Hope Hospice, Inc.

“Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to respect the patient’s right to participate in decisions about their care, treatment, or services. On review of HosRRHV#2 the patient representative elected to receive the Notice of Non-Covered Items, Services, and Drugs addendum. The form was presented and signed by the patient representative on the day of admission, however the form did not list the drugs that were determined, per the record, to not be covered such as Losartan, Aspirin, Gemfibrozil, and Nifedipine. The form also noted that lab tests, x-ray, PT, OT, and ST would not be covered by hospice, yet per regulations, the services could be included in a patient’s individualized plan of care as appropriate and determined by the IDG. Similar findings were noted as non-covered drugs were not listed and a similar statement of non covered testing and treatments was noted in all active records reviewed. These observations were reviewed with the Hospice Clinical Manager and discussion occurred that noted the hospice had the ability to provide the services as needed, but did not fully understand the form and was completing incorrectly. Observed in Record Review. In 1 of 2 patient records reviewed, for live discharge, the organization failed to respect the patient’s right to participate in decisions about their care, treatment, or services. On review of HosRRDC#1 who was discharged for extended prognosis, the Notice of Medicare Non-Coverage was completed and signed on the day of discharge and not at least 2 days prior as required. This observation was reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to document a patient specific comprehensive assessment and reassessment to identify the patient’s need for hospice care and services. On review of HosRRNHV#10 there was documentation of 7 wounds on admission. In subsequent skilled nursing visits after admission there was only documentation of assessment of 3 wounds: the rt. thigh, rt. midaxillary, and sacrum. There was no assessment of the other 4 wounds documented which were to the foot, knee and rt. and lt. hip. This observation was reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that were specific, measurable, and time-bound. On review of all clinical records there were goals that were not individualized, specific and measurable. In HosRRHV#1 an example of a non-specific, not measurable goals was patient will be reoriented when confusion presents itself and Reduction of spiritual distress. In HosRRHV#2 an example was the caregiver will be knowledgeable with nutritional changes as the patient declines. Further, in HosRRHV#2 all goals were not individualized as they were all to be achieved within 1 certification period. In HosRRHV#3 an example of a goal that was not specific or measurable was Patient will re-establish normal bowel functioning. Further example of goals that were not individualized, specific and measurable could be seen in HosRRNHV#4, HosRRNHV#5, HosRRNHV#6, HosRRNHV#7, HosRRNHV#8, HosRRNHV#9, and HosRRNHV#10. This observation was reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 2 of 10 patient records reviewed, The organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. On review of HosRRHV#3 the patient had a 5 day respite stay in a skilled nursing facility in August yet the stay was not reflected in the plan of care. In HosRRHV#4 the patient had active pain per documentation and had orders for scheduled oxycodone but there was no care plan to address pain. These observations were reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 8 of 10 patient records reviewed, the organization failed to ensure plan of care revision were based on information from updates to the patient’s comprehensive assessment and address the patient’s progress toward goals and outcomes. On review of the clinical records there was a pattern noted on care plan goals and interventions that were repeated benefit period to benefit period without update or revision based on changes from the comprehensive assessment. Most goals were established with a target date of within 1 certification (cert) period yet on the next certification period the same goal and interventions remained unchanged. An example of a goal that was not updated in HosRRHV#2 was caregiver will verbalize understanding of interventions to prevent and manage constipation. The goal was to be achieved within 1 certification period yet remained unchanged cert to cert. HosRRNHV#5 had a goal stating Caregiver/facility staff will verbalize understanding of oxygen safety, including proper use, storage, and precautions to be achieved within 1 month yet it remained an active goal not updated, based on comprehensive assessment, from cert to cert. Further examples of care plans that remained active without update based on the comprehensive assessment could be seen in HosRRHV#1, HosRRHV#3, HosRRNHV#4, HosRRNHV#6, HosRRNHV#8, HosRRNHV#9. These observations were reviewed with the Administrator, and Hospice Clinical Manager.”

“Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. In review of HosRRNHV#10 there was documentation of 7 wounds with corresponding wound treatments ordered per the plan of care. There was no documentation in the record that the wound care for wounds numbered 4, 5, 6, and 7 were performed as ordered. In the record the wound care for wounds #1, 2, and 3 was documented each nursing visit but there was no documentation that the remaining wounds were addressed as ordered. This observation was reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 5 of 10 patient records reviewed, the organization failed to ensure the RN provided written patient care instructions for the hospice aide. On review of HosRRHV#3 there was documentation the patient had a wound to the back, yet there were no specific instructions to the aide as to how to handle the wound/dressing while providing care. In review of HosRRNHV#5 and HosRRNHV#6 there was documentation of wounds with wound treatment, yet no instructions for the aide on how to handle the wounds. In HosRRHV#7 the patient was on continuous oxygen but there was no indication if the aide could remove the oxygen while care was provided. Similar lack of specific instructions could be seen in HosRRNHV#10 as there were multiple wounds with treatments and continuous oxygen, yet no specific instructions to guide the aide while providing care. These observations were reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to maintain complete and accurate clinical records as conflicting documentation was noted in the record. On review of HosRRHV#1 the care plan for oxygen safety noted a description that patient continues to smoke with oxygen, however on review of the clinical record and the oxygen safety risk assessment there is clear documentation that there is no smoking going on the patient home. Also, on home observation there was no indication of smoking such as smoke smell or smoking materials noted in the home. This observation was reviewed with the Hospice Clinical Manager.”

“Observed in Record Review. In 1 of 6 patient records reviewed, the update of the comprehensive assessment was based upon changes that took place since the initial assessment, but did not include information about the patient’s progress toward desired outcomes and a reassessment of the patient’s response to care. In the chart for HSRRNHV#5, the MSW documented that the patient refused further MSW visits and would be removed from the plan of care. At the next IDG, the frequency of MSW had been removed, however the note input into the meeting was from 2 months prior to the IDG and there was no information about the patient’s desire to stop MSW services nor the progress or lack of progress toward social work goals. This was discussed with the Hospice Clinical Manager.”