Catholic Hospice Inc.

“It is required that the documented comprehensive assessment includes the drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 1 of 35 (3%) clinical records reviewed revealed that the agency did not ensure that the medication profile was updated to include indication for as needed medications. CLINICAL RECORD 7: The patient elected the hospice benefit on 11/21/2024 with malignant neoplasm of cervix. The Plan of Care for the certification period of 11/21/2024 to 02/18/2024 included the following medications: Ondansetron 4mg PO every six hours as needed, Acetaminophen 325mg PO every six hours PRN, Oxygen 2 LPM PRN, Oxycodone 10 mg PO every four hours, and Loperamide 2 mg PO every four hours as needed. There was no documented evidence that the plan of care included a description of the patient’s medical signs and symptom for the as-needed medication. In an interview with the clinical director, it was agreed that the medication profile was incomplete.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following, intervention to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 6 of 27 (22%) clinical records reviewed of patient receiving services in private residence or skilled nursing facilities revealed that the agency did not ensure there were documented interventions to manage pain and systems on the plan of care. CLINICAL RECORD 1: The patient elected the hospice benefit on 12/29/2021. The certification period 10/14/2024-12/12/2024 was reviewed. In the comprehensive assessment dated 10/14/2024 the RN documented “patient’s restlessness continues mainly in the afternoon, oxygen 3L via nasal cannula for anxiety/agitation, with more frequently using Haldol, Quetiapine ordered, lorazepam, and pain medication as needed.” In the RN note of the IDT meeting dated 10/23/2024 the RN documented, “increased anxiety/agitation, using medication to control, using Haldol, Lorazepam, increased dysphagia resulting in recent weight loss.” On the most recent plan of care dated 10/23/2024 there was no documented evidence of planned interventions based on problems identified in the IDT meeting dated 10/23/2024. CLINICAL RECORD 5: The patient elected the hospice benefit on 02/21/2024. In an RN IDT note dated 12/11/2024 the RN documented that the patient had dysphagia and high aspiration risk. A problem of anorexia and dysphagia was identified on the plan of care dated 10/18/2024-12/16/2024. There were no planned interventions documented for these problems identified. CLINICAL RECORD 8: The patient elected the hospice benefit on 10/08/2024, The Plan of Care (POC) for the certification period 10/08/2024 to 01/05/2025 included Levetiracetam 250mg by mouth twice daily (anticonvulsant). The POC did not include seizure precautions or any planned interventions to manage possible seizures. CLINICAL RECORD 12: The patient elected the hospice benefit on 05/24/2023 with cerebral atherosclerosis. The Plan of Care (POC) for the certification period of 09/15/2024 to 11/13/2024 included Eliquis (anticoagulant) 5 mg twice daily. The plan of care did not include bleeding precautions or any planned interventions to prevent or treat any bleeding issues. CLINICAL RECORD 22: The patient elected the hospice benefit on 03/25/2023. The plan of care dated 11/27/2024 in certification period 11/20/2024 -01/18/2025 identified problems of pain and shortness of breath at times. There was no documented evidence of planned interventions based on problems identified. CLINICAL RECORD 28: The patient elected the hospice benefit on 12/10/2024. On an RN assessment dated 12/11/2024 the RN documented “PO meds given; patient swallowed with great difficulty”. The RN assessment dated 12/13/2024 also specified that patient suffered from dysphasia. On the plan of care update on 12/12/2024 there was no documented evidence of planned interventions based on problems identified in the updated assessments. In the RN assessment dated 12/11/2024 the RN documented “Multiple bruises, scratches, and scabs noted all around the patient’s body”. On the plan of care dated 12/12/2024 there was no documented evidence of planned interventions based on the dysphasia and the skin integrity problem identified. In an interview and joint review of the clinical records with the clinical director she agreed that the plans of care did not include interventions based on problems identified in the comprehensive assessments.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. This standard was not met as evidenced by clinical record review and interview. In 4 of 35 (11%) clinical records reviewed revealed that the agency did not ensure that the plan of care included a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. CLINICAL RECORD 9: The patient elected the hospice benefit on 07/11/2024. The clinical record for the certification period dated 07/11/2024 - 10/08/2024 included volunteer notes on 10/03/204 and 10/08/2024. There was no documented evidence on the plan of care of a detailed statement of volunteer services needed to meet patient and family needs. CLINICAL RECORD 11: The patient elected the hospice benefit on 12/29/2021. The clinical record for the certification period of 08/11/2024 to 11/08/2024 included volunteer visit notes for 08/13, 08/14, 08/15, 9/18 (two notes for this date), 09/19 (four notes for this date), 09/20 (four notes for this date), and 09/23/2024 (four notes for this date). There was no documented evidence on the plan of care dated 08/11/2024 of a detailed statement of volunteer services needed to meet patient and family needs. CLINICAL RECORD 17: The patient elected the hospice benefit on 08/13/2023. On the initial RN assessment, it was documented that the patient was to receive physical therapy. Visits were made by physical therapy on 08/19/2024 for evaluation and again on 08/27/2024 and 08/29/2024. There was no documented evidence of a detailed statement of the service necessary to meet patient needs, or scope and frequency of the service on the plans of care dated 08/15/2024, 08/22/2024, and 09/05/2024. CLINICAL RECORD 21: The patient elected the hospice benefit on 07/27/2023. The plan of care dated 07/27/2023 ordered “Nursing/APRN/HLPN: (PRN) 25 visits starting 09/19/2023 (week 11) Reason for PRN: follow up.” In an interview with the clinical director, she stated “this is a generic reason they put for as needed visits, so it covers everything.” In an interview on 12/20/2024 with the clinical director she agreed that the needed services to meet patient and family needs were missing from the plan of care.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 35 (11%) clinical records reviewed revealed that the agency did not ensure that the plan of care included measurable outcomes anticipated from implementing the plan of care. CLINICAL RECORD 2: The patient elected the hospice benefit on 05/23/2023. Certification period 11/13/2024-01/11/2025 was reviewed. On the plan of care dated 11/13/2024 the RN identified a problem of “RN noted a deep tissue injury in the right hip.” During joint review and interview with the Director of clinical care there was no documented evidence found on the plan of care of measurable outcomes anticipated form implementing and coordinating the plan of care for integumentary. CLINICAL RECORD 22: The plan of care dated 11/27/2024 in certification period 11/20/2024 -01/18/2025 identified problems of pain and shortness of breath at times. There was no documented evidence of measurable outcomes anticipated from implementing and coordinating the plan of care. CLINICAL RECORD 28: The patient elected the hospice benefit and admitted as GIP on 12/10/2024. On the plan of care dated 12/10/2024 problems of agitation and safety were documented, however there was no documented evidence of any measurable outcomes anticipated from implementing the plan of care related to these problems. CLINICAL RECORD 30: The patient elected the hospice benefit on and admitted GIP on 12/11/2024. A care plan created on 12/16/2024 identified pain management, the RN documented “patient c/o pain 7/10 in abdomen and chest, grimacing, and is restlessness.” There is no documented evidence of measurable outcomes anticipated from implementing interventions on the plan of care. The goal created stated “patient’s pain will be controlled within limits of disease.””

