All Americans Hospice Care, Inc.

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over the counter (OTC) drugs. 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 10 of 19 (53%) records reviewed, it was revealed that the agency did not ensure the drug profile contained the patient’s current prescription and over the counter (OTC) drugs. Clinical Record 4: The start of care (SOC) assessment dated 10/12/23, documented Oxygen at 2.5 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 5: The SOC assessment dated 9/21/23, documented Oxygen at 5 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. The medication profile included, “Hydrocodone-Acetaminophen 18-325mg oral 1 tablet every 4 hours as needed.” However, there was no indication of use for the “as needed” frequency. Clinical Record 6: The SOC assessment dated 9/19/23, included Oxygen at 3 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 7: The SOC assessment dated 9/7/23, included Oxygen at 2 liters per minute via nasal cannula. The nurse visit note dated 10/31/23, included “zinc oxide to small area on bottom.” However, the medication profile did not include Oxygen, or Zinc Oxide. Clinical Record 8: The SOC assessment dated 7/15/23, included Oxygen at 2 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 9: The SOC assessment dated 7/14/23, included Oxygen at 2 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 11: The SOC assessment dated 8/3/23, included Oxygen at 2 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 15: The SOC assessment dated 9/21/23, included Oxygen at 2 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 17: The SOC assessment dated 8/12/23, included Oxygen at 2 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. Clinical Record 18: The SOC assessment dated 6/17/23, included Oxygen at 2 liters per minute via nasal cannula. However, the medication profile did not include Oxygen. During a record review and interview on 11/9/23, the Director of Patient Care Services confirmed the findings.”

“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 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 6 of 19 (32%) clinical records reviewed, it was revealed that the agency did not ensure that each written plan of care included a detailed statement of the scope and frequency of services. Clinical Record 1: The hospice election of benefit was dated 1/20/23. The plan of care (POC) dated 9/17/23, included “MSW 3 PRN (as needed), SC 5 PRN, and PT 2 PRN.” There was no detail regarding the indication for use of the PRN frequency. Clinical Record 2: The hospice election of benefit was dated 10/30/23. The POC dated 10/30/23, included “MSW 3 PRN, SC 5 PRN.” There was no detail regarding the indication for use of the PRN frequency. Clinical Record 3: The hospice election of benefit was dated 9/29/23. The POC dated 9/29/23, read in part, “MSW 3 PRN, SC 5 PRN.” There was no detail regarding the indication for use of the PRN frequency. Clinical Record 4: The hospice election of benefit was dated 10/12/23. The POC dated 10/12/23, included “MSW 3 PRN, SC 5 PRN.” There was no detail regarding the indication for use of the PRN frequency. There were nursing visits documented weekly for the following dates: 10/12/23, 10/16/23, 10/26/23, 11/2/23, and 11/6/23. However, the POC Clinical Record 5: The hospice election of benefit was dated 9/21/23. The POC dated 9/21/23, included “MSW 3 PRN SC 5 PRN.” There was no detail regarding the indication for use of the PRN frequency. Clinical Record 7: The hospice election of benefit was dated 9/7/23. The POC dated 9/7/23, included “MSW 3 PRN, SC 5 PRN.” There was no detail regarding the indication for use of the PRN frequency. During an interview on 11/9/23, the Director of Patient Care Services confirmed the finding and stated that, the specific frequencies had inadvertently been omitted.”

“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 drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 5 of 19 (26%) clinical records reviewed, it was revealed that the agency did not ensure the written plan of care included all of the patient’s drugs and treatment. Clinical Record 7: The nurse visit note dated 10/31/23, documented “zinc oxide to small area on bottom.” The plans of care (POC) dated 10/4/23 and 10/18/23, did not include wound care orders. Clinical Record 9: The revised POC dated 9/4/23, included: “Clean pressure ulcer with wound cleanser, pat dry, cover with exuderm dressing, change every 3-5 days and as needed.” There was no indication of use for the as needed frequency. Clinical Record 12: The start of care (SOC) assessment dated 10/5/23, included wound care orders for a right forearm skin tear that read, “Cleanse with saline cleanser, apply triple antibiotic ointment and leave open to air during the day. At night cleanse with saline cleanser, cover with nonadherent dressing, wrap with ace bandage to hold in place. Wound care to be done daily and at bed time until healed.” However, the POC dated 10/5/23, did not include wound care. Clinical Record 18: The SOC assessment dated 6/17/23, included a PEG tube and a tracheostomy. However, the POC dated 6/17/23, did not include a PEG tube or tracheostomy care. During a record review and interview on 11/9/23, the Director of Patient Care Services confirmed the findings.”

“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. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. The bereavement services reflect the needs of the bereaved per a bereavement plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. In 3 of 3 (100%) clinical records reviewed, with the provision of bereavement services, the agency did not ensure that the post death bereavement assessment was completed per agency policy. Agency policy H:2-053, Bereavement Assessment, stated in part, “ After death occurs, the hospice Social Worker or Bereavement Coordinator will complete the bereavement follow-up assessment ... The Bereavement Coordinator will develop a plan for intervention based on the findings of the bereavement follow-up assessment.” Agency policy H:2-008, Bereavement Services, stated in part, “After a death has occurred, the bereavement assessment will be updated, and the family/caregiver needs will be discussed at the next interdisciplinary group meeting ... Bereavement interventions will be reflective of the family/caregiver’s choices to participate in the bereavement program.” Clinical Record 15: The hospice election of benefit was dated 9/21/23. The initial bereavement assessment was dated 9/22/23. The date of patient death was documented as 9/28/23. There was documentation of post death interdisciplinary discussion and a bereavement care plan dated 10/2/23. However, there was no documentation of a post death updated bereavement assessment. Clinical Record 16: The hospice election of benefit was dated 10/2/23. The initial bereavement assessment was dated 10/3/23. The date of patient death was documented as 10/16/23. There was documentation of post death interdisciplinary discussion and a bereavement care plan dated 10/18/23. However, there was no documentation of a post death updated bereavement assessment. Clinical Record 17: The hospice election of benefit was dated 8/12/23. The initial bereavement assessment was dated 8/15/23. The date of patient death was documented as 8/23/23. There was evidence of post death interdisciplinary discussion and a bereavement care plan dated 8/25/23. However, there was no documentation of a post death updated bereavement assessment. During a record review and interview on 11/9/23, the Director of Patient Care Services confirmed the finding and stated that, the post death bereavement assessments had inadvertently been omitted.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in 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, that included the provision of aide services, it was revealed that the agency did not ensure the hospice aide provided services included in the plan of care. Clinical Record 8: The aide plan of care (POC) dated 9/8/23, included an aide visit frequency of 2 x week. However, there was only one visit documented for the weeks of 9/8/23 and 9/23/23, which were dated 9/8/23 and 9/23/23. There was no documentation of explanation as to why services were not provided as ordered. Clinical Record 10: The aide POC dated 9/26/23, included an aide visit frequency of 2 x week. There was no documentation of aide visits for the week of 9/26/23. There was no documentation of explanation as to why services were not provided as ordered. Clinical Record 14: The aid POC dated 10/27/23, included an aide visit frequency of 2 x week. There was only one visit documented the week of 10/27/23, which was dated 10/27/23. There was no documentation of explanation as to why services were not provided as ordered. Clinical Record 15: The aide POC dated 9/2/23, included an aide visit frequency of 2 x week. There was only one visit documented the week of 9/21/23, which was dated 9/21/23. There was no documentation of explanation as to why services were not provided as ordered. During a joint record review and interview on 11/9/23, the Director of Patient Care Services confirmed the finding.”