Elara Caring Xxiii

“Based on record review and interview, the hospice failed to ensure a bereavement care plan was initiated or was included as a part of the overall POC after the initial and ongoing spiritual/bereavement assessments for 15 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and #15) of 19 patients. Findings: Patient #1 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 05/07/24, and psychosocial and spiritual assessments on 05/10/24. A review of a POC dated 05/07/24 to 08/04/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #2 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 03/29/22, and psychosocial and spiritual assessments on 03/31/22. A review of a POC dated 05/17/24 to 07/15/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #3 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 09/28/23, and psychosocial and spiritual assessments on 10/02/23. A review of a POC dated 05/25/24 to 07/23/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #4 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 03/02/21, and psychosocial and spiritual assessments on 03/15/21. A review of a POC dated 04/15/24 to 06/13/24 and IDG updates to the POC on 04/19/24, 05/03/24, 05/17/24 and on 05/31/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #5 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 03/19/24, and psychosocial and spiritual assessments on 03/22/24. A review of a POC dated 03/19/24 to 06/16/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #6 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 11/11/23, and psychosocial and spiritual assessments on 11/14/23. A review of a POC dated 05/09/24 to 07/07/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #7 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 02/02/23, and psychosocial and spiritual assessments on 02/06/24. A review of a POC dated 05/02/24 to 07/30/24 and IDG updates to the POC on 05/03/24, 05/17/24 and on 05/31/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #8 A review of the clinical record showed an election of the hospice benefit on 01/04/24 and completion of bereavement and spiritual assessments on 01/08/24. A review of a POC dated 04/03/24 to 07/01/24 and IDG updates to the POC on 04/18/24, 05/02/24 and on 05/30/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #9 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 06/16/23, and psychosocial and spiritual assessments on 06/19/23. A review of a POC dated 04/11/24 to 06/09/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #10 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 05/17/24, psychosocial assessment on 05/20/24 and a spiritual assessment on 05/21/24. A review of a POC dated 05/17/24 to 05/28/24 and IDG updates to the POC on 05/28/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #11 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 02/06/23, psychosocial assessment on 02/10/23 and a spiritual assessment on 02/09/24. A review of a POC dated 04/01/24 to 05/30/24 and IDG updates to the POC on 04/18/24, 05/02/24, 05/16/24 and on 05/30/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #12 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 02/15/24, psychosocial assessment on 02/20/24 and a spiritual assessment per patient request on 02/29/24. A review of a POC dated 05/15/24 to 08/12/24 and IDG updates to the POC on 05/16/24 and on 05/30/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #13 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 12/15/22, psychosocial assessment on 12/19/22 and a spiritual assessment on 12/16/22. A review of a POC dated 04/08/24 to 06/06/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #14 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 05/10/24, psychosocial assessment on 05/16/24 and a spiritual assessment on 05/15/24. A review of a POC dated 05/10/24 to 08/07/24 and IDG updates to the POC on 05/16/24 and on 05/30/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #15 A review of the clinical record showed an election of the hospice benefit and completion of the bereavement assessment on 12/31/20, psychosocial assessment on 01/05/21 and a spiritual assessment on 01/07/21. A review of a POC dated 05/03/24 to 07/01/24 and IDG updates to the POC on 05/16/24 and on 05/30/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. On 06/04/24 at 10:30 a.m., Staff C stated: 1. Patients are given a bereavement risk score at the time of the SOC assessment and are advised of spiritual and bereavement services provided by the Hospice. 2. The bereavement program consists of intermittently timed mail outs and follow up telephone calls which begin after the patients death. 3. The Hospice does not maintain a written POC for bereavement and, 4. Bereavement is not included on the overall POC unless the patients family or caregiver is assessed at a moderate to high risk for bereavement, then social work and/or chaplain services are provided as needed and interventions and/or related goals for each discipline is added to the plan of care.”

