Kaplan Hospice, Inc.

Arrangement with Other Facilities (42 CFR 418.113(b)(5))

“Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency. There is no evidence of an agreement with another agency/hospice to receive patients in the event the hospice cannot provide care to their patients during and emergency.”

Rule E0025. Standard-level.

Names and Contact Information (42 CFR 418.113(c)(1))

“Upon observation, there was no evidence the Emergency Plan communication plan includes all of the following: Names and contact information for the following: • Hospice employees • Entities providing services under arrangement • Patients’ physicians • Other hospices (Corrected on site by compiling a list of contacts and contact information.)”

Rule E0030. Standard-level.

Notice of rights and responsibilities (42 CFR 418.52(a)(1))

Rule L0502. Standard-level.

Notice of rights and responsibilities (42 CFR 418.52(a)(2))

“Upon patient record review, 1 of 14 (Patient #1) 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 #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia and inability to make decisions.”

Rule L0503. Standard-level.

Notice of rights and responsibilities (42 CFR 418.52(a)(3))

“Upon patient record review, 1 of 14 (Patient #1) 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 #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia and inability to make decisions.”

Rule L0504. Standard-level.

Exercise of rights/respect for proprty/person (42 CFR 418.52(b)(3))

Rule L0507. Standard-level.

Rights of the patient (42 CFR 418.52(c)(2))

“Upon client record review, 1 of 14 (Patient #1) 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 #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia and inability to make decisions.”

Rule L0513. Standard-level.

Rights of the patient (42 CFR 418.52(c)(4))

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia and inability to make decisions.”

Rule L0515. Standard-level.

Rights of the patient (42 CFR 418.52(c)(5))

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence of the appropriate documentation for release of confidential information. Patient #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia and inability to make decisions.”

Rule L0516. Standard-level.

Rights of the patient (42 CFR 418.52(c)(7))

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia.”

Rule L0518. Standard-level.

Rights of the patient (42 CFR 418.52(c)(8))

“Upon patient record review, 1 of 14 (Patient #1) 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 #1: Upon observation of the medical record, the patient printed her initials (PD) on the admission paperwork. The initial nursing assessment and the Certification of Terminal Illness identified her primary diagnosis as Alzheimer’s disease with a score of FAST 7A indicating severe dementia and inability to make decisions.”

Rule L0519. Standard-level.

Content of comprehensive assessment (42 CFR 418.54(c)(6))

Rule L0530. Standard-level.

Content of comprehensive assessment (42 CFR 418.54(c)(7))

Rule L0531. Standard-level.

Content of plan of care (42 CFR 418.56(c)(4))

“Upon patient record review, 1 of 14 (Patient #3) 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 medications and treatments. Patient #3: Upon observation of home visit, the patient was taking Vascepa one gram daily. There was not an order for this medication. Additionally, the patient had stopped taking Gabapentin 300 mg TID, a week ago and there was no order to discontinue the medication. Correct”

Rule L0549. Standard-level.

Content (42 CFR 418.104(a)(2))

Rule L0673. Standard-level.

Authentication (42 CFR 418.104(b))

“Upon patient client record review, 9 of 14 (Patient #1,2,3,4,6,7,8,9,10) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1,2,3,4,6,7,8,9,10: Upon record review the hospice staff signature on the election statement was not clear, complete and authenticated.”

Rule L0679. Standard-level.

Label dispose storage drugs (42 CFR 418.106(e)(2)(i)(A))

Rule L0695. Standard-level.

Label dispose storage drugs (42 CFR 418.106(e)(2)(i)(B))

Rule L0696. Standard-level.

Label dispose storage drugs (42 CFR 418.106(e)(2)(i)(C))

“Upon client record review, 1 of 14 (Patient #1) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #1: Upon observation there is no evidence the patient did not receive information on policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative. There is no signature on the management and disposal of controlled drugs form. The Patient acknowledgement form does not include medication disposal.”

Rule L0697. Standard-level.