Hospice of Okeechobee Incorporated

“Based on review of the Hospice’s Policy and Procedure, record review and interview, the Hospice failed to coordinate services and provide copies of the Skilled Nurse’s Visit Notes and the Hospice Recertification Assessment to the facility where the patient resides for1 of 1 sampled patients (Patient #8). The findings included: Review of the Hospice’s Policy titled, “;Hospice Care for Nursing Facility Residents effective 05/27/21 documents “;...the designated IDG (Interdisciplinary group) member is responsible for: providing overall coordination of the hospice care...”. On 02/04/25 at 3:40 PM, a side-by-side review of Patient #8s clinical record was conducted with the Hospice Risk Manager who stated the patient’s Start of Care date was 07/06/24 and had a terminal diagnosis of Hemiplegia-Cerebral Infarction. The patients last recertification of terminal illness was dated 12/27/24, the last (physician’s) order was for Skilled Nurse (SN) visits three (3) times a week, and the patients last Recertification period started on 01/02/25. On 02/05/25 at 3:50 PM, a joint home visit to the facility where the patient resides was conducted with Staff C, Registered Nurse (RN) and the Hospice Compliance Manager for Patient #8 who resides in a skilled nursing home facility; an interview was conducted with Staff C who stated that Patient #8 had a declining oral intake and increased lethargy. Staff C stated she provided care and services to the patient three (3) times a week; during the visit, Staff C was asked for the Hospices documentation that she provided to the facility and stated that the facilitys Director of Nursing (DON) requested that all Hospice documentation was to be sent via e-mail for them to scan them and keep it electronically, not on paper, added that the Hospice office was responsible for that; Staff C asked the surveyor to check with the facilitys medical records staff. On 02/05/25 at 4:10 PM, a joint interview and a side-by-side record review with the Hospice Staff C, RN, Hospice Compliance Manager and the facilitys Medical Records Clerk was conducted; the Medical Records Clerk stated she receives very few e-mails from the Hospice and proceeded to open Patient #8s Hospice documentation, the record reveals the patients last Inter-Disciplinary Group (IDG) meeting review was dated 02/04/25. Further review reveals no evidence of documentation of the SNs visits and the recertification assessment in the patients facilitys electronic medical record; the Medical Records Clerk stated that this was all the documentation she had at that time from the Hospice related to Patient #8 and nothing pending to be uploaded; she asked to check with the DON; the Hospice Compliance Manager confirmed there were no SN visit notes uploaded on Patient #8s medical record reviewed with the Medical Records Clerk. On 02/05/25 at 4:20 PM, a joint interview with the Hospice Staff C, RN, Hospice Compliance Manager and the facilitys DON was conducted; the DON stated she asked the Hospice to e-mail the patients documentation to medical records for them to upload them into the patients chart (record); the DON was informed that the record had no current Nursing notes and the last uploaded documents were from 12/16/24; the DON stated she did not have any paper documentation from the Hospice for Patient #8 to be uploaded, added she does not get e-mails with documentation from the Hospice; during the joint interview with the Compliance Manager and Staff C, it was asked again what Hospice documentation the facility should have in Patient #8s medical record and Staff C stated she could not answer that question and will ask her manager and no additional response from Staff C has been received to date. On 02/05/25 at 4:30 PM, an interview was conducted with the Compliance Manager who stated that they have to send documents such as recertification, updated orders and SN visit notes to the facility; will check to see if the Hospice has sent any other documents to the facility after 12/16/24 and the Hospice policy. On 02/06/25 at 10:45 AM, during an interview, the Compliance Manager stated that the latest e-mail sent to the facility included Patient #8s last IDG review done on 02/04/25, and the latest SN visit notes has not been sent out to the facility. On 02/06/25 at 11:45 AM, during an interview, the Chief of Compliance Officer, and the Vice President/Executive Director were apprised of the findings.”

