Kindred Hospice

“Upon patient record review 3 of 14 records (Patient #2,#7,#10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #2: The patient was admitted on 11/7/23. The record indicated that the spiritual assessment was completed on 3/7/24. Patient #7: The patient was admitted on 4/8/24. The record indicated that the spiritual assessment was completed on 4/16/24. Patient #10: The patient was admitted on 1/23/24. The record indicated that the spiritual assessment was completed on 3/19/24.”

“Upon patient record review, 3 of 14 records (Patient #1, #4,#6) 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: Upon home visit, the record at the ALF did not contain Acetaminophen, Levsin, or Ondansetron. These medications were part of the medication profile on the hospice record. Patient #4: The medication profile contained Azithromycin for a URI, dated 5/31/23. Give 2 tabs on the first day and 1 tab for 4 days after. This remained on the medication profile. Corrected on site. Patient #6: The medication profile contained Acetaminophen 500mg tabs, 2 tabs daily prn pain or fever. There was not evidence of a parameter for the fever. Corrected on site.”

“Upon patient record review, 1 of 14 records (Patient #1) did not have evidence in the patient record that the comprehensive assessment includes a bereavement 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 assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1: The record indicated that the patient had a spouse that lived at the facility (ALF, in the same room). The record indicated that a bereavement risk assessment was conducted on the patient’s daughter but not the spouse.”

“Upon patient record review, 1 of 14 records (Patient #10) did not have evidence that a Registered Nurse ensured continuous assessment of the patient and family’s needs and coordinated 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 #10: The record indicated a call to triage dated 2/24/24 at 2:20pm. The caller stated that he thinks the patient has a UTI as she is hallucinating. A visit was advised. An order for Levaquin was noted on this date but there was not evidence of a contact to the caller or a visit until 2/29/24 at 3:13pm.”

“Upon patient record review, 2 of 14 records (Patient #5,#9) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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 #5: The patient was admitted with a diagnosis of malignant neoplasm of the colon. There was not evidence that pain was included to reflect patient/family goals and interventions. Corrected on site. Patient #9: The patient was on Eliquis 5mg BID. There was not evidence that bleeding precautions were a part of the plan of care. Corrected on site.”

“Upon client record review, 3 of 14 records (Patient #4,#7,#9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: The skilled nurse visit frequency for the benefit period beginning 3/16/24 was 1 every 2w2, 1w8. The visits occurred on 3/19/24, 3/26/24, 4/2/24... (1x/week) Patient #7: The skilled nurse visit frequency was 3w1, 2w11. The patient was admitted on 4/8/24 and the record indicated that visits were conducted only on 4/8/24 and 4/10/24 for the first week. In addition the patient had a biliary drain on his right side. The patient was caring for the drain but there was not evidence in the plan of care of problems/goals/interventions regarding the care or dressings required to care for this drain. Corrected on site. Patient #9: The record indicated a visit dated 2/12/24 by the occupational therapist. There was not evidence that this was in the plan of care. Corrected on site. In addition, the patient had a Foley catheter inserted on 2/8/24. The Foley catheter was changed on 4/1/24. There was not evidence of an order to change the Catheter or if a flush was to be attempted, and for what reason. Corrected on site. In addition, the skilled nurse visit frequency at the start of care (2/5/24) was 3w1, 2w11. Visits were conducted on 2/5/24 and 2/7/24.”

“Upon patient record review 2 of 14 records (Patient #3,#8) did not have evidence of documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #3: The aide plan of care indicated to provide a shave at every visit. For the dates of 3/21/24 and 3/26/24, the aide documented, ‘No, per frequency not needed.’ Patient #8: The aide plan of care indicated to provide a shave at every visit. For the dates of 3/12/24, 3/26/24, 4/2/24, and 4/19/24, the aide documented, ‘No, per frequency not needed.’”