7 Star Hospice Care Inc.

“Observed in Record Review. In 8 out of 8 records, hospice did not develop an individualized plan of care for each patient related to Spiritual and Psychosocial needs. Examples: In RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRHV#1, RRHV#2, and RRNHV#3, the Chaplain and MSW each had a planned frequency of Initial evaluation within 5 days and once every recert. This was confirmed by the DPCS. Observed in Record Review. In 7 out of 7 records, the hospice did not develop an individualized plan of care with measurable goals. Examples: In RRNHV#1, the following goals were not measurable: Provide timely, effective pain relief to maintain comfort; For patient/family/PC to remain satisfied with living arrangement it is essential to link patient/family caregiver to have all available resources; Improve sleep quality and promote restful nighttime sleep; In RRNHV#1 there were no individualized goals related to GERD and Hypertension. In RRNHV#2, the following goals were not measurable: Patient will achieve restful sleep and remain comfortable overnight;; Patient/family/PCG to remain satisfied with living arrangement; Maintain patient comfort. In RRHNV#3, patient had a foley catheter but no GU goals. In RRNHV#4, RRNHV#5, and RRNHV#7, patients have medication orders to manage pain but did not have any identified pain goals. In RRNHV#6, patient did not have a skin/integumentary goal and patient had a wound. Patient also had a foley and not have a GU goal. Spiritual goals in RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, and RRNHV#6 were interventions and not measurable. Examples of the Spiritual goals included: Provide prayer, meditation, scripture reading; Assess spiritual needs and preferences; and Facilitate articulations of spiritual concerns. This was confirmed with the DPCS.”

“Observed in Record Review. In 2 out 10 charts, the plan of care did not include interventions to manage symptoms and care. Example: In RRNHV#3, the plan of care did not include orders related to the 16F foley catheter identified on admission. The plan of care also did not include wound care orders for the patient’s stage 2 wound identified on admission. In RRNHV#6, there were no wound care orders on the initial plan of care for a stage 4 wound identified on admission. There were also no Foley Catheter orders on the plan of care. This was confirmed with the DPCS.”

“Observed in Record Review. In 4 out of 7 records, multiple PRN medications were ordered to address the same symptom but the orders did not clarify when each medication was to be administered. Examples: In RRHV#1, Acetaminophen and morphine sulfate were ordered to address pain prn but did not state when each was to be given. Lorazepam tablets and Lorazepam concentrate solution were ordered prn for agitation but did not state when each was to be given. In RRNHV#3, Acetaminophen suppositories, Norco, and Diclofenac Sodium gel were ordered prn for pain but did not state when each was to be used. In RRNHV#4, Acetaminophen suppositories and morphine sulfate were ordered prn for pain but did not state when each should be given. . In RRNHV#6, Norco, Acetaminophen suppositories, and Morphine Sulphate was ordered prn for pain but did not state when each should be given. Bisacodyl suppository and Docusate Sodium capsules were ordered prn for constipation but did not state when each should be given. This was confirmed by the DPCS.”

“Observed in Record Review. In 4 out of 10 records, the organization did not provide services in accordance with the plan of care. Examples: In RRHV#1, there was a missed SN visit in weeks 2, 4, 5, and 6 of benefit period #1. In RRNHV#1, an extra nursing visit was made during weeks 2, 4, 5, and 6 of benefit period 8. In RRNHV#2, an extra nursing visit was made during weeks 3, 4, 6, 7, and 8 of benefit period 17. In RRNHV#5, an extra nursing visit was made during weeks 2 and 3 of admission. In RRBR#2, Bereavement mailings were not sent out per the stated Bereavement POC. This was confirmed with the DPCS.”