Hospice of the Valley

“Upon patient record review, 2 of 14 (Patients #4 and 9) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including the following: A detailed statement of both the scope and frequency of services necessary to meet the specific patient and family needs: Patient #4: SOC was 09/11/24, with the Chaplain competing chaplain assessment visit on 09/16/24. The 09/19/24 IDG POC did not include the planned spiritual visit frequency. Patient #9: SOC was 08/13/24, with the Chaplain competing his chaplain assessment visit on 08/16/24, and a subsequent visit on 09/23/24. The 09/19/24 IDG POC did not include the planned spiritual visit frequency.”

“Upon patient record review, 2 of 14 (Patients #3 and 5) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #3: During the Surveyor-attended home visit on 10/01/24 the employed in-home caregiver reported the following skin care intervention to the patient’s right hip and coccyx area wound(s); with each diaper change. Wash with wound cleanser, pat dry, apply Medi-honey, then border gauze. The current IDG POC only refers to this wound intervention for a Stage II pressure ulcer on the coccyx. The POC does not include this wound intervention to also be completed for the right hip wound. This is not a complete wound order. Patient #5: A verbal order was obtained on 09/09/24 for, “Cleanse redness to coccyx with Normal Saline, pat dry, and apply Calmoseptine B.I.D., and as needed soiling, etc ...” This treatment order did not include ‘who’ in the home was to provide this wound treatment on such B.I.D. frequency.”

“Upon patient record review, 4 of 14 (Patients #1, 3, 8, and 10) did not contain documented evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: During surveyor-attended home visit on 10/01/24 it was noted that the patient had a hospital bed. This was not on the POC. Patient #3: During surveyor-attended home visit on 10/01/24 it was noted that the patient had: 1) hospital bed; 2) overbed table; 3) air mattress; and 4) Oxygen concentrator. These DME were not on the POC. Patient #8: The RN SOC assessment reflected the use of a walker. This DME was not on the POC. Patient #10: The SOC CTI assessment reflected the use of a walker. This DME was not on the POC.”

“Upon patient record review, 2 of 14 (Patients #2 and 7) did not contain evidence that the revised Plan of Care included information from the patient’s updated comprehensive assessment(s): Patient #2: During the 10/01/24 Surveyor-attended home visit, the RN stated that the patient was taking only Ensure and water orally, for approximately the past 1-2 months. The 09/19/24 IDG POC does not reflect this. The POC includes, “Offer food/fluids as tolerated and offer supplements as ordered”, and “Teach caregiver on importance of diet in maintenance of adequate bowel function.” Ensure was not included on the POC. Patient #7: The RN SOC assessment reflected that the patient had a history of coccyx pressure ulcers. The POC does not include an active Problem/Intervention/Goal for this area of potential concern.”

“Upon personnel record review, 1 of 11 (Personnel #7) did not contain evidence of a completed Aide Skills Competency Assessment having been conducted, which included all CMS-required tasks. A Skills Competency was conducted on 04/26/2024. However, the following CMS-required tasks were not evaluated for, while the Aide was providing care/services to patient or pseudo-patient: ·Reading and recording temperature, pulse, and respiration were evaluated verbally. ·Appropriate and safe techniques in personal hygiene and grooming that include-- · Bed bath was evaluated verbally. · Shower bath was evaluated verbally. · Sponge and Tub bath were not evaluated for. · Shampoo, sink, tub, and be were evaluated verbally. · Nail care was evaluated verbally. · Skin care was evaluated verbally. · Oral hygiene was evaluated verbally. ·Toileting and elimination was evaluated verbally. ·Normal range of motion was not evaluated for. The other subject area, which may be evaluated through written examination, oral examination, or after observation of a Hospice Aide with a patient; that was not evaluated for was: · The physical, emotional, and developmental needs of and ways to work with the populations served by the Hospice.”

“Upon patient record review, 3 of 14 (Patient #1, 4, and 10) did not contain evidence that each patient record contained: Signed Election of Hospice Benefit Statement (EOB) in accordance with 418.24 Patient #1: The EOB did not include: • The effective date of the Hospice Election. This line had been left blank. • Identification of the patient’s choice of Attending Physician, if any. This section had been left blank. • The section of the EOB intended for the patient/representative to acknowledge whether they had been informed of their right to request/receive a “Patient Notification of Hospice Non-Covered Items, Services, and Drugs”, had been left blank; without any indication that the patient/representative had been informed of this right. Patients #4 and 10: The section of these patients’ EOB(s) intended for the patient/representative to acknowledge whether they had been informed of their right to request/receive a “Patient Notification of Hospice Non-Covered Items, Services, and Drugs”, had been left blank; without any indication that the patient/representative had been informed of this right.”

“Upon patient record review, 3 of 14 (Patient #1,2,8) did not contain evidence that all entries were clear and complete: Patient #1: The admission Consent form included a section for the admitting clinician to document whether or not the patient had any Advance Directives. This section of the Consent had been left blank. Patient #2: The 07/17/24 RN SOC assessment noted, “Rash to peri-groin and peri-anal areas. Treating with Nystatin Powder and Triamcinolone Cream. Both the 07/18 and 07/19/24 LVN visits documented incontinent of bowel and bladder, with no skin integrity problem. Patient #8: The RN SOC visit noted that the patient had a pressure ulcer to the coccyx, and that wound care was provided. There was not documentation regarding the detail of such wound care provided.”