Full Hearts Hospice LLC

“It is required that the written Patient Bill of Rights includes the right to receive information about the services covered under the hospice benefit. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical records reviewed, in which the patient elected the non-covered items addendum, it was revealed that the agency did not ensure the written information was provided to the patient. Clinical Record 6: The patient elected the hospice benefit on 3/10/2024, for the diagnosis of malignant neoplasm of the prostate. During admission on 3/10/2024, the patient/legal representative requested the non-covered items addendum. There was no evidence the patient/legal representative received the written information, as required. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator confirmed the clinical record did not include evidence of the written addendum provided to the patient.”

“It is required that the hospice registered nurse completes an initial assessment within 48 hours of the patient’s election of hospice care, in accordance with CMS §418.24 (the elements of the hospice care election statement). This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed, it was revealed that the agency did not ensure the registered nurse completed the initial assessment within 48 hours of the patient’s election of hospice care. Clinical Record 6: The patient elected the hospice benefit on 03/10/2024 for the diagnosis of malignant neoplasm of the prostate. The initial nursing assessment was completed on 03/13/2024, 72 hours after the patient’s election of hospice care. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator confirmed the initial nursing assessment was dated 03/13/2024 and the election of hospice care was 03/10/2024.”

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation and interview. In 2 of 6 (33%) clinical records reviewed, it was revealed that the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. Clinical Record 2 / Home Visit 2: The patient elected the hospice benefit on 02/01/2024 for the diagnosis of hyperlipidemia. A home visit was conducted on 05/01/2024 with the registered nurse (RN). Medications were compared to the hospice drug profile. The patient was observed to be on continuous oxygen via nasal cannula at 2 liters per minute. The oxygen was not listed on the hospice drug profile. Metformin 1000 mg once daily was listed on the hospice drug profile. However the medication bottle documented Metformin 1000 mg twice daily. Clinical Record 3 / Home Visit 3: The patient elected the hospice benefit on 02/01/2024 for the diagnosis of Alzheimer’s dementia. A home visit was conducted on 05/01/2024 with the RN. Medications were compared to the hospice drug profile. The hospice drug profile listed Isosapent Ethyl 0.6 mg daily, dated 02/01/2024 on admission. However, the medication bottle dated prior to admission was 1 gram. A review of the medication revealed the medication is not available in a 0.6 mg dosage. During a joint record review and interview on 05/01/2024, the RN confirmed the patient’s current prescription’s were not reconciled with the hospice drug profile.”

“It is required that the Interdisciplinary Group, in collaboration with the individual’s attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient’s condition requires. This standard was not met as evidenced by clinical record review and observation. In 2 of 6 (33%) clinical records reviewed, it was revealed that the agency did not ensure the individualized plan of care was updated as frequently as the patient’s condition required. Clinical Record 5: The patient elected the hospice benefit on 02/15/2024 for the diagnosis of Alzheimer’s dementia. A nursing visit dated 02/19/2024 documented in part, “Patient caregiver states that patient will need stronger pain patch for continued pain. Director notified and states she will be getting order from MD. Fentanyl patch ordered.” The plan of care dated 02/15/2024, did not include a problem or intervention for pain. There was no evidence the plan of care was revised after the 02/19/2024 visit. Clinical Record 6: The patient elected the hospice benefit on 03/10/2024 for the diagnosis of malignant neoplasm of the prostate. The initial nursing assessment documented the patient had a Foley catheter and stated in part, “Related issues due to prostate cancer.” However, the plan of care did not include a problem or intervention for the Foley. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator confirmed the plans of care were not revised as frequently as the patient’s condition required.”

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical records reviewed for hospice aide services, it was revealed that the agency did not ensure the aide provided services included in the plan of care. Clinical Record 4: The patient elected the hospice benefit on 02/07/2024 for the diagnosis of malignant neoplasm of the upper lobe. The hospice aide care plan dated 02/07/2024 included the task of providing a bed bath. The hospice aide visits dated 02/28/2024 and 03/31/2024 did not document the completion of a bed bath as ordered in the plan of care. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator confirmed the hospice aide did not follow the plan of care.”

“It is required that volunteer services are noted in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed of volunteer services, it was revealed that the agency did not ensure volunteer services were included in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 02/04/2024 for the diagnosis of chronic kidney disease. Clinical record review revealed volunteer visits were documented on 02/20/2024 and 03/18/2024. However, volunteer services were not noted in the plan of care. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator/Volunteer Coordinator confirmed the plan of care did not include volunteer services.”

“It is required that the hospice provides an initial orientation for each employee that addresses the employee’s specific job duties. This standard was not met as evidenced by personnel record review, document review, and interview. In 1 of 8 (12%) personnel records reviewed, it was revealed that the agency did not provide an initial orientation for the employee’s job-specific duties. Agency policy HC.C10, Competency Assessment (2022), stated in part, “Competency evaluations are specific to the skills need for each job category and the services provided. Specific competencies are delineated in job descriptions and performance evaluations.” Personnel Record 6: A bereavement coordinator/spiritual counselor was hired on 05/05/2023. There was a bereavement coordinator job description. However, there was no evidence of a spiritual counselor job description. There was a bereavement coordinator competency and skills checklist dated 08/10/2023. However, there was no evidence of a spiritual counselor competency and skills checklist. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator confirmed the finding.”

“It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services. This standard was not met as evidenced by document review, interview and personnel record review. In 1 of 8 (12%) personnel records reviewed, it was revealed that the hospice did not assess the skills and competencies of all individuals providing care. Agency policy HR C 19, Competency Assessment (2022), stated in part, “Competency evaluations are carried out by professionals that have appropriate supervisory experience in the area of expertise of the person being evaluated (i.e. an MSW will perform a competency on an MSW).” Personnel Record 4: A registered nurse (RN) hired on 07/21/2023, had skills and competencies signed off by the administrator. There was no evidence the director of nursing or other clinical professional, in the appropriate area of expertise, assessed the skills and competencies of the RN, as required per policy. During a joint record review and interview on 05/01/2024, the Administrator and Alternate Administrator confirmed the finding, and stated “The competency should have been signed by an RN or MD.””

“It is required that the hospice medical director or physician designee reviews the clinical information for each patient being evaluated for admission and provides written certification that it is anticipated that the patient’s life expectancy is six months or less if the illness runs its normal course. This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed, it was revealed that the agency did not ensure the hospice medical director or physician designee provided written certification for the patient. Clinical Record 1: The patient elected the hospice benefit on 02/04/2024 for the diagnosis of chronic kidney disease. The clinical record included a faxed note signed and dated by the hospice medical director on 01/23/2024, eleven (11) days before the patient was evaluated by the admission nurse. The note was scanned in the electronic medical record under the title of “Attending Physician Certification.” The faxed note did not contain the benefit period, correct start of care date, or 6 month prognosis life expectancy statement. There was no other evidence of a written certification. During an interview and joint record review on 05/01/2024, the Administrator and Alternate Administrator confirmed the finding and stated, “The medical director had written the certification the day the referral was received and not on the day of admission.””