Beth Israel Lahey Health at Home

“Based on medical record review, interview, and policy review it was determined that the hospice agency failed to ensure and document the ongoing sharing of information between all disciplines providing care in accordance with the hospice agency’s own policy for 4 of 19 patients reviewed (Patient Identifiers #5, #7, #9, and #10). Findings include: Review on 2/27/24 of the facility’s policy titled “Hospice Interdisciplinary Group”, with an approved date of 5/23, revealed: “The membership of the Interdisciplinary Group (IDG) must include, but is not limited to: hospice physician (doctor of medicine or osteopathy); registered nurse; social worker; a pastoral or other counselor. Responsibilities: 1. To collaborate with the patients, agency, and patient’s hospice attending physician to develop a patient directed written plan of care. 2. To collaborate together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the patient and family facing a terminal illness and bereavement. 3. Provide the care and services offered by the hospice in its entirety, must supervise the care and services. 4. Designate a registered nurse to provide coordination of care and to ensure continuous assessment of each patient’s and family’s needs and implementation of the interdisciplinary plan of care. 5. Establishment of policies and procedures governing day-to-day provision of hospice care and services. 6. review, revise, and document the individualized plan no less frequently than every 15 calendar days.” Patient #9 Review on 2/27/24 of Patient #9’s medical record revealed that Patient #9 lives in an Assisted Living Facility (ALF). Further review of Patient #9’s medical record Case Conference Notes revealed that Patient #9 was scheduled to be reviewed by the IDT on the following dates: 12/20/23, 1/3/24, 1/17/24, 1/31/24, 2/14/24, and 2/28/24. Further review of the Case Conference Notes revealed the following information: On 12/20/23 no notes were written on that day. A Spiritual care note was written on 12/19/23 and an IDT Psychosocial note was written on 12/21/23. Not all required disciplines appeared to be sharing information. On 1/3/24 revealed the following notes: an IDT psychosocial note and a note from the nurse. Not all required disciplines documented information. On 1/17/24 revealed a SN (skilled Nurse) template and the Medical Social Worker (MSW) note was written on 1/16/24. Not all required disciplines documented information. On 1/31/24 revealed a SN template and a Spiritual care note written on 1/30/24. Not all required disciplines documented information. On 2/14/24 revealed a Medical Social Worker note only. Not all required disciplines documented information. On 2/28/24 revealed SN template note and both MSW and Spiritual Care notes were written on 2/27/24. Not all required disciplines documented information. Patient #10 Review on 2/27/24 of Patient #10’s medical record revealed that Patient #10 lives in nursing facility. Further review of Patient #10’s medical record Case Conference Notes revealed that Patient #10 was scheduled to be reviewed by the IDT on the following dates: 11/29/23,12/13/23, 11/27/23, 1/10/24, 1/24/24, 2/7/24, and 2/21/24. Further review of the Case Conference Notes revealed the following information: On 11/29/23 A Spiritual care note written, a Registered nurse (RN) note on 11/29/23, and a MSW note was written on 11/27/23. Not all required disciplines documented information. On 12/13/23 revealed the following notes: an IDT Psychosocial note and a MSW note was written on 12/12/23. Not all required disciplines documented information. On 12/27/23 revealed a MSW note, and the Spiritual care note written on 12/29/23. Not all required disciplines documented information. On 1/10/24 revealed a MSW note, and a Spiritual care note written on 1/9/24. Not all required disciplines documented information. On 1/24/24 revealed both a SN template and MSW note were written, and a Spiritual care note written on 1/23/24. Not all required disciplines documented information. On 2/7/24 revealed both a SN template and MSW note were written, and a Spiritual care note written on 2/6/24. Not all required disciplines documented information. On 2/21/24 revealed the SN, Spiritual care and the MSW had written notes. Not all required disciplines documented information. Interview with Staff D on 2/27/24 at approximately 1:30 p.m. revealed that the IDT disciplines that are present review the notes that are documented at the time of the meeting. Staff A confirmed the above findings for the IDT meeting dates for Patient #9 and Patient #10 and confirmed that not all required IDT disciplines had written notes for review at the IDT meetings. Patient #5 Review on 2/27/24 of Patient #5’s Case Conference Notes revealed that Patient #5 was scheduled to be reviewed by the Interdisciplinary Team (IDT) on the following dates: 10/11/23, 10/25/23, 11/23/23, 12/6/23, 12/20/23 and 2/14/24. further review of the Case Conference Notes revealed the following information: On 10/11/23, a psychosocial note was documented completed on 10/16/23 which is outside the 15 days. Not all required disciplines documented information. On 10/25/23, a nursing documented completed on 11/8/23 which is outside the 15 days. Not all required disciplines documented information. On 11/22/23, psychosocial documentation was not completed. Not all required disciplines documented information. On 12/6/23, nursing documentation was not completed. Not all required disciplines documented information. On 12/20/23, nursing documentation was not completed. Not all required disciplines documented information. On 2/14/24, nursing documentation was not completed. Not all required disciplines documented information. Interview on 2/27/24 with Staff D (Hospice Quality Nurse) confirmed that the above findings were accurate and that the agency did not share information between disciplines for patient #5’s IDT meetings. Patient #7 Review on 2/27/24 of Patient #7’s Case Conference Notes revealed that Patient #7 was scheduled to be reviewed by the IDT (Interdisciplinary Team) on the following dates: 11/1/23 and 2/6/24. Further review of the Case Conference notes revealed the following information: On 11/1/23, nursing documentation was not completed. Not all required disciplines documented information. On 2/6/24, social work documentation was completed on 2/7/24. Nursing documentation was not completed. Not all required disciplines documented information.”

