Haywood Hospice and Palliative Care

“Based on agency policy, clinical record review, and staff interviews, the agency failed to update the plan of care goals with each new episodes of care for 3 of 3 records [# 17, 18, and 19] reviewed. The findings included: The policy, Interdisciplinary Group [IDG] Membership and Responsibilities [revised 2/1/25], was provided by the office manager on 3/2/26 at 1 pm. The policy stated, “...The hospice IDG collaborates with the patient’s attending physician to develop and maintain a patient-directed, individualized plan of care...The responsibilities include but are not limited to...Reviewing, revising, and documenting the individualized plan of care as frequently as the patient’s condition requires, but no less frequently than every 15 days...”1. Patient # 17 had a Start of Care [SOC] date of 5/30/25 with a terminal diagnosis of basal cell carcinoma of skin [skin cancer] and malignant neoplasm of maxillary sinus [sinus cancer]. Review of the Plan of Care [POC] for the certification period 1/25/26-3/25/26 included orders for SN [skilled nursing] 2 times a week for 8 weeks, 1 time a week for 1 week; hospice aide 1 time a week for 8 weeks; MSW [medical social worker] 1 time a month for 3 months; Chaplin 1 time a month for 1 month, 2 times a month for 2 months. Review of the Plan of Care goals for the period 1/25/26-3/25/26 revealed the same goals as the SOC POC to include, “Within one week of hospice admission, patient/caregiver will verbalize understanding of hospice services, hospice philosophy, care for the hospice patient, and the ability to contact hospice agency 24 hours a day, 7 days a week...Patient/caregiver will verbalize/demonstrate understanding of medications within 48 hours of admission to hospice services...Patient will demonstrate an increased in interest in socialization and activities by 12/1/25...”2. Patient # 18 had a Start of Care [SOC] date of 12/3/25 with terminal diagnoses of COPD [chronic obstructive pulmonary disease-lung condition] and neoplasm of lung [cancer]. Review of the Plan of Care [POC] for the certification period 2/1/26-4/1/26 included orders for SN [skilled nursing] 1 time a week for 9 weeks; hospice aide 1 time a week for 9 weeks; MSW [medical social worker] 1 time a month for 2 months; Chaplin 1 time a month for 2 months. Review of the Plan of Care goals for the period 2/1/26-4/1/26 revealed the same goals as the SOC POC to include, “...Patient/caregiver will verbalize/demonstrate understanding of medications within 48 hours of admission to hospice services...”3. Patient # 19 had a Start of Care [SOC] date of 8/11/25 with a terminal diagnosis of antineutrophilic cytoplasmic antibody [autoantibodies that attack neutrophils, causing them to damage small blood vessels and leading to systemic vasculitis- a group of rare diseases characterized by inflammation of blood vessels, leading to narrowing, weakening, or scarring that restricts blood flow and damages tissues/organs]. Review of the Plan of Care [POC] for the certification period 2/7/26-4/7/26 included order for SN [skilled nursing] 2 times a week for 8 weeks, 1 time a month for 1 week; MSW [medical social worker] 1 time every 2 months for 2 months, 1 time a month for 1 month. Review of the Plan of Care goals for the period 2/7/26-4/7/26 revealed the same goals as the SOC POC to include, “Within one week of hospice admission, patient/caregiver will verbalize understanding of hospice services, hospice philosophy, care for the hospice patient, and the ability to contact hospice agency 24 hours a day, 7 days a week...Patient/caregiver will verbalize/demonstrate understanding of medications within 48 hours of admission to hospice services...”During an interview with the agency administrator on 3/4/26 at approximately 11:30 am, it was confirmed the agency failed to update the plan of care goals accordingly.”