“Based on review of the Hospice’s Policy and Procedure, record review and interview, the Hospice failed to provide the patients Skilled Nursing Facility (SNF) with a copy of the Hospice Election Form and the Physician Recertification Of Terminal Illness for 1 of 1 sampled patients residing in a SNF (Patient #8). The findings included: Review of the Hospices Policy titled, “;Hospice Care for Nursing Facility Residents effective 05/27/21 documents “;... following an admission an e-signature of the Hospice Medicare Benefit Election form in the Electronic Medical Record (EMR), the nurse will ensure that a signed copy is provided to the Facility via electronic transmission or on paper and will verify the signed copy Hospice Medicare Benefit Election form is located in the patients medical record at the facility...the hospice nurse is responsible for providing or facilitating the following documents be provided to the facility via electronic transmission or on paper and verifying they are in the patients medical record: ...Physician certification and recertification of the terminal illness...”. Review of Patient #8s electronic clinical record documents a Start of Care for Hospice services on 07/06/24 with a physician recertification of terminal illness signed on 12/27/24 and a Skilled Nurse (SN) recertification assessment completed on 01/02/25. On 02/05/25 at 3:50 PM, a joint home visit to the facility where the patient resides was conducted with Staff C, Registered Nurse (RN) and the Hospice Compliance Manager for Patient #8 who resides in a skilled nursing home facility; an interview was conducted with Staff C who stated that Patient #8 had a declining oral intake and increased lethargy. Staff C stated she provided care and services to the patient three (3) times a week; during the visit, Staff C was asked for the Hospices documentation that she provided to the facility and stated that the facilitys Director of Nursing (DON) requested that all Hospice documentation was to be sent via e-mail for them to scan them and keep it electronically, not on paper, added that the Hospice office was responsible for that; Staff C asked the surveyor to check with the facilitys medical records staff. On 02/05/25 at 4:10 PM, a joint interview and a side-by-side record review with the Hospice Staff C, RN, Hospice Compliance Manager and the facilitys Medical Records Clerk was conducted; the Medical Records Clerk stated she receives very few e-mails from the Hospice and proceeded to open Patient #8s Hospice documentation, the record reveals no evidence of documentation of a signed copy of Patient #8s Hospice Election Form and the latest Recertification Of Terminal Illness; the Medical Records clerk stated that she did not see those documents for Patient #8 and asked to check with the DON; the Hospice Compliance Manager confirmed the documents were not in the patients file. On 02/05/25 at 3:50 PM, a joint home visit was conducted with Staff C, Registered Nurse (RN) Hospice Compliance Manager and the facilitys DON; the DON stated she asked the Hospice to e-mail the patients documentation to the SNFs medical records department and then for the Medical Records Department to upload them into the patients chart (record); the DON was informed that the patients record had no current SN notes, the last uploaded documents were from 12/16/24 and the latest Recertification Of Terminal Illness was not on file; the DON stated she did not have any paper documentation from the Hospice for Patient #8 to be uploaded and added that she does not get e-mails with documentation from the Hospice; during the joint interview with the Compliance Manager and Staff C, they were asked again what Hospice documentation the facility should have for Patient #8s medical record and Staff C stated she could not answer that question and will ask her manager and no additional response from Staff C has been received to date. On 02/05/25 at 4:30 PM, an interview was conducted with the Compliance Manager who stated that they have to send documents such as recertification, updated orders and SN visit notes to the facility; will check to see if the Hospice has sent any other documents to the facility after 12/16/24 and the Hospice policy. On 02/06/25 at 10:45 AM, during an interview, the Compliance Manager stated that the latest e-mail to the facility included Patient #8s last IDG (Interdisciplinary Group) review done on 02/04/25, added the last Physician Recertification Of Terminal Illness signed on 12/27/24 has not been sent to the facility. On 02/06/25 at 11:45 AM, during an interview, the Chief of Compliance Officer, and the Vice President/Executive Director were apprised of the findings.”