“Based on record review and interview, the hospice failed to ensure: 1. Hospice aide visits were provided in accordance with the plan of care for six (Patients #3, 5, 8, 11, 12 and #13) of 19 patients. 2. SN visits were provided in accordance with the plan of care for one (Patient #5) of 19 patients. 3. Chaplain visits were provided in accordance with the plan of care for two (Patients #7 and #8) of 19 patients. Medical Social Work visits were provided in accordance with the plan of care for three (Patients #7, 8 and #13) of 19 patients. Findings: Patient #3 A review of a POC dated 05/25/24 to 07/23/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 ordered hospice aide visits at a frequency of two visits every week for eight weeks. Documentation showed during the week of 05/26/24 to 06/01/24 hospice aide visits were conducted on 05/26/24 (two visits ordered, one visit conducted). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency for the hospice aide. On 06/04/24 at 12:55 p.m., Staff B stated the hospice aide frequency was not followed as ordered for patient #3. Patient #5 A review of a POC dated 03/19/24 to 06/16/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 ordered hospice aide visits at a frequency of one time a week for one week, then two visits every week for 11 weeks and a SN visit frequency of three times a week for one week, then two times a week for 12 weeks. Documentation showed during the week of 05/12/24 to 05/18/24 hospice aide visits were conducted on 05/16/24 (two visits ordered, one visit conducted) and during the week of 05/19/24 to 05/25/24 SN visits were conducted on 05/21/24 (two visits ordered, one visit conducted). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency for the hospice aide. On 06/04/24 at 1:05 p.m., Staff B stated the hospice aide and SN visit frequencies were not followed as ordered for patient #5. Patient #7 A review of a POC dated 05/02/24 to 07/30/24 and IDG updates to the POC on 05/03/24, 05/17/24 and on 05/31/24 ordered chaplain visits at a frequency of one visit every week for 13 weeks and Medical Social Work visits at a frequency of one visit every week for 13 weeks. Documentation showed during the weeks of 05/12/24 to 05/18/24 and 05/19/24 to 05/25/24 no chaplain visits were conducted (two visits ordered, no visits conducted) and no MSW visit was conducted (two visits ordered, no visits conducted). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency for the hospice aide. On 06/04/24 at 1:10 p.m., Staff B stated the Chaplain and MSW visit frequencies were not followed as ordered for patient #7. Patient #8 A review of a POC dated 04/03/24 to 07/01/24 and IDG updates to the POC on 04/18/24, 05/02/24 and on 05/30/24 ordered hospice aide visits at a frequency of one time a week for one week, then two visits every week for 12 weeks, chaplain visits at a frequency of one visit every two weeks for 12 weeks and Medical Social Work visits at a frequency of one visit every two weeks for 10 weeks. Documentation showed during the weeks of 04/03/24 to 04/06/24 no chaplain visit was conducted (one visit ordered, no visit conducted), 04/07/24 to 04/13/24 a hospice aide visit was missed on 04/12/24 (two visits ordered, no visit conducted, 04/14/24 to 04/20/24 no chaplain visit was conducted (one visit ordered, no visit conducted), and 05/26/24 to 06/01/24 no chaplain visit was conducted (one visit ordered, no visit conducted) and no MSW visit was conducted (one visit ordered, no visit conducted). Documentation showed no patient or family refusal of visits and no changes in the ordered frequencies for the hospice aide, chaplain or MSW services. On 06/04/24 at 1:15 p.m., Staff B stated the Aide, Chaplain and MSW visit frequencies were not followed as ordered for patient #8. Patient #11 A review of a POC dated 04/01/24 to 05/30/24 and IDG updates to the POC on 04/18/24, 05/02/24, 05/16/24 and on 05/30/24 ordered hospice aide visits at a frequency of two visits every week for nine weeks, increased to three times a week effective 04/23/24. Documentation showed during the week of 05/12/24 to 05/18/24 a hospice aide visit was missed on 05/13/24 (two visits ordered, no visits conducted), 05/19/24 to 05/25/24 hospice aide visits were missed on 05/20/24 and 05/23/24 (two visits ordered, no visits conducted). Documentation showed no changes in the ordered frequency for the hospice aide. On 06/04/24 at 1:32 p.m., Staff B stated the hospice aide frequency was not followed as ordered for patient #11. Patient #12 A review of a POC dated 05/15/24 to 08/12/24 and IDG updates to the POC on 05/16/24 and on 05/30/24 ordered hospice aide visits at a frequency of two visits every week for one week, then three visits a week for 12 weeks. Documentation showed during the week of 05/26/24 to 06/01/24 hospice aide visits were conducted on 05/29 and on 05/31/24 (three visits ordered, two visits conducted). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency for the hospice aide. On 06/04/24 at 1:40 p.m., Staff B stated the hospice aide frequency was not followed as ordered for patient #12. Patient #13 A review of a POC dated 04/08/24 to 06/06/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 ordered hospice aide visits at a frequency of two visits every week for nine weeks and Medical Social Work visits at a frequency of one visit every two weeks for eight weeks. Documentation showed during the weeks of 04/21/24 to 04/27/24 no MSW visit was conducted (one visit ordered, no visit conducted), 04/28/24 to 05/04/24 a hospice aide visit was missed on 04/30/24 (two visits ordered, no visit conducted and 05/19/24 to 05/25/24 a hospice aide visit was missed on 05/23/24 (two visits ordered, no visit conducted). Documentation showed no patient or family refusal of visits and no changes in the ordered frequencies for the hospice aide or MSW services. On 06/04/24 at 1:45 p.m., Staff B stated the Aide and MSW visit frequencies were not followed as ordered for patient #13.”