“It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. In 4 of 4 (100%) clinical records reviewed that were on the bereavement program revealed that the agency did not ensure that a bereavement plan of care was developed by the qualified professional responsible for the bereavement program. CLINICAL RECORD 26: The patient elected the hospice benefit on 05/28/2024 and expired on 07/04/2024. There was no documented evidence of a bereavement plan of care or post-death bereavement risk assessment. There was a phone call made to bereaved on 07/05/2024 and 07/24/2024 with no answer and message left. There was a card sent on 07/05/2024. There was no documented evidence of any other follow up made. CLINICAL RECORD 27: The patient elected the hospice benefit on 05/06/2024 and expired on 07/18/2024. There was one call documented on 07/18/2024 that was made to the bereaved and a card sent. There was no documented evidence of a bereavement plan of care or any other follow up made to the bereaved. CLINICAL RECORD 25: The patient elected the hospice benefit on 04/09/2024 and expired on 08/14/2024. There was no documented evidence of a bereavement plan of care, or any contact made with the bereaved until 08/14/2024, 4 months after the patient expired. A call was made on 08/14/2024 with no answer, and 08/29/2024 with no answer and a message left. No other contact was found. CLINICAL RECORD 24: The patient elected the hospice benefit on 07/30/2024 and expired on 08/16/2024. THer was no documented evidence of a bereavement plan of care, or any contact made with the bereaved until 12/18/2024, 5 months after the patient expired. There was one documented phone call made on 12/18/20204 with no answer and message left. In an interview on 12/20/2024 with the clinical directors and the bereavement coordinator they all agreed that the bereavement plan of care should be included in the patient record.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 3 of 28 (11%) clinical records reviewed did not ensure that there were written patient care instructions for the hospice aide. CLINICAL RECORD 2: The hospice patient elected the hospice benefit on 05/23/2024. The plan of care dated 11/13/2024-01/11/2024 included an order aide visit for 7 times a week for 9 weeks (7xwx9). The patient had an unstageable deep tissue wound documented on her sacrum. On the aide plan of care dated 11/15/2024 a shower and shampoo hair were ordered with no notification of wound on sacrum or instructions for soiled or dislodged dressing. CLINICAL RECORD 7: The patient elected the hospice benefit on 11/21/2024. The plan of care dated 11/21/2024 to 02/18/2025 included aide services with bed baths. The patient was on oxygen 2LPM as needed and had nephrostomy tubes that required dressings and draining. The aide care plan dated 11/25/2024 did not include oxygen precautions or notification of the nephrostomy tubes. There were no documented instructions for aide in a situation that the dressings for tubes or tubes themselves needed attention. The Plan of Care dated 11/21/2024 to 02/18/2025 included Eliquis (anticoagulant) 5 mg twice daily. There were no specific instructions or precautions on the aide plan of care for bleeding precautions. CLINICAL RECORD 16: The patient elected the hospice benefit on 11/12/2024. The Plan of Care for the certification period 10/06/2024 to 12/04/2024 included Levetiracetam (anticonvulsant) 1000mg twice daily. The aide care plan dated 11/13/2024 did not include seizure precautions or instructions on when to notify the RN in the situation of patient having a seizure. In an interview and joint review of the clinical record on 12/20/2024 with the Director of Clinical she agreed that the aide plan of care should include written instructions for the aide to follow when the patient has special needs.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed for patients that received physical therapy services revealed the agency did not ensure that the patient’s record included physician’s order for physical therapy services. CLINICAL RECORD 17: The patient elected the hospice benefit on 08/13/2024 with a diagnosis of heart disease. A review of the clinical record included documentation for visits made by the physical therapist on the dates of 08/19/2024, 08/27/2024 and 08/2029. There was no documented evidence of a physician’s order for physical therapy. In an interview and joint review of clinical record with director of clinical (Personnel Record 11), she was unable to locate a physician’s order for physical therapy in the clinical record.”