Elite Hospice and Palliative Care LLC

“Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to respect the patient’s right to participate in decisions about their care, treatment, or services. For example: on review of RRNHV#5 the patient elected to receive the patient notification of non-covered items, services, and drugs on admission. At the time of survey nearly 2 weeks post start of care there was no documentation that the notification had been supplied to the patient/family. In RRNHV#7 the patient elected notification of non-covered items yet there was no documentation that the document was presented within the 5 days after start of care. Similar lack of documentation of the notice delivered within 5 days of admission was noted in RRNHV#10. These observations were reviewed with the Director of Nursing.”

“Observed in Record Review. In 7 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#5 there was documentation that the patient was a high fall risk with multiple past falls yet fall safety was not reflected in the plan of care. In review of RRHV#3, RRNHV#6, RRNHV#7, RRNHV#8 the patient was being seen by the Medical Social Worker yet there were no psychosocial care plans to guide the care. In RRNHV#6 the patient was admitted with protein calorie malnutrition with nutrition being a focus of the care yet there was no nutrition care plan open. In RRNHV#9 there was documentation of an ankle, and sacral wound but no care plan to address skin integrity. In RRHV#2 the documentation and discussion in the home observation revealed many psychosocial issues surrounding family conflict yet there was no psychosocial care plan to guide the care. These observations were reviewed with the Director of Nursing.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to ensure the plan of care include all drugs and treatments needed for the palliation and management of the terminal illness and related conditions. On review of RRNHV#9 there was documentation of a stage3 sacral wound that required treatment yet there was no physicians order noted on the plan of care for the wound. In RRHV#3 there was documentation of a skin tear to the left calf with wound treatment yet no physicians order for treatment noted as part of the plan of care. These observations were reviewed with the Director of Nursing.”

“Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. In review of RRNHV#5 the hospice aide was ordered per the plan of care 2 times a week, yet there were no visits documented provided the week following admission. In RRNHV#6 and RRNHV#8 the plan of care ordered the chaplain monthly yet per documentation the chaplain was available to the patient as needed and monthly visits were not being made. In RRNHV#9 the chaplain was ordered monthly but there was no visits documented in July or August. These observations were reviewed with the Director of Nursing.”

“Observed in Patient Home. In 1 of 10 patient records reviewed, the organization failed to ensure the patient record contain information that reflects the patient’s care, treatment, and services. For example: on review of RRHV#1 during the home observation of the medication reconciliation it was noted the medications metoprolol, Eliquis, and Ocuvite supplement were being given to the patient as part of the facility medication profile yet were not part of the hospice medication profile. In discussion with the Director of Nursing the medications had been discontinued months prior on the hospice profile. This observation was reviewed with the Director of Nursing.”

“Observed in Record Review. In 1 of 2 patient records reviewed, for live discharge, the organization failed to ensure the discharge summary include all required elements. In review of RRDC#2 the patient revoked hospice services yet the discharge summary only noted that the patient/family revoked seeking aggressive treatment yet did not include a summary of the patient’s stay, including treatments, symptoms, and pain management - The patient’s current plan of care - The patient’s latest physician orders - Any other documentation that will assist in post discharge continuity of care or that is requested by the attending physician or receiving provider as required. This observation was reviewed with the Director of Nursing.”