“Based on agency policy, clinical record review and staff interviews the MSW [medical social worker] failed to project visit projections for the next 15 days for 17 of 22 records [# 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 17, 18, 19, 20, 21, and 22] reviewed with MSW orders; and the Chaplin failed to project visit frequencies for the next 15 days for 15 of 22 records [# 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 17, 18, 20, and 21] reviewed with Chaplin orders. The policy, Interdisciplinary Group [IDG] Membership and Responsibilities [revised 2/1/25], was provided by the office manager on 3/2/26 at 1 pm. The policy stated, “...The hospice IDG collaborates with the patient’s attending physician to develop and maintain a patient-directed, individualized plan of care...The responsibilities include but are not limited to...Reviewing, revising, and documenting the individualized plan of care as frequently as the patient’s condition requires, but no less frequently than every 15 days...”1. Patient # 4 had a Start of Care date 1/28/26 with a terminal diagnosis of protein calorie malnutrition. Review of the Plan of Care for the certification included orders for SN [skilled nursing] 3 times a week for 13 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 1 month; Chaplin 1 time a month for 4 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed an IDG meeting was conducted on 2/4/26 [the patient expired on 2/8/26]. Review of the IDG minutes for the 2/4/26 meeting revealed no visit projections for the next 15 days from the MSW or the Chaplin.2. Patient # 5 had a Start of Care date of 2/4/26 with a terminal diagnosis of COPD [chronic obstructive pulmonary disease-lung condition]. Review of the Plan of Care for the certification period 2/4/26-5/4/26 included orders for SN [skilled nursing] 3 times a week for 13 weeks, 1 time a week for 1 week; hospice aide 2 times a week for 1 week, 5 times a week for 12 weeks, 1 time a week for 1 week; MSW [medical social worker] 2 times a month for 3 months; Chaplin 1 time a month for 3 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were conducted on 2/11/26 and 2/18/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.3. Patient # 6 had a Start of Care date of 1/24/26 with a terminal diagnosis of unspecified severe protein calorie malnutrition [the body does not take in enough calories/nutrients to sustain itself]. Review of the Plan of Care for the certification period 1/26/26-4/3/26 included orders for SN [skilled nursing] 1 time a week for 1 week; MSW [medical social worker 1 time a month for 1 month; Chaplin 1 time a month for 1 month. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were conducted 1/28/26, 2/11/26, and 2/25/26. Review of the IDG minutes revealed no visit projection plans for the next 15 days by the MSW or the Chaplin for the 2/11/26 or 2/25/26 meetings.4. Patient # 7 had a Start of Care date of 1/7/26 with a terminal diagnosis of hypertensive heart disease with heart failure [heart does not pump effectively]. Review of the Plan of Care for the certification period 1/7/26-4/8/26 included orders for SN [skilled nursing] 2 times a week for 13 weeks; MSW [medical social worker] 1 time a month for 3 months; Chaplin 1 time a month for 3 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were conducted on 1/14/26, 1/28/26, and 2/11/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.5. Patient # 9 had a Start of Care date of 2/12/26 with a terminal diagnosis of breast cancer and lung cancer. Review of the Plan of Care for the certification period 2/12/26-5/12/26 included orders for SN [skilled nursing] 2 times a week for 1 week, 3 times a week for 12 weeks; hospice aide 3 times a week for 12 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 1 month; Chaplin 1 time a month for 4 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed an IDG meeting was conducted on 2/18/26. Review of the IDG minutes revealed no visit projection plans for the next 15 days by the MSW or the Chaplin.6. Patient # 10 had a Start of Care date of 1/12/26 and a terminal diagnosis of end-stage malignant neoplasm of the pancreas [cancer]. Review of the Plan of Care for the certification period 1/12/26-4/11/26 included orders for SN [skilled nursing] 3 times a week for 1 week, 2 times a week for 12 weeks; hospice aide 2 times a week for 13 weeks; MSW [medical social worker] 1 time a month for 4 months; Chaplin 1 times a month for 4 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 1/14/26, 1/21/26, 2/4/26 and 2/18/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.7. Patient # 11 had a Start of Care date of 2/11/26 with a terminal diagnosis of Alzheimer’s Disease. Review of the Plan of Care for the certification period 2/11/26-5/11/26 included orders for SN [skilled nursing] 2 times a week for 13 weeks; MSW [medical social worker] 1 time a month for 4 months; Chaplin 2 times a month for 1 month, 1 time a month for 1 month. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were conducted on 2/18/26 and 2/25/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin. 8. Patient # 12 had a Start of Care date of 1/21/26 with a terminal diagnosis of liver cell carcinoma [cancer]. Review of the Plan of Care for the certification period 1/21/26-4/20/26 included orders for SN [skilled nursing] 2 times a week for 13 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 4 months; Chaplin 2 times a month for 2 months, 1 time a month for 1 month. