NC Hospice Inc.

“Upon patient record review 3 of 14 (Patients #6, 7, 8) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #6: There is no evidence of a Spiritual care initial assessment in the record. Patient #7: There is no evidence of a Spiritual care initial assessment in the record. Patient #8: There is no evidence of a Spiritual care initial assessment in the record.”

“Upon patient record review, 1 of 14 (Patient #8) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #8: There is no evidence of an initial bereavement assessment being completed within 5 days of admission.”

“Upon patient record review, 5 of 14 (Patients #1, 2, 4, 6, 9) 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 #1: The POC does not include interventions or goals for foley catheter and GU system. There are no interventions or goals for the use of a nebulizer, despite it listed under DME. Patient #2: The patient has a G-tube. There are no interventions or goals for G tube on the POC. Patient #4: The patient has a nebulizer with nebulized medications. There are no interventions or goals for the use of nebulizer on the POC. Patient #6: The patient has a nebulizer with nebulized medications. There are no interventions or goals for the use of nebulizer on the POC. The patient is on Eliquis and Aspirin, the POC does not have interventions and goals for use of anticoagulants and bleeding precautions on the POC. Patient #9: The patient was admitted with pancreatic cancer with malignant ascites. There are no interventions or goals in the POC for cancer or ascites.”

“Upon personnel record review, 1 of 11 (Personnel #9) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #9: The personnel record did not have proof that the following were performed with a patient or pseudo patient: Tub bath, shower, use of bedpan, transfers from chair to stand, and use of a cane. The record listed that the method of orientation was verbal.”

“Upon patient record review, 3 of 14 (Patients #1, 2, 5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1: The hospice aide POC did not include aspiration precautions. It also did not include oxygen and precautions. Patient #2: The hospice aide POC did not include diet, which is important as patient is NPO. The POC also did not include seizure precautions. Patient #5: The hospice aide POC did not include bleeding precautions.”