Clear Path Hospice and Palliative Care, Inc.

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice, including the written information concerning its policies on advanced directives and description of state law were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the hospice obtained the patient’s or representative’s signature confirming that they received a copy of the Patient’s Rights and Responsibilities. Patient #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient’s rights to the extent allowed by state law. Patient #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon client record review, 1 of 14 (Patient #10) did not have evidence that the plan of care included IDG’s documentation of the patient’s or families level of understanding, involvement and agreement with the plan of care. Patient #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice, including the choice for physician, were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence of the appropriate documentation for release of confidential information. Patient #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice, including release of confidential information, were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #10: Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #10: Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice were signed by a caregiver without any proof of legal authority to sign for the patient.”

“Upon patient record review, 2 of 14 (Patient #6, 7) 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: On 12/20/24, patient complained of “heavy cough” New medication, Promethazine was prescribed for cough. There was no evidence of follow up call or visit on new medication for 7 days. Patient #7: On 12/17/24, patient called needing “something more for pain”, also complained of a cough and stated that “sugars were high that day. There was new prescriptions ordered for Promethazine for the cough, Ibuprofen for the increased pain, and a new Diabetic med named Synjardy. There was no follow”

“Upon patient record review, 8 of 14 (Patients #2, 3, 4, 5, 6, 7, 8, 10) 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 is taking Aspirin. There are no interventions or goals on the POC for use of anticoagulants/bleeding. Patient #3: The patient is taking Aspirin. There are no interventions or goals on the POC for use of anticoagulants/bleeding. Patient #4: The patient is taking Aspirin. There are no interventions or goals on the POC for use of anticoagulants/bleeding. There are no goals of interventions for depression on the POC. There are no goals or interventions for use of oxygen on the POC. Patient #5: The patient is taking Aspirin. There are no interventions or goals on the POC for use of anticoagulants/bleeding. Patient #6: The patient is taking Aspirin. There are no interventions or goals on the POC for use of anticoagulants/bleeding. The patient is on a mechanical soft diet, however, there is no interventions or goals for nutrition on the POC. Patient #7: The patient is on a mechanical soft diet, however, there is no interventions or goals for nutrition on the POC. Patient #8: The patient is taking Aspirin. There are no interventions or goals on the POC for use of anticoagulants/bleeding. Patient #10: The patient POC does not include goals or interventions for schizophrenia including hallucinations, or interventions and goals for Parkinson’s disease.”

“Upon patient record review, 8 of 14 (Patients #1, 2, 3, 5, 6, 7, 9, 10) 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 #1: The patient has a walker according to initial assessment, this is not listed under DME in the POC. Patient #2: The patient has a walker per the initial assessment, this is not on the POC. Upon home visit to this patient, patient also has hospital bed, full side rails x2, an over bed table, and supplies including gloves, briefs, and blue pads. These items are not included on the POC. Patient #3: The patient has a walker and oxygen concentrator as well as oxygen E tank according to initial assessment. The E tank is not mentioned on the POC. Patient #5: The patient has a cane and walker according to initial assessment, these items are not listed as DME on the POC. Patient #6: The patient has a cane and walker according to initial assessment, these items are not listed as DME on the POC. Patient #7: The patient has an oxygen concentrator, E tank back up, cane and walker according to initial assessment, the cane, walker, and back up e tank are not listed as DME on the POC. Patient #9: The patient has a cane and walker according to initial assessment, these items are not listed as DME on the POC. Patient #10: The patient has a walker according to initial assessment, this item is not listed as DME on the POC.”

“Upon patient client record review, 1 of 14 (Patient #10) 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 #10: There is no evidence that the representative signing for patient rights and the authority under State law to authorize care. Patient resides in a board and home. It is questionable of the patient’s mentation at admission to hospice as he was having hallucinations and confusion related to Parkinson’s, Schizophrenia, and Bi-polar disorder. The record reports there is no family. The information was presented to and consents for hospice, including patient rights and election of benefits with hospice election addendum were signed by a caregiver without any proof of legal authority to sign for the patient.”