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 1/28/26, 2/4/26, and 2/18/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.9. Patient # 13 had a Start of Care date of 1/29/26 with a terminal diagnosis of protein calorie malnutrition [body does not take in enough calories or nutrients to sustain life]. Review of the Plan of Care for the certification period 1/29/26-4/28/26 included orders for SM [skilled nursing] 2 times a week for 13 weeks, 1 time a week for 1 week; hospice aide 1 time a week for 1 week, 2 times a week for 12 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 3 months; Chaplin 1 time a month for 3 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were conducted on 2/4/26, 2/11/26, and 2/25/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.10. Patient # 14 had a Start of Care date of 2/3/26 with a terminal diagnosis of neoplasm of right upper lobe [lung cancer]. Review of the Plan of Care for the certification period 2/3/26-5/5/26 included orders for SN [skilled nursing 3 times a week for 1 week, 2 times a week for 12 weeks; MSW [medical social worker] 3 times a month for 1 month, 1 time a month 2 months; Chaplin 2 times a month 3 month. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 2/11/26 and 2/25/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.11. Patient # 15 had a Start of Care date of 1/30/26 with a terminal diagnosis of senile degeneration of the brain [a progressive, age-related deterioration of mental ability]. Review of the Plan of Care for the certification period 1/30/26-5/1/26 included orders for SN [skilled nursing] 2 times a week for 13 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 3 months; Chaplin 1 time a month for 3 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 2/4/26 and 2/18/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.12. Patient # 17 had a Start of Care date of 5/30/25 with a terminal diagnosis of basal cell carcinoma of skin [skin cancer] and malignant neoplasm of maxillary sinus [sinus cancer]. Review of the Plan of Care for the certification period 1/25/26-3/25/26 included orders for SN [skilled nursing] 2 times a week for 8 weeks, 1 time a week for 1 week; hospice aide 1 time a week for 8 weeks; MSW [medical social worker] 1 time a month for 3 months; Chaplin 1 time a month for 1 month, 2 times a month for 2 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 1/28/26, 2/11/26, and 2/25/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.13. Patient # 18 had a Start of Care date of 12/3/25 with terminal diagnoses of COPD [chronic obstructive pulmonary disease-lung condition] and neoplasm of lung [cancer]. Review of the Plan of Care for the certification period 2/1/26-4/1/26 included orders for SN [skilled nursing] 1 time a week for 9 weeks; hospice aide 1 time a week for 9 weeks; MSW [medical social worker] 1 time a month for 2 months; Chaplin 1 time a month for 2 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 2/11/26 and 2/25/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.14. Patient # 19 had a Start of Care date of 8/11/25 with a terminal diagnosis of antineutrophilic cytoplasmic antibody [autoantibodies that attack neutrophils, causing them to damage small blood vessels and leading to systemic vasculitis- a group of rare diseases characterized by inflammation of blood vessels, leading to narrowing, weakening, or scarring that restricts blood flow and damages tissues/organs]. Review of the Plan of Care for the certification period 2/7/26-4/7/26 included order for SN [skilled nursing] 2 times a week for 8 weeks, 1 time a month for 1 week; MSW [medical social worker] 1 time every 2 months for 2 months, 1 time a month for 1 month. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 2/11/26 and 2/25/26. Review of the IDG minutes revealed no visit projection plans for the next 15 days by the MSW.15. Patient # 20 had a Start of Care date of 2/4/26 with a terminal diagnosis of cerebral atherosclerosis [the buildup of plaque—cholesterol, fat, and calcium—within the artery walls in the brain]. Review of the Plan of Care for the certification period 2/4/26-5/13/26 included orders for SN [skilled nursing] 2 times a week for 13 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 1 month, 2 times a month for 1 month; Chaplin 1 time a month for 4 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 2/11/26 and 2/18/26. Review of the IDG minutes for the meeting dates revealed no visit projections for the next 15 days from the MSW or the Chaplin.16. Patient # 21 had a Start of Care date of 2/17/26 with a terminal diagnosis of atherosclerosis heart disease [plaque buildup in arterial walls]. Review of the Plan of Care for the certification period 2/17/26-5/17/26 included orders for SN [skilled nursing] 3 times a week for 1 week, 2 times a week for 12 weeks; MSW [medical social worker] 1 time a month for 2 months, 2 times a month 1 month; Chaplin 1 time a month for 4 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed an IDG meeting was conducted on 2/25/26. Review of the IDG minutes for that meeting date revealed no visit projections for the next 15 days from the MSW or the Chaplin.17. Patient # 22 had a Start of Care date of 12/18/25 with a terminal diagnosis of multiple myeloma [blood cancer]. Review of the Plan of Care for the certification period 12/18/25-3/17/26 included orders for SN [skilled nursing] 2 times a week for 13 weeks, 1 time a week for 1 week; MSW [medical social worker] 1 time a month for 4 months. Review of the IDG [Interdisciplinary Group - team of professionals responsible for the holistic care of the hospice patient and their family] Summary Report revealed IDG meetings were on 12/24/25, 1/7/26, 1/21/26, 2/4/26, and 2/18/26. Review of the IDG minutes revealed no visit projection plans for the next 15 days by the MSW.An interview was conducted with the MSW and the Chaplin on 3/4/26 at approximately 3 pm. During the interview, it was confirmed the visit frequencies where not projected for the next 15 days during IDG.”