Valley Hospice Care

“Upon patient record review, 3 of 14 (Patients #1, 6 and 10) did not contain evidence of a current/comprehensive Medication Profile: Patient #1: During the Surveyor-attended home visit on 12/19/23 it was noted that the patient used Oxygen 2 l.p.m. p.r.n. at bedtime. This was not included on the current Medication Profile. Patient #6: The Medication Profile included, “Debrox. Instill 5 drops into the affected ear B.I.D., x3 days maximum for ear wax build-up.” This medication does not indicate which ear to instill into. Patient #10: The POC dated 10/01-12/29/23 noted, “Oxygen 3 l.p.m. via nasal cannula.” The Medication Profile did not include Oxygen.”

“Upon patient record review, 1 of 14 (Patient #8) did not contain evidence that the Comprehensive Assessment included a Bereavement Risk Assessment component, which includes the needs of the patient’s family and other individuals; focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial Bereavement Risk Assessment is incorporated into the Plan of Care and is considered in the Bereavement Plan of Care. The Clinical Manager was not able to locate documented evidence that this assessment was conducted as a part of the Comprehensive Assessment.”

“Upon patient record review, 8 of 14 (Patients #4, 5, 6, 7, 9, 10, 11, and 12) did not contain evidence that the Hospice had 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: Patients #4, 6, 7, 9, 10, 11, 12: Advance Directives and code status was not present on initial plan of care. Patient #5: The POC dated 07/12-10/09/23 included, “Physical Therapy to Evaluate and Treat.” There was no evidence located that these services had been provided. Yet, this same order remained on all subsequent Plan(s) of Care up to and including the POC dated 12/09/23-02/06/24.”

“Upon patient record review, 5 of 14 (Patients #1, 3, 6, 7, and 10) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #1: During the Surveyor-attended home visit on 12/19/23 it was noted that the patient used Oxygen 2 lpm p.r.n. at bedtime. This was not included on the current POC. Patient #3: The POC dated 11/07/23-01/05/24, and the IDG POC dated 12/08/23 both included, “Wound care to coccyx wound each visit.” This is not a complete treatment order, as it does not include the details of such wound care, nor if the staff of the Adult Forster Care Home is to provide such wound care in the absence of the Hospice nurse. Patient #6: The POC included, “Debrox. Instill 5 drops into the affected ear B.I.D x3 days maximum for ear wax build-up.” This does not indicate which ear to instill into. Patient #7: The IDG POC dated 12/08/22 included, “Patient wearing Oxygen at night”, without the details of such Oxygen order. Patient #10: The POC dated 10/01-12/29/23 noted, “Oxygen 3 l.p.m. via nasal cannula.” This is missing whether the Oxygen is to be used p.r.n. or continuously.”

“Upon patient record review, 2 of 14 (Patients #1 and 2) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: During Surveyor-attended home visit on 12/19/23 the patient was noted to have/use a cane. This was not included on the POC. Patient #2: During Surveyor-attended home visit on 12/20/23 the patient was noted to have: 1) Shower bench; and 2) Toilet Riser. These were not included on the POC.”

“Upon patient record review, 5 of 14 (Patients #1, 2, 3, 5, and 7) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #1: The 12/08/23 IDG POC RN notes, “Ordered PT to help reduce pain”, with a Physician order to “Evaluate and Treat.” There was no evidence located that these services had been provided. Patient #2: The POC dated 10/12/23 noted a new skin tear on bilateral lower extremities. The 10/12/23 SN visit note documented, “Upon arrival the patient presented with blood running down his legs. The ALF staff were not aware of this when brought to their attention. I cleansed the wounds with wound wash, applied Zeroform gauze, ABD, then Kerlix.” There was no order for this wound care on the POC. Patient #3: The POC dated 11/07/23-01/05/24 included an order for SW visits 1x per month. There was no documented evidence of any SW visits in November. Patient #5: The POC dated 07/12-10/09/23 included, “Physical Therapy to Evaluate and Treat.” There was no evidence located that these services had been provided. The POC dated 10/10-12/08/23 included, “Volunteer weekly visits for companionship.” There were no Volunteer visits made the week of November 19-25 2023. Patient #7: The POC dated 10/26-12/24/23 included, “SW declined (post the initial CA visit on 10/27/23). There was an additional SW visit made on 11/22/23 without an order. The IDG POC dated 12/08/23 listed, “Volunteer services have been started for companionship.” The POC did not include a ‘frequency’ for such Volunteer services. Volunteer visits were made 11/28, 12/03, 12/09, and 12/16/23 without a clear order for such visit frequency.”

“Upon patient record review, 11 of 14 (Patients #1, 2, 4, 5, 6, 9, 10, 11, 12, 13, and 14) did not contain evidence that the Hospice Aide assignments/POC and duties contained: Evidence that the Aide Plan of Care indicates 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: Patients #1, 2, 4, 5, 6, 9, 13, and 14: The most current/recent Aide Plan(s) of Care for these patients listed: 1) Change linen; 2) Light housekeeping; and 3) Make bed. All of these tasks were assigned at a frequency of, “as needed and/or as requested”. Patients #10 and 11: The most current/recent Aide Plan(s) of Care for these patients listed: 1) Change linen; and 2) Light housekeeping. These tasks were assigned at a frequency of, “as needed and/or as requested”. Patients #12: The Aide Plan of Care assigned backrub-massage per patient request.”

“Upon patient record review 1 of 14 (Patient #3) did not contain evidence that the Hospice Aide had provided care/services only as were: • Ordered by the Interdisciplinary Group • Included in the Plan of Care Patient #3: During Surveyor-attended home visit on 12/20/23 the Aide reported that she routinely completed the following, “I wash the coccyx area with soap and water, dry it, then apply Optin dressing, every (3) days; as I was directed to by the RN Case Manager.” The RN Case Manager was present for this conversation. This intervention was not on the Aide POC established 12/13/23.”

“Upon patient client record review, 1 of 14(Patient #7) 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 #7: The IDG POC dated 12/08/23 listed, “Volunteer services have been started for companionship.” Elsewhere in the same POC was the statement, “Volunteer declined.” This POC did not include a ‘frequency’ for such Volunteer services.”