Chicago Hope & Palliative Healthcare Inc.

“It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, the agency did not ensure the individualized written plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessment. Clinical Record 6: The patient elected the hospice benefit on 09/12/2024. The plan of care dated 09/12/2024 through 12/09/2024 included an order for “Social Work 1 time monthly.” The plan of care did not include patient specific interventions related to the patient’s psycho-social status and assessment. Clinical Record 10: The patient elected the hospice benefit on 03/14/2024. On 03/14/2024, the physician ordered: “Xarelto [anticoagulant medication with side effect of increased risk of bleeding] 10 mg tablet by mouth daily.” The plan of care dated 03/14/2024 through 07/11/2024 did not include interventions related to the patient being at risk for bleeding. Clinical Record 12: The patient elected the hospice benefit on 07/24/2024. On 07/24/2024, the physician ordered: “Eliquis [anticoagulant medication with side effect of increased risk of bleeding] 2.5 mg tablet by mouth every 12 hours.” The plan of care dated 07/24/2024 through 10/21/2024 did not include interventions related to the patient being at risk for bleeding. Clinical Record 14: The patient elected the hospice benefit on 07/18/2024. On 07/18/2024, the physician ordered: “Eliquis 2.5 mg tablet by mouth every 12 hours and Norco 10mg-325mg tablet every 6 hours as needed for pain.” The plan of care dated 07/18/2024 through 10/15/2024 did not include interventions related to pain or the patient being at risk for bleeding. During an interview and review of records on 11/26/2024, the Director of Nursing confirmed the plans of care did not include interventions for pain, bleeding risk, and psycho-social needs.”

“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 14 (29%) clinical records reviewed, the agency did not ensure the individualized plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 6: The patient elected the hospice benefit on 09/12/2024. The plan of care dated 09/12/2024 through 12/09/2024 included an order for “Social Work 1 time monthly.” The plan of care did not include measurable outcomes associated with psycho-social interventions. Clinical Record 10: The patient elected the hospice benefit on 03/14/2024. On 03/14/2024, the physician ordered: “Xarelto [anticoagulant medication with side effect of increased risk of bleeding] 10 mg tablet by mouth daily.” The plan of care dated 03/14/2024 through 07/11/2024 did not include measurable outcomes associated with interventions related to the patient being at risk for bleeding. Clinical Record 12: The patient elected the hospice benefit on 07/24/2024. On 07/24/2024, the physician ordered: “Eliquis [anticoagulant medication with side effect of increased risk of bleeding] 2.5 mg tablet by mouth every 12 hours.” The plan of care dated 07/24/2024 through 10/21/2024 did not include measurable outcomes associated with interventions related to the patient being at risk for bleeding. Clinical Record 14: The patient elected the hospice benefit on 07/18/2024. On 07/18/2024, the physician ordered: “Eliquis 2.5 mg tablet by mouth every 12 hours and Norco 10mg-325mg tablet every 6 hours as needed for pain.” The plan of care dated 07/18/2024 through 10/15/2024 did not include measurable outcomes associated with interventions related to pain or the patient being at risk for bleeding. During an interview and review of records on 11/26/2024, the Director of Nursing confirmed the plans of care did not include measurable outcomes from interventions utilized for pain, bleeding risk, and psycho-social needs.”

“It is required that hospice aides are assigned to a specific patient by a Registered Nurse (RN) 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 5 of 14 (36%) clinical records reviewed with aide services provided, the agency did not ensure the hospice aide was provided with patient specific care instructions. Clinical Record 4: The patient elected the hospice benefit on 09/24/2024. The initial nursing assessment dated 09/24/2024 included documentation that the “Patient has a history of seizures.” The clinical record included a physician order dated 09/24/2024 for “Aide services 2 times per week.” The aide care plan assignment dated 09/24/2024 did not include instructions to the aide regarding the patient’s history of seizures and/or seizure precautions. Clinical Record 7: The patient elected the hospice benefit on 07/15/2024. The clinical record included a physician order dated 07/15/2024 for wound dressing changes to the patient’s PleurX catheter [small flexible catheter that a doctor places within the patient’s chest to drain fluid from the pleural space around the lungs] site and included an order for “Aide services 2 times per week.” The hospice aide care plan dated 07/15/2024 assigned the aide the tasks of “Bed bath at every visit.” The aide care plan did not include instructions to the aide related to the PleurX catheter dressing, including how to care for the dressing during a bath and what to do should the dressing become wet or dislodged during the bed bath. Clinical Record 8: The patient elected the hospice benefit on 05/24/2024. The clinical record included a physician order dated 05/24/2024 for wound care and wound dressing changes to a wound on the patient’s right leg. On 05/28/2024, the physician ordered “Aide services 3 times per week.” The aide care plan dated 05/28/2024 assigned the aide the task of “Bed bath at every visit.” The aide care plan did not include instructions to the aide related to the patient’s right leg wound dressing, including how to care for the dressing during a bath and what to do should the dressing become wet or dislodged. Clinical Record 12: The patient elected the hospice benefit on 07/24/2024. The clinical record included a physician order dated 07/24/2024 for wound care with wound dressing changes to wounds on the patient’s right leg, right knee, right buttock, and right elbow and included an order for “Aide services 3 times per week.” The aide care plan dated 07/24/2024 assigned the aide the task of “Bed bath at every visit.” The aide care plan did not include instructions to the aide related to the patient’s right leg, right knee, right buttock, and right elbow wound dressings, including how to care for the dressings during a bath and what to do should the dressing become wet or dislodged. Clinical Record 13: The patient elected the hospice benefit on 08/28/2024. The clinical record included a physician order dated 08/28/2024 for wound care with wound dressing changes to wounds on the patient’s bilateral hips, sacrum, left hand, and bilateral legs and included an order for “Aide services 3 times per week.” The aide care plan dated 08/28/2024 assigned the aide the task of “Bed bath at every visit.” The aide care plan did not include instructions to the aide related to the patient’s bilateral hip, sacrum, left hand, and bilateral leg wound dressings, including how to care for the dressing during a bath and what to do should the dressing become wet or dislodged. During an interview and review of records on 11/26/2024, the Director of Nursing confirmed that the aide care plans did not include wound dressing instructions or seizure precautions.”