“Based on record review and interview, the hospice failed to ensure: 1. Individualized plans of care were fully developed to include physician pain reporting parameters for seven (Patients #1, 2, 5, 7, 8, 17 and #19) of 19 patients and. 2. Individualized plan of care was fully developed to include urinary catheter management treatment intervention due date or last changed date for one (Patient #12) of 19 patients. Findings: Patient #1 A review of a POC dated 05/07/24 to 08/04/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 05/07/24, 05/14/24, 05/16/24 and on 05/23/24 documented a patient reported pain level of two of 10. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. Patient #2 A review of a POC dated 05/17/24 to 07/15/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 05/30/24 documented a patient reported pain level of 10 of 10. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. Patient #5 A review of a POC dated 03/19/24 to 06/16/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 03/27/24 showed a reported pain level of 2, 04/01/24 showed a reported pain level of 3, 04/13/24 showed a reported pain level of 2. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. Patient #7 A review of a POC dated 05/02/24 to 07/30/24 and IDG updates to the POC on 05/03/24, 05/17/24 and on 05/31/24 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 05/03/24 showed a reported pain level of 3, 05/07/24 showed a reported pain level of 3, 05/13/24 showed a reported pain level of 4, 05/14/24 showed a reported pain level of 4, 05/16/24 showed a reported pain level of 6, 05/17/24 showed a reported pain level of 3, 05/28/24 showed a reported pain level of 2, 05/30/24 showed a reported pain level of 4. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. Patient #8 A review of a POC dated 04/03/24 to 07/01/24 and IDG updates to the POC on 04/18/24, 05/02/24 and on 05/30/24 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 05/06/24 showed a reported pain level of 2. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. Patient #12 A review of a POC dated 05/15/24 to 08/12/24 and IDG updates to the POC on 05/16/24 and on 05/30/24 ordered SN to change urinary catheter 16 FR/10 ml every month. Documentation showed no treatment last change or intervention due date for the certification period. Patient #17 A review of a POC dated 03/21/24 to 06/18/24 and IDG updates to the POC on 04/03/24 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 03/02/24 showed a reported pain level of 3. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. Patient #19 A review of a POC dated 09/26/23 to 12/24/23 and IDG updates to the POC on 11/02/23, 11/16/23, 11/30/23 and on 12/14/23 showed orders for SN to assess, monitor and instruct patients pain level every visit. POC documentation showed no pain reporting parameters for physician notification. SN visits conducted on 10/10/23 showed a reported pain level of 5, 10/13/23 showed a reported pain level of 4, 11/03/23 showed a reported pain level of 1, and 11/10/23 showed a reported pain level of 3. Documentation showed no patient tolerable pain level on scale of one to 10, showed no physician notifications and no change in orders. On 06/05/24 at 12:45 p.m. to 2:00 p.m., Staff B stated: 1. The POCs for patients #1, 2, 5, 7, 8, 17 and #19 had no physician pain reporting parameters. 2. The POC for patient #12 did not include a treatment last change or intervention due date for the certification period.”

“Based on record review and interview, the hospice failed to ensure: 1. Patient refusal of hospice aide services was communicated and addressed by the IDG for one (Patient #8) of 19 patients. 2. Patient refusal of MSW services was communicated and addressed by the IDG for one (Patient #19) of 19 patients. Findings: Patient #8 A review of a POC dated 04/03/24 to 07/01/24 and IDG updates to the POC on 04/18/24, 05/02/24 and on 05/30/24 ordered hospice aide visits at a frequency of one time a week for one week, then two visits every week for 12 weeks. Documentation showed patient refusal of hospice aide visits on 04/08/24, 04/15/24, 04/19/24, 04/22/24, 04/24/24, 04/26/24, 05/01/24, 05/03/24, 0510/24, 05/15/24, 05/17/24, 05/20/24, 05/27/24 and on 05/28/24. Documentation showed no attempts to reschedule the visits or follow up with the patient, showed no IDG team meeting discussions of patient refusal of hospice aide visits and no changes in hospice aide visit frequency. On 06/04/24 at 1:15 p.m., Staff B stated IDG documentation showed no discussion of patient refusal of hospice aide services during the IDG team meetings, no physician notification, and no changes in orders. Patient #19 A review of a POC dated 09/26/23 to 12/24/23 and IDG updates to the POC on 11/02/23, 11/16/23, 11/30/23 and on 12/14/23 showed orders for MSW one time a week for one week, then one time every other week for 12 weeks. Documentation showed patient refusal of MSW on 10/12/23, a MSW visit during week of 10/29/23 to 11/04/23, 11/08/23, a MSW visit during week of 11/19/23 to 11/25/23 and on 12/21/23. A coordination note dated 11/23/23 documented the patient/family had no MSW needs. Documentation showed no attempts to reschedule the visits or follow up with the patient, showed no IDG team meeting discussions of patient refusal of MSW visits and no changes in MSW visit frequency. On 06/04/24 at 2:00 p.m., Staff B stated IDG documentation showed no discussion of patient refusal of MSW services during the IDG team meetings, no physician notification, and no changes in orders.”