“Based on review of the Hospice’s Policy and Procedure, record review and interview, the Hospice failed to ensure that their Volunteers’ Background Screening results were added to the Agency For Health Care Administration (AHCA)’s Background Screening Clearinghouse Roster, in accordance with State requirements, for 2 of 2 sampled Volunteers files reviewed (Volunteer #9 and #10). The findings included: 1) Review of the Hospices Policy titled, “;Background and Criminal Screening for Employment effective 12/08/22” documents, “;...all company entities shall conduct appropriate Level 1 or Level 2 criminal background investigations on ...volunteers’ candidates...screening handled through the clearinghouse must now be initiated and registered through the clearinghouse prior to referring...for fingerprinting...”. On 02/05/25 at 9:03 AM, a joint “;Teams” (telephone) interview and side-by-side review of Volunteer #9s electronic file was conducted with the Staff A, Acting Volunteer Coordinator, out of State, Staff B, Regional Volunteer Services Manager, and the Hospices Vice President/Executive Director that reveals Volunteer #9s start date was 10/26/24, a Background Screening was completed with an expiration of their fingerprints on 02/18/28 and an Attestation of Compliance signed on 03/13/23; further review reveals that Volunteer #9 was not added to the AHCA Background Screening Clearinghouse; during the review, Staff B stated the Volunteer Services Manager is supposed to add the Volunteers to the Clearinghouse on their hire date and added that the Volunteers Coordinator and the staff were not trained on how to do it; Staff A and Staff B were asked where Volunteer #9 provided the service hours; Staff B stated the Volunteer did patient home visits; Staff B and the Vice President Executive Director confirmed that Volunteer #9 was not listed in the AHCA Background Screening Clearinghouse in accordance with State requirements. 2) On 02/05/25 at 9:08 AM, a joint “;Teams” (telephone) interview and side-by-side review of Volunteer #10s electronic file was conducted with the Staff A, Acting Volunteer Coordinator, out of State, Staff B, Regional Volunteer Services Manager, and the Hospices Vice President/Executive Director that reveals Volunteer #10s start date was on 12/09/24, had a Background Screening completed with expiration of their fingerprints on 02/21/28 and an Attestation of Compliance signed on 03/20/23; further review reveals that Volunteer #10 was not added to the AHCA Background Screening Clearinghouse; during the review, Staff B stated the Volunteer Services Manager is supposed to add the Volunteers to the Clearinghouse on their hire date and added that the Volunteers Coordinator and the staff were not trained on how to do it; Staff A and Staff B were asked where Volunteer #10 provided the service hours; Staff B stated that Volunteer #10 did patient home visits; Staff B and the Vice President Executive Director confirmed that Volunteer #10 was not listed in the AHCA Background Screening Clearinghouse in accordance with State requirements.”

“Based on review of the Hospice Policy, interview and record review, the Hospice failed to respond to and resolve a voiced grievance, according to their own Policy, for 1 of 3 sampled patients (Patient #1). The findings included: Review of the Hospice Policy titled, “Complaint Resolution-Patient/Caregiver and All Other Individuals” effective 09/19/22 reveals, “Purpose: To set forth guidelines for the resolution of patient concerns, dissatisfaction, or complaints and to protect patient and family rights. ... Policy: ... The Executive Director/Administrator will be informed of situations that may become detrimental to good patient relations and will be committed to maintaining a consistently high level of patient relations. ... Procedure: 1. The organization’s personnel receiving the concerns/Grievances/Complaint will discuss, verbally and in writing, the grievance with the Clinical Supervisor within 72 hours of the alleged grievance.” This Policy further described supplemental actions to be taken by the Hospice provider. During a telephone interview on 11/28/23 at 9:41 AM, the adult family member and patient representative stated she was promised continuous care with “all hands-on deck and plenty of help” for Patient #1, as he became imminent during his final days. The patient representative voiced Patient #1 did not receive 24/7 care from the Hospice provider, stated she was very vocal about her concerns to Hospice staff who made home visits, and made a telephone call to the new person in charge, but never received a return call. Review of the record revealed Patient #1 was admitted to Hospice services on 01/03/23 and passed away at home on 08/13/23. Review of the levels of care revealed Patient #1 was on routine home care from 07/24/23 until his passing. During a telephone interview on 11/28/23 at 2:00 PM, Staff A, Social Worker, confirmed she recalled Patient #1 and volunteered she was very involved with the family, especially the patient representative. When asked if the patient representative voiced any concerns related to care and services, the Social Worker explained the patient representative had been promised continuous care, may have received it for a very short time, but then they had to “pull” the staff as the patient did not meet the criteria. The Social Worker stated she spoke with the “Interim Management at the time, relaying the patient representative’s concerns, but was simply told Patient #1 did not meet criteria for continuous care. During a telephone interview on 11/28/23 at 2:13 PM, Staff B, Certified Nursing Assistant (CNA) and Hospice Aide, confirmed she recalled Patient #1, and volunteered that she met the patient during respite care at the Hospice House, and then cared for him in the home. When asked if the patient representative voiced any concerns related to care and services, the CNA stated she was “a bit upset that they pulled the 24/7 care.” The CNA explained she provided several hours of care on just one occasion, and then was told by the nurse that Patient #1 did not quality for continuous care. The CNA again stated the patient representative was not happy about the lack of 24/7 Hospice staff at the home. The Clinical Manager was asked to locate and provide any grievance or complaint related to Patient #1. On 11/28/23 at 3:00 PM, the Clinical Manager stated there were no documented complaints or grievances for Patient #1. When told both the Social Worker and CNA for Patient #1 knew of the patient representative’s voiced grievance regarding the lack of continuous care, the Clinical Manager agreed there should have been a written grievance and attempted resolution.”