Palm Beach Hospice and Palliative Care By Morselife

“It is required that the patient’s pain is assessed as part of a comprehensive assessment. Assessment of pain in children and adolescents is conducted with consideration of age and neurocognitive development. The documented assessment of the patient’s pain includes history of pain and its treatment, both pharmacological and non-pharmacological, use of a standardized pain assessment tool appropriate to the patient’s developmental and cognitive status, characteristics of the pain, including location, frequency, and intensity, how pain impacts the patient’s ability to engage in usual activities and function (e.g., appetite, sleeping), and the patient’s/family’s goals for pain management and their satisfaction with the current level of pain control. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the patient’s pain was assessed as part of the comprehensive assessment. Clinical Record 5: The patient elected the hospice benefit on 12/27/2024 with a terminal diagnosis of Parkinson’s Disease. The Registered Nurse documented on the comprehensive assessment dated 12/27/2024 that the patient had dementia and was unable to answer questions. The comprehensive assessment completed at the start of care did not include an assessment of the patient’s pain. There was no documented evidence that the nurse completed a pain assessment or that the nurse used a non-verbal pain assessment tool to assess the patient’s pain level. Clinical Record 18: The patient elected the hospice benefit 11/18/2024 with a terminal diagnosis of dementia. The start of care comprehensive assessment completed by the Registered Nurse on 11/18/2024 did not include an assessment of the patient’s pain. Clinical record review revealed the patient had Morphine concentrate ordered at the start of care at 100mg/5ml 5mg every 4 hours and the patient was receiving the medication. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed that the start of care comprehensive assessments did not include a pain assessment for the patient.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a Registered Nurse (RN) as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Hospice Aide reported a change in the patient’s needs to the Registered Nurse. Clinical Record 7: The patient elected the hospice benefit on 07/25/2024 with a terminal diagnosis of Alzheimer’s Disease. The hospice aide care plan dated 12/30/2024 included an order for hospice aide visit frequency four times per week. The Hospice Aide documented a missed visit on the aide visit note dated 01/01/2025. However, there was no documented evidence that the Hospice Aide reported the missed visit to a Registered Nurse During an interview and record review on 02/13/2025, the QAPI [Quality Assurance Performance Improvement] Registered Nurse confirmed that the record did not include documentation that the RN was notified of the missed visit.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed with patient discharge or revocation, the agency did not ensure the hospice discharge summary included a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. Clinical Record 14: This patient elected the hospice benefit on 12/29/2023 with a terminal diagnosis of amyotrophic lateral sclerosis. The patient revoked the hospice benefit on 02/25/2024. The hospice discharge summary sent to the patient’s attending physician dated 02/25/2024 did not include a summary of the patient’s hospice stay. Clinical Record 15: This patient elected the hospice benefit on 04/12/2024 with a terminal diagnosis of exocrine pancreatic insufficiency. The patient was a live discharge on 10/08/2024. The hospice discharge summary sent to the patient’s attending physician dated 10/08/2024 did not include a summary of the patient’s hospice stay. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed that the discharge summaries sent to the patient’s attending physician did not include a summary of the patient’s hospice stay.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: the patient’s current plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed with patient discharge or revocation, the agency did not ensure the hospice discharge summary included the patient’s current plan of care. Clinical Record 14: This patient elected the hospice benefit on 12/29/2023 with a terminal diagnosis of amyotrophic lateral sclerosis. The patient revoked the hospice benefit on 02/25/2024. The hospice discharge summary sent to the patient’s attending physician dated 02/25/2024 did not include a summary of the patient’s current plan of care. Clinical Record 15: This patient elected the hospice benefit on 04/12/2024 with a terminal diagnosis of exocrine pancreatic insufficiency. The patient was a live discharge on 10/08/2024. The hospice discharge summary sent to the patient’s attending physician dated 10/08/2024 did not include a summary of the patient’s current plan of care. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed that the discharge summaries sent to the patient’s attending physician did not include a summary of the patient’s plan of care.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: the patient’s latest physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed with patient discharge or revocation, the agency did not ensure the hospice discharge summary included the patient’s latest physician orders. Clinical Record 14: This patient elected the hospice benefit on 12/29/2023 with a terminal diagnosis of amyotrophic lateral sclerosis. The patient revoked the hospice benefit on 02/25/2024. The hospice discharge summary sent to the patient’s attending physician dated 02/25/2024 did not include a summary of the patient’s latest physician orders. Clinical Record 15: This patient elected the hospice benefit on 04/12/2024 with a terminal diagnosis of exocrine pancreatic insufficiency. The patient was a live discharge on 10/08/2024. The hospice discharge summary sent to the patient’s attending physician dated 10/08/2024 did not include a summary of the patient’s latest physician orders. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed that the discharge summaries sent to the patient’s attending physician did not include a summary of the patient’s latest physician orders.”

“It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IID representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review, observation, and interview. In 3 of 3 (100%) clinical records reviewed for patients that resided in a skilled nursing facility (SNF), the agency did not ensure the hospice plan of care specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 11/18/2024 with a terminal diagnosis of Alzheimer’s Disease. The patient resided in a SNF. The hospice plan of care did not include documentation to specify which provider was responsible to perform the functions included in the patient’s plan of care. Clinical Record 13: The patient elected the hospice benefit on 01/05/2025 with a terminal diagnosis of benign neoplasm of meninges. The patient resided in a SNF. The hospice plan of care did not include documentation to specify which provider was responsible to perform the functions included in the patient’s plan of care. Clinical Record 18: The patient elected the hospice benefit on 11/18/2024 with a terminal diagnosis of Dementia. The patient resided in a SNF. The hospice plan of care did not include documentation to specify which provider was responsible to perform the functions included in the patient’s plan of care. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed the hospice plans of care for patients that were in Skilled Nursing Facilities did not include which provider was responsible for performing the functions that were included in the plans of care.”