mental function, behavior, and mood]) 50 milligram (mg, a unit of measurement) one tablet daily for anxiety and agitation. The common side effects of Seroquel included dry mouth, akathisia (a feeling of muscle quivering, restlessness, and inability to sit still), weight gain, and dizziness. On 2/17/2024, at 1:00 p.m., a home visit was conducted at Patient 8’s residence. Patient 8 was observed sitting on a chair at dining area looking sleepy and weak. During an interview and concurrent record review with the DPCS on 2/18/2024, at 1:00 p.m., the DPCS stated that there was no plan of care developed for the anti-depressant medication management (Zoloft) for Patient 8. Further review of Patient 8s clinical record indicated there was no plan of care developed that included management of the identified psychological problem, monitoring of the effects and side effects of the medication (Zoloft), and interventions necessary in the palliation (relieve symptoms) and management of the terminal illness and related condition. A review of the agency’s undated policy and procedure titled, “Plan of Care”, indicated a written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted to the hospice program. The care provided to the patient must be in accordance with the plan of care.”

“Based on observation, interview, and record review, the hospice agency (HA) failed to notify the attending physician regarding a low blood pressure reading for one out of six sampled patients (Patient 8). These failures had the potential to result in poor quality care that can affect the affected patients’ quality of life. A review of Patient 8’s demographics (identifying information such as patients name, date of birth and address, along with insurance information) indicated Patient 8 was admitted to the hospice agency on 2/1/2024, with a terminal diagnosis of hepatic failure (loss of liver function). A review of Patient 8s POC (Plan of Care)/IDG (Interdisciplinary Group) Review, indicated an order for visits dated 2/14/2024, for routine level of care (routine visits from a home provided by licensed medical professionals under the direct supervision of a physician) by a skilled nurse (SN) twice a week, Social Worker (MSW) to evaluate and assess for needs within five days of admission, and the Spiritual Care Coordinator (SC) for spiritual assessment within five days of admission to identify spiritual needs. On 2/17/2024, at 1:00 p.m., a home visit was conducted at Patient 8’s residence. Patient 8 was observed sitting on a chair at dining area looking sleepy and weak. On 2/18/2024, at 11:00 a.m., during a review of Patient 8’s LVN (license vocational nurse) note dated 2/15/2024, indicated a blood pressure reading of 96/59 (a normal blood pressure reading is 120/80), however there was no documented evidence the physician was notified of low blood pressure reading. A further review of Patient 8’s clinical record indicated no documented evidence of a communication note that the physician was notified of the low blood pressure reading. On 2/18/2024, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS), the DPCS stated the blood pressure reading was low and the visiting nurse should have notified the physician about it. A review of the facilitys undated policy and procedure titled, “Monitoring Patient’s Response/Reporting To Physician,” indicated during each hospice visit, the clinician will notify the patient’s physician or the hospice medical director on the same day when there are changes in the patient’s condition”

“Based on record review and interview, the hospice agency (HA) failed to ensure one of six sampled patients (Patient 1) received monthly spiritual counseling assessments as prescribed by the physician to meet patient’s spiritual needs. The deficient practice had the potential to result in patients not receiving spiritual and emotional support as necessary to cope with the terminal diagnosis and disease process. Findings: During a review of Patient 1s admission record indicated start of care date of 2/18/2023 with a terminal diagnosis of unspecified heart disease. During a review of Patient 1’s POC (Plan of Care) Summary form, indicated there was an order, dated 2/19/2023, for the Spiritual Counselor (SC) to visit patient once a month and one prn (pro re nata, which means “;as needed”) visit for spiritual support, needs, and concerns. During a joint home visit, on 2/17/2024 at 2:56 p.m. with the licensed vocational nurse (LVN 1), Patient 1 was observed laying in bed, awake, alert, oriented to place only, and forgetful. During a concurrent interview with Patient 1s family member (FM 1), FM 1 stated Patient 1 and her family spoke with the agencys SC only a couple of times during admission and none after that. During a review of Patient 1s clinical record indicated there was only one spiritual assessment conducted and dated 2/19/2023. During a concurrent interview and record review on 2/18/2024 at 11:10 a.m., with the Director of Nursing Service Designee (DPCSD), DPCSD stated and acknowledged there was only one spiritual assessment conducted for Patient 1 since the start of care. DPCSD stated hospice care and service should be in accordance with the plan of care. During a review of the agencys policy and procedure titled, “;Spiritual Services”, revised March 2013, indicated the Chaplain/Spiritual Counselor is designed to oversee the spiritual care of the patient, family and caregivers and to ensure that the patients needs are met and rights preserved. The Chaplain/Spiritual Counselor provides spiritual counseling and services for patients, families and caregivers, as requested to meet needs in a manner consistent with patient/familys beliefs and desires. During a review of the agencys policy and procedure titled, “;IDG Care Planning Process”, revised 2014, indicated hospice has designated an interdisciplinary group (IDG, a team responsible for the holistic care of the hospice beneficiary) which, in consultation with the patients attending physician, prepares a written plan of care for each patient. The care plan specifies the care and services necessary to meet the patient and family-specific needs identified in the comprehensive assessment as such needs related to the terminal illness and related conditions.”

“Based on interview and record review, the agency failed to ensure clinical records were completed and documented timely for one of six sampled patients (Patient 17) when the Hospice Aide (HA) visit notes were incomplete. This failure had the potential to result in inadequate provision of care and undocumented missed visits by the aide. Findings: During a review of Patient 17’s admission records indicated a start of care (SOC) date of 10/5/2023, with a terminal diagnosis of atherosclerotic heart disease (a build-up of cholesterol plaque in the walls of arteries causing obstruction of blood flow) of native coronary artery without angina pectoris (a type of chest pain caused by reduced blood flow to the heart). During a review of Patient 17s POC (Plan of Care)/IDG (Interdisciplinary Group, a team responsible for the holistic care of the hospice beneficiary) form dated 1/3/2024, indicated the frequency of visits of hospice aide to three times per week to perform ADL (or activities of daily living, are activities related to personal care which includes bathing, grooming, dressing, toileting, and eating) care and assistance as assigned by the registered nurse (RN) supervisors plan of care. During a review of Patient 17s History of HA Visits indicated the last HA visit note submitted was on 1/31/2024. During a concurrent interview and record review on 2/18/2024 at 11:10 a.m., with the Director of Nursing Service Designee (DPCSD), DPCSD stated agencys nursing staff visit notes should be submitted and documented on the patients electronic medical records on a Monday of the following week after the visit per the agencys policy and procedure. DPCSD stated that in the case of Patient 17, there was a delay in the submission of visit notes by the hospice aide for the month of February 2024. During a review of the agencys policy and procedure titled, “;Timely Submission of Patient Documentation”, revised 2014, indicated hospice will ensure the timely and proper submission of patient documentation. Itineraries, plan of care (POC) and all visit reports must be submitted every Monday of the following week. All patient visit reports from contract personnel must be submitted within three (3) business days from the date of the visit.”