New Haven Hospice Care, Inc.

“Upon patient record review, 2 of 5 (Patient #1 & 3) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1: Multiple medications for pain (Tylenol, Morphine Sulfate concentrate, and Norco) listed on medication record without clear directions on which medication to use for specific pain level. No evidence of pain rating or severity that would indicate medication use, stating only “pain”. Patient 3: Multiple medications for pain (Tylenol and Norco) listed on medication record without clear directions on which medication to use for specific pain level. No evidence of pain rating or severity that would indicate medication use, stating only “pain”.”

“Upon patient record review, 2 of 5 (Patient #1 & 3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 1: Multiple medications for pain (Tylenol, Morphine Sulfate concentrate, and Norco) listed on medication record without clear directions on which medication to use for specific pain level. No evidence of pain rating or severity that would indicate medication use, stating only “pain”. Patient 3: Multiple medications for pain (Tylenol and Norco) listed on medication record without clear directions on which medication to use for specific pain level. No evidence of pain rating or severity that would indicate medication use, stating only “pain”.”

“Upon patient record review, 1 of 14 (Patient #9) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #9, On call note documented on 7/4/23 at 1600, patient is having a spell with chest pain, documented nurse to make visit. Visit was completed on 7/5/23 at 1000 when oxygen was ordered.”

“Upon patient record review, 1 of 14 (Patient #1) 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 #1, The care plans did not have evidence of goals or interventions related to terminal illness and related conditions.”

“Upon patient record review, 11 of 14 (Patient #1,2,3,5,6,8,9,10,11,13,14) 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. Patient #1, SN frequency 2x/week with 10 PRN. Patient #2, SN frequency 2x/week with 5 PRN. MSW frequency 1x/week with 5 PRN. Patient #3, SN frequency 2x/week with 10 PRN. Patient #5, SN frequency 2x/week with 10 PRN. Patient #6, SN frequency 2x/week with 10 PRN. Recertification frequency SN 2x/week and 5 PRN, MSW 1x/week and 5 PRN. Patient #8, SN frequency 2x/week with 5 PRN. MSW 1x/week and 5 PRN. Patient #9, SN frequency 4/6/23 1x/week, 4/9/23 2x/week, 6/28/23 10 PRN, 9/20/23 10 PRN, 11/29/23 10 PRN. MSW 8/18/23 1w4, 6/28/23 10 PRN, 9/28/23 3 PRN. SC 6/28/23 10 PRN, 8/12/23 1w2, 8/13/23 1w4. Patient #10, SN frequency 2x/week, 3 PRN, 11/13/23 10 PRN. Patient #11, SN frequency 2w1, 10 PRN. Patient #13, SN frequency 2x//week 15 PRN. Volunteer 16 PRN visits. Patient #14, SN frequency 2x/week 14 PRN.”

“Upon client record review, 6 of 14 (Patient #1,2,3,7,9,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, Volunteer 1x/week, no visits made. Patient #2, SN frequency 2x/week, 3 visits made the first week. Volunteer frequency 1x/week, no evidence of visits made. Patient #3, SC frequency 1xweek, missed first 2 weeks. Volunteer 1x/week, missed first week and 2 visits missed between 12/19/23 and 1/19/24. Patient #7, SN frequency 2x/week, missed 1 visit first week then seen 3x/week the next 2 weeks. Patient #9, SN frequency 4/6/23 1x/week, 4/9/23 2x/week, 4/16/23 1x/week, 6/28/23 2x/week, Visits completed on 4/6/23, 4/10/23, 4/13/23, 4/17/23, 4/26/23, 5/3/23, 5/8/23, 5/10/23. Patient #14, SN frequency 4/14/23 2x/week, 4/25/23 7x/week”

“Upon patient record review, 1 of 14 (Patient #1) 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 #1, Aide care plan states shave face as needed, weekly.”

“Upon patient record review 2 of 14 (Patient #1, 2) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1, Aide care plan states shave face as needed, weekly. Visits completed 1/31/24, 2/2/24, 2/6/24 with shave face completed. Patient #2, Aide care plan does not state to provide back rub. Back rub provided 1/30/24, 2/2/24, 2/6/24.”