Accord Hospice

“Upon patient record review, 2 of 19 (Patient #5, 15) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #5: Admitted with indwelling Foley catheter. No related problems, goals, interventions. Patient #10: Per initial SN assessment includes that patient needs supplemental continuous oxygen when up; at rest, she needs it from time to time. Further references that patient has history of SpO2 in 70’s. There is no related problems, goals, interventions. Patient 15: Patient has order for Oxygen 2-5 LPM NC with no related problems, goals, interventions. There is a Respiratory problem, but it does not include Oxygen and/or related education/safety precautions as intervention.”

“Upon patient record review, 5 of 19 (Patient #1, 5, 6, 9, 11) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients #5, 6: The POC only includes frequency of SC 3 prn as needed for the initial and ongoing frequency. This is not a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs. Patient #1, 9, 11: The POC only includes frequency of MSW 3 prn as needed for the initial and ongoing frequency. This is not a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs.”

“Upon client record review, 4 of 19 (Patient #2, 7, 9, 16) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: Admitted 11/16/24. Order for music therapy volunteer 2x/mo since initial POC and thru 1/22/25. The notes in record are notes for massage therapy volunteer 11/26 and 12/10/24. There are no additional notes and there is no order to discontinue or evidence that further services were declined. Patient #7: SN Visits 12/16, 12/23, 12/30/24 - SN noted that hip bones and sacral bone covered with Duoderm to prevent any breakdown. No further reference in SN Visit notes 1/6, 1/13, 1/20/25 visits. There are no orders to start, change or stop the Duoderm treatment. Patient #9: A single volunteer visit is documented 12/9/24. There is no order to start or discontinue and no evidence that further visits were declined. Interview with staff state this was a training visit and actually should not have been documented in EMR as actual volunteer visit. Patient #16: Admitted 3/21-6/17/25 with MSW frequency of 1-2/month and duration of 90/qtr. Only 1 visit was made 3/21/24 with no update to orders/POC and no documented decline of further visits.”

“Upon patient record review, 3 of 19 (Patient #17, 18, 19) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients# 17. 18, 19: The bereavement services offered and/or care plan do not clearly reflect the individual needs of the bereaved. There is record of one call to unspecified bereaved, with voice mail left regarding condolences and services available. There is no additional documentation of attempts to assess individual needs/desires for services. There is no clearly identified and individualized bereavement care plan, although routine mailings are sent at intervals.”

“Upon personnel record review, 1 of 15 (Personnel #7) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #7: Agency form does not specify types of bath and/or shampoos and does not specifically include nail care, toileting and elimination therefore no evidence of specific competency for these items for aide.”

“Upon patient record review, 2 of 19 (Patient #2,14) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: Admitted 11/16/24. Aide care plan has frequency of 5x/week. Initial POC has 5x week frequency, but subsequent IDG/POC meetings have Freq 3x/wk since thru 1/22/25. Aide is following aide care plan for 5x week frequency. Patient #14: Patient SOC 11/14/24. 12/24/24 order for Oxygen 2-5 lpm via NC. The problems, goals and interventions were updated, but aide care plan was not updated to include Oxygen therapy, flow rate and/or relate safety precautions.”

“Upon patient client record review, 1 of 19 (Patient #6) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #6: IDG Meeting note entry 1/22/25: “Patient continues to have seizures, however, less frequently.” There was no additional documentation referencing seizure activity. Interview with staff pointed out that patient is actually on seizure medication for history of syncopal episodes, not seizures activity. Conclude that documentation was in error.”

“Based on staff interview, it was determined the Hospice failed to ensure counseling services were available for patients and families. This has the potential to affect all patients and families serviced by the Hospice with a current census of 124 patients. Findings include: 1. During the entrance interview conducted on 05/14/2024 with the Administrator and Director of Operations, the Administrator stated that currently the Hospice does not have a Chaplain or Spiritual Counselor on staff. 2. During an interview with the Director of Operations on 05/14/2024 at approximately 11:00AM, the Director of Operations stated and confirmed that the Hospice has not had a Chaplain or Spiritual Counselor since 12/11/2023.”