“Based on medical record review and interview, it was determined that the agency failed to supervise the quality of care and services provided by hospice aides no less frequently than every 14 days for 2 of 12 patients reviewed for hospice aides in a survey sample of 19 patients (Patient Identifiers #4 and #10). Findings include: Patient #4 Review on 2/27/24 of Patient #4’s hospice aide visits revealed the following visit dates: 11/16/23,11/22/23,11/25/23,11/30/23,12/5/23, and 12/8/23. Review of Patient #4’s nursing visit notes revealed that on-site visits by a registered nurse to assess the adequacy and care of the hospice aide services were completed on 11/8/23 and 11/22/23, revealing that 15 days had elapsed between assessments. Review also revealed that a nurse visit was completed on 1/10/24 in which 21 days had elapsed since the supervisory visit assessment on 12/20/23 that was documented correctly. Interview on 2/27/24 at approximately 3:00 p.m. with Staff D (Hospice Quality Nurse) confirmed the above findings. Patient#10 Review on 2/28/24 of Patient #10’s hospice aide visits revealed the following visit dates: 11/20/23,11/28/23,12/1/23,12/5/23, 12/8/23,12/2/23,12/15/23,12/19/23,12/22/23, 12/26/23, 12/29/23,1/2/24, and1/5/24. Review of Patient #10’s nursing visit notes revealed that on-site visits by a registered nurse to assess the adequacy and care of the hospice aide services were completed on 11/21/23,11/30/23,12/6/23, 12/14/23, and 12/29/23, revealing that 15 days had elapsed between assessments. Interview on 2/28/24 at approximately 1:30 p.m. with Staff D confirmed the above findings.”

“Based on record review, interview, and policy review, it was determined that the facility failed to ensure all Interdisciplinary Group (IDG) entries were completed, authenticated, and dated timely, within 15 days, in accordance with hospice policy for 4 of 19 records reviewed (Patient Identifiers #3, #8, #15, and #16) Findings include: Review on 2/28/24 of facility’s policy titled “Hospice Interdisciplinary Group” last revised on 2/2019, revealed: “;Responsibilities:...6. Review, revise, and document individualized plan no less frequently than every 15 calendar days.” Patient #15 Review on 2/28/24 of Patient #15s clinical record revealed 2023 skilled nursing “;Care Team Conference Summary IDG” entries beyond 15 calendar, as follows: Care Team Conference Summary IDG 3/8/23 – note entered 2/28/24 at 12:27 AM Care Team Conference Summary IDG 5/31/23 – note entered 2/27/24 at 11:50 PM Care Team Conference Summary IDG 6/14/23 – note entered 2/27/24 at 11:53 PM Care Team Conference Summary IDG 6/28/23 – note entered 2/27/24 at 11:57 PM Care Team Conference Summary IDG 7/26/23 – noted entered 2/28/24 at 12:04 AM Care Team Conference Summary IDG 8/28/23 – note entered 2/28/24 at 12:11 AM Care Team Conference Summary IDG 8/9/23 – note entered 2/28/24 at 12:09 AM Care Team Conference Summary IDG 9/6/23 – note entered 2/28/24 at 12:14 AM Patient #16 Review on 2/28/24 of Patient #16s record revealed 2023 skilled nursing “Care Team Conference Summary IDG” entries beyond 15 calendar days, as follows: Care Team Conference Summary IDG 6/14/23 – note entered 2/27/24 at 9:28 PM Care Team Conference Summary IDG 6/28/23 – note entered 2/27/24 at 9:31 PM Care Team Conference Summary IDG 6/28/23 – note entered 2/27/24 at 9:31 PM Interview on 2/28/24 at approximately 10:50 a.m. with Staff A (Hospice Clinical Manager) confirmed the above findings. Patient #3 Review on 2/27/24 of Patient #3’s Case Conference Notes revealed that Patient #3 was reviewed at the Interdisciplinary Team (IDT) meeting on 2/7/24. Further review revealed that Staff B (Registered Nurse) documented on Patient #3 on 2/21/24 for the IDT meeting held on 2/7/24. Patient #8 Review on 2/27/24 of Patient #8’s Case Conference Notes revealed that Patient #8 was reviewed at the IDT meeting on 1/17/24 and that Staff C (Registered Nurse) did not document until 1/20/24. Interview on 2/28/24 with Staff D (Hospice Quality) confirmed the above findings for Patients #3 and #8.”