“Based on record review and interview, the hospice failed to ensure: 1. Initial spiritual assessments were conducted by the Chaplain within the five-day timeframe required to complete the initial comprehensive assessment for two (Patients #4 and #15) of 19 patients. 2. Initial psychosocial assessments were conducted by the MSW within the five-day timeframe required to complete the initial comprehensive assessment for two (Patients #4 and #8) of 19 patients. Findings: Patient #4 A review of the clinical record showed an election of the hospice benefit/SOC on 03/02/21; and psychosocial and spiritual assessments conducted on 03/15/21 (12 days from the date of election). Documentation showed no declined chaplain or MSW visits and no changes in orders. On 06/04/24 at 1:00 p.m., Staff B stated the Chaplain and MSW had not conducted the initial spiritual and psychosocial assessments for patient #4 within the five-day timeframe required to complete the initial comprehensive assessment. Patient #8 A review of the clinical record showed an election of the hospice benefit/SOC on 01/04/24 and no completion of the psychosocial assessment (Documentation showed a missed visit on 01/15/24 and a telephone contact call on 02/19/24). Documentation showed no changes in orders. On 06/04/24 at 1:15 p.m., Staff B stated the MSW had not conducted the initial psychosocial assessments for patient #8 within the five-day timeframe required to complete the initial comprehensive assessment. Patient #15 A review of the clinical record showed an election of the hospice benefit/SOC on 12/31/20 and a spiritual assessment on 01/07/21 (6 days from the date of election). Documentation showed no changes in orders. On 06/04/24 at 1:55 p.m., Staff B stated the Chaplain had not conducted the initial spiritual assessment for patient #15 within the five-day timeframe required to complete the initial comprehensive assessment.”

“Based on record review and interview, the agency failed to ensure continued review and update of a home hospice aide care plan for seven (Patients #2, 3, 7, 9, 11, 13 and 15) of 19 patients. Findings: Patient #2 A review of a POC dated 05/17/24 to 07/15/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 ordered hospice aide visits at a frequency of two visits every week for eight weeks. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 07/19/22. Patient #3 A review of a POC dated 05/25/24 to 07/23/24 and IDG updates to the POC on 05/17/24 and on 05/31/24 ordered hospice aide visits at a frequency of two visits every week for eight weeks. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 10/05/23. Patient #7 A review of a POC dated 05/02/24 to 07/30/24 and IDG updates to the POC on 05/03/24, 05/17/24 and on 05/31/24 ordered hospice aide visits at a frequency of one time a week for one week, three visits every week for 12 weeks, then one time a week for one week. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 02/08/24. Patient #9 A review of a POC dated 04/11/24 to 06/09/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 one time a week for one week, then two visits every week for eight weeks. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 11/20/23. Patient #11 A review of a POC dated 04/01/24 to 05/30/24 and IDG updates to the POC on 04/18/24, 05/02/24, 05/16/24 and on 05/30/24 ordered hospice aide visits at a frequency of two visits every week for nine weeks, increased to three times a week effective 04/23/24. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 02/07/24. Patient #13 A review of a POC dated 04/08/24 to 06/06/24 and IDG updates to the POC on 04/16/24, 04/30/24, 05/14/24 and on 05/28/24 ordered hospice aide visits at a frequency of two visits every week for nine weeks. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 12/15/22. Patient #15 A review of a POC dated 05/03/24 to 07/01/24 and IDG updates to the POC on 05/16/24 and on 05/30/24 ordered hospice aide visits at a frequency of two visits every week for eight weeks, then one time a week for one week. Documentation showed no update to the hospice aide care plan, including frequency and durations of service since 04/10/23. On 06/05/24 at 12:50 p.m. to 1:55 p.m., Staff B stated: 1. Clinical record documentation for patients #2, 3, 7, 9, 11, 13 and 15 showed no updated or hospice aide care plans with current hospice aide service discipline frequencies and durations. The hospice does not update the aide care plans unless the aide tasks change.”