Aseracare Hospice

“Upon patient record review, 1 of 19 (Patient #7) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon patient record review, 1 of 19 (Patient #7) did not have evidence that the hospice obtained the patient’s or representative’s signature confirming that they received a copy of the Patient’s Rights and Responsibilities. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon patient record review, 1 of 19 (Patient #7) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient’s rights to the extent allowed by state law. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon patient record review, 1 of 19 (Patient #7) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon patient record review, 1 of 19 (Patient #7) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon patient record review, 1 of 19 (Patient #6) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient #6: Records indicate in RN Comprehensive Assessment that patient has no abnormal Neurological symptoms and no pain on 3/25/24. RN narrative documents, “patient does experience increased confusion.” In addition to narrative documentation, “Husband request taking Ritalin Dr Sauer was notified. Patient to take 2.5mg PO BID. Patient has Ritalin in home. No evidence of RN education on medication or discussion with Spouse on purpose. Narrative states, “Mary denies pain and shows no verbal or nonverbal signs of pain during visit.” Ritalin ordered for “pain” on 3/25/24.”

“Upon patient record review, 6 of 19 (Patient #1,#2, #4, #5, #6, #7, ) 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: Records indicate RN submitted an incomplete order on 5/11/24, “Okay for foley catheter to dependent drain for urinary retention.” No evidence of insertion technique, frequency of foley changes and who is managing. Patient #2: Records indicate RN submitted an incomplete order on 2/15/23, “Calf Board.” No evidence of purpose of calf board or instructions in order. Patient #4: Records indicate upon start of care comprehensive assessment on 12/01/23, patient is on oxygen in home. Oxygen safety form signed by POA upon Admission. No evidence of Oxygen documented on Initial Plan of care with order date, 01/31/24, on medication profile for Oxygen 2L PRN. Patient #5: Records indicate on Initial Plan of Care under DME oxygen ordered. No evidence documented under medications for dose frequency, purpose or route on initial Plan of Care. Physician order for oxygen Concentrator & Oxygen supplies on 1/26/24. Oxygen added to medication profile on 4/26/24. In addition, oxygen not listed on Recertification Plan of care Order on 4/10/24. Patient #6: Records indicate verbal order submitted by RN incomplete and not specific, “Obtain UA. Do C&S if indicated.” Patient #7: Records indicate RN submitted verbal order, “Daily visits for a few days over the weekend for change in status’’. Order is not specific to frequency of daily visits. SN effective 01/28/24, 4wk1, 3wk1, 2wk10. In addition, Verbal order submitted by RN on 2/26/24, “Discontinued all medications except for Hospice Medications. Order is not specific.”

“Upon patient client record review, 1 of 19 (Patient #7) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #7: Records indicate that patient signed own election statement consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in election statement and consent forms.”

“Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon observation, there was no evidence the hospice discussed the policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in record is not clear if patient is cognitively aware of understanding content in consent forms.”

“Upon client record review, 1 of 19 (Patient #7) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #7: Records indicate that patient signed own consents with documented Diagnosis of Cerebral Infarction with Aphasia on 1/23/24. RN documented on Initial Comprehensive assessment, “Daughter states that pt can be completely Alert and oriented at times and then other’s can be confused and disoriented. FAST Score for Dementia 7A or worse.” RN also documented upon start of care that was alert and oriented to place and self. In addition, RN visit on 1/29/24 has evidence of documentation, “ abnormal neurologic findings, slow to respond to stimuli, withdrawn, alert, confused, disoriented, forgetful, abnormal cognitive function, abnormal attention, abnormal remote memory, and abnormal recent memory. The documentation in records is not clear if patient is cognitively aware of understanding content in consent forms.”