Rivercross Healthcare

“Based on record review and interview, the hospice failed to maintain evidence that its QAPI program showed measurable improvement in indicators related to improved palliative outcomes and hospice services. This failed practice had the potential to place 102 current patients and any new patient admitted to the hospice at risk of poorly identified outcome measures related to symptom control. (See L561) Based on record review and interview, the hospice failed to analyze quality indicators. This failed practice had the potential to place 102 current patients and any new patient admitted to the hospice at risk for repeated hospice mishaps due to failure of the hospice to self-identify problem areas. (See L562) Based on record review and interview, the hospice failed to maintain evidence of the use of quality indicator data in their QAPI program. This failed practice had the potential to negatively affect patient care due to hospice failure to collect and correct areas of deficient practices for all 102 current patients and any new patient admitted to the hospice. (See L563) Based on a record review and interview, the hospice failed to implement and maintain an effective QAPI Program and failed to ensure performance improvements were tracked to ensure that improvements were sustained. This failed practice had the potential to place 102 current patients and any new patient admitted to the hospice at risk for repeated unidentified areas of poor care and symptom management. (See L570) Based on a record review and interview, the governing body failed to ensure a QAPI program was maintained and evaluated annually. This failed practice had the potential to place all patients on service for the calendar years of 2022 and 2023 at risk for poor outcomes due to the lack oversight and governing body involvement. (See L574)”

“Based on record review and interview, the hospice failed to ensure 1. skilled nurse visits were provided in accordance with the plan of care for one (Patient #12) of 19 patients and 2. hospice aide visits were provided in accordance with the plan of care for two (Patients #12 and 13) of 19 patients. Patient #12 A review of the plan of care dated 04/14/24 to 06/12/24 with plan of care updates dated 04/24/24 and 05/02/24 showed a skilled nurse frequency of two visits per week for eight weeks and one visit per week for one week and a hospice aide frequency of two visits per week for eight weeks and one visit per week for one week. A review of the clinical record showed the following: A skilled nurse missed visit note dated 05/02/24 documented a missed visit due to the patient being in the hospital for the week of 04/28/24 to 05/04/24 (one of two completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide visit was completed 04/29/24 with no other visits documented for the week of 04/28/24 to 05/04/24 (one of two completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #13 A review of the plan of care dated 02/12/24 to 05/11/24 with plan of care updates dated 02/14/24 and 02/28/24 showed a hospice aide frequency of one visit per week for one week and two visits per week for eight weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 02/24/24 documented the reason for the missed visit as patient refusal of shower for the week of 02/18/24 to 02/24/24 (only one of two completed visits for this week). Documentation showed no offer or refusal of other hospice aide services, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 02/26/24 documented the reason for the missed visit as patient refusal of shower for the week of 02/25/24 to 03/02/24 (only one of two completed visits for this week). Documentation showed no offer or refusal of other hospice aide services, no attempts to reschedule the missed visit and no change in the ordered frequency. On 05/17/24 at 1:30 p.m., Staff B stated: 1. the skilled nurse frequency was not followed as ordered for Patient #12 and 2. the hospice aide frequency was no followed as ordered for Patients #12 and 13.”

“Based on record review and interview, the hospice failed to ensure an individualized plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for sixteen (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. 15 and 16) of 19 patients reviewed. Patient #1 A plan of care dated 02/29/24 to 05/28/24 documented a primary diagnosis of congestive heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #2 A review of the plan of care dated 02/02/24 to 05/01/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #3 A plan of care dated 04/09/24 to 07/07/24 documented a primary diagnosis of acute and chronic respiratory failure and hypercapnia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #4 A plan of care dated 04/24/24 to 07/22/24 documented a primary diagnosis of cancer of right bronchus/lung and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #5 A plan of care dated 02/22/24 to 04/21/24 documented a primary diagnosis of cancer of right breast and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #6 A plan of care dated 04/10/24 to 06/08/24 documented a primary diagnosis of chronic kidney disease stage V and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #7 A plan of care dated 03/04/24 to 05/02/24 documented a primary diagnosis of multiple sclerosis and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #8 A plan of care dated 02/26/24 to 04/25/24 documented a primary diagnosis of Alzheimer’s disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #9 A plan of care dated 04/11/24 to 06/09/24 documented a primary diagnosis of Parkinson’s disease with dyskinesia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #10 A plan of care dated 03/21/24 to 05/19/24 documented a primary diagnosis of hemiplegia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #11 A plan of care dated 01/27/24 to 03/26/24 documented a primary diagnosis of dysphasia following cerebral infarction and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #12 A plan of care dated 04/14/24 to 06/12/24 documented a primary diagnosis of Alzheimer’s disease with heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #13 A plan of care dated 02/12/24 to 05/11/24 documented a primary diagnosis of cancer of the right breast and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #14 A plan of care dated 04/12/24 to 07/10/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #15 A review of the plan of care dated 03/08/24 to 05/06/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #16 A review of the plan of care dated 03/28/24 to 06/25/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 05/16/24 at 2:05 pm, Staff A stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and 16 failed to include individualized services necessary for the palliation and management of the terminal illness.”

“Based on record review and interview, the hospice failed to maintain evidence that its QAPI program showed measurable improvement in indicators related to improved palliative outcomes and hospice services. This failed practice had the potential to place 102 current patients and any new patient admitted to the hospice at risk of poorly identified outcome measures related to symptom control. A review of administrative records showed no evidence of measurable improvements in indicators related to improved palliative outcomes and hospice services for 2023 and from 01/01/24 to 05/16/24. On 05/16/24 at 2:15 pm, Staff A stated there was no documentation showing measurable improvement in indicators related to palliative outcomes and hospice services for 2023 and from 01/01/24 to 05/16/24.”

“Based on record review and interview, the hospice failed to maintain evidence of the use of quality indicator data in the QAPI program. This failed practice had the potential to negatively affect patient care due to hospice failure to collect and correct areas of deficient practices for all 102 current patients and any new patient admitted to the hospice. A review of administrative records showed no use of quality indicator data in their QAPI program for 2022. On 05/16/24 at 2:15 pm, Staff A stated the QAPI program did not include the use of quality indicator data for 2022.”

“Based on a record review and interview, the hospice failed to implement and maintain an effective QAPI Program and failed to ensure performance improvements were tracked to ensure that improvements were sustained. This failed practice had the potential to place 102 current patients and any new patient admitted to the hospice at risk for repeated unidentified areas of poor care and symptom management. A review of administrative records showed no implemented changes designed to measure and track performance or that improvements were sustained for 2023. The hospice failed to ensure the QAPI Program mandated actions aimed at performance improvement, measured success after implementation and tracked performance to ensure that improvements were sustained. On 05/16/24 at 2:15 pm, Staff A stated the QAPI program did not contain documentation of measurