Bristol Hospice - Noco

“Based on record review and interview, the agency failed to incorporate the initial bereavement assessment into the plan of care for seven of ten active patients reviewed (Patients #2, #4, #5, #6, #7, #8 and #9). Findings include: 1. On 1/13/25 Review of Patient #2s medical record revealed a start of care date of 11/13/24. The initial Plan of Care assessment was completed on 11/13/24 and revealed the patient was admitted to the hospice with a terminal illness of hypertensive heart disease with heart failure. The plan of care was completed on 11/14/24 for the certification period of 11/13/24 through 2/10/25. a. The agency failed to ensure the initial bereavement assessment was utilized and incorporated into the plan of care. Further record review revealed the plan of care was completed on 11/14/24 and reviewed by the interdisciplinary group (IDG) on 11/21/24. The plan of care revealed that the bereavement assessment considerations were not included on the plan of care. 2. Similar findings were found for Patients #4, #5, #6, #7, #8 and #9. 3. During an interview on 1/15/25 at 3:43p.m., the administrator confirmed the initial start of care assessment included bereavement however this assessment was not documented and incorporated into the plan of care.”

“Based on interview and record review, the hospice failed to ensure a registered nurse (RN) completed hospice aide (HA) supervised visits every 14 days to assess the quality of care and services provided by the aide for 5 of 7 patient records reviewed who received HA services (Patients #1, #4, #5, #8, #9). Findings include: Agency Policy According to the agency policy titled, “;Hospice Aide Supervisory Visits,” dated November, 2021 (in pertinent parts): “;The frequency of supervisory visits will be based upon the needs of the patient after the plan of care is established. They must be conducted no less frequently than every 14 days.” 1. The clinical record for Patient #5 was reviewed on 1/15/25. The patient was admitted to hospice care and services on 10/12/24, with a terminal diagnosis of cerebral atherosclerosis. The plan of care (POC) for the certification period dated 10/12/24 to 1/9/25, included orders for skilled nurse (SN) two times a week for disease management, pain management, and comfort measures; hospice care aid (HA) three times a week for bathing and personal care; and Medical Social Work (MSW) one time a month for advanced care planning and client/family coping. The patient resided at home. Subsequent POC for the time period dated 1/10/25 to 4/9/25 included orders for SN one time a week for one week and two times a week for 13 weeks; HA visits one time a week for one week, three times a week for 13 weeks, two times a week for one week, and three times a week for 12 weeks; and MSW visit one time a month for four months. a) Clinical record review revealed the hospice failed to ensure HA supervisory visits were completed, at a minimum, of every 14 days. Review of the clinical record from 10/12/24 to 1/14/25 revealed Patient #5 received SN and HA visits in accordance with the POC. However, the record failed to reveal documentation of required supervisory visits. There were a total of six supervisory visits without documentation of HA supervision to assess the quality of care provided to Patient #5 by the HA in accordance with the POC. During an interview on 1/14/25 at 2:30 p.m. with the Director of Clinical Services (DCS) and the Executive Director (ED), staff verbalized awareness that supervisory visits for the HA were not being completed by the registered nurse (RN) every 14 days. 2. The clinical record for Patient #8 was reviewed on 1/14/25. The patient was admitted for hospice services on 11/21/23 with a terminal diagnosis of chronic obstructive pulmonary disease. The POC for the certification period of 11/15/24 to 1/13/25 included orders for SN one time a week for oxygen safety, pain status, and respiratory status; HA one time a week for companionship, personal care, and support service; and MSW one time a month for advanced care planning and client/family coping. Patient #8 resides at home. Subsequent review of Patient #8 clinical records revealed HA visits were initiated on 9/12/24. a) Clinical record review revealed the hospice failed to ensure HA supervisory visits were completed, at a minimum, every 14 days. Review of the clinical record from 9/12/24 to 1/14/25 revealed Patient #5 received SN and HA visits in accordance with the POC. Record review revealed HA supervisory visits were documented as completed by the RN on 9/18/24, 11/11/24, 11/19/24, 12/23/24, and 1/14/25. However, the record failed to reveal documented supervisory visits between 9/18/24 and 11/11/24. Additionally, it was revealed that supervisory visits were missing between 11/19/24 to 12/23/24 and 12/23/24 to 1/14/25. A total of six HA supervisory visits were not documented as completed for Patient #8. During an interview on 1/14/25 at 10:45 a.m. with the Registered Nurse (RN) #4, the RN stated she was the primary RN assigned to Patient #8. RN #4 stated HA supervisory visits were supposed to be completed on a regular schedule. She further stated that sometimes the visits are missed if the electronic medical record (EMR) does not prompt that documentation to be completed. During an interview on 1/15/25 at 3:43 p.m., the ED confirmed HA supervisory visits were not completed every 14 days by the scheduled RN. 3. The clinical record for Patient #1 was reviewed on 1/15/25. The patient was admitted for hospice services on 11/25/24 with a terminal diagnosis of chronic kidney disease with heart failure. The POC for the certification period of 11/25/24 to 2/22/25 included orders for SN visits one time a day for one day, one time a week for 13 weeks, and as needed visits for sign and symptom complication; HA visits two times a week for 12 weeks for bathing and personal care; MSW visits one time a day for one day and two times per month for three months for bereavement needs and client/family coping; and clergy visits one time a day for one day and one time a week for 12 weeks for funeral planning and spiritual needs. The patient resides in an assisted living facility (ALF). a) Clinical record review revealed the hospice failed to ensure HA supervisory visits were completed, at a minimum, every 14 days. Review of the clinical record from 11/25/24 to 1/14/25 revealed Patient #1 received SN and HA visits in accordance with the POC. Record review showed one HA supervisory visit was completed by RN #9 on 12/3/24. However, additional records failed to reveal any additional completed supervisory visits from 12/3/24 to 1/14/25. A total of four HA supervisory visits were documented as incomplete. During an interview on 1/15/25 at 2:45 p.m. with the RN clinical supervisor, staff stated supervisory visits for Patient #1 were not documented as completed during those dates. 4. Similar findings of the hospice failing to complete HA supervisory visits every 14 days was found with Patients #4 and #9. 5. A follow up interview on 1/15/25 on 3:22 p.m. with the executive director and DCS the staff stated they reviewed the missing documentation of completed supervisory visits for Patient #1, #5, and #8. They produced a performance improvement plan (PIP) to address the missing visits. The DCS indicated that training for the RNs would be started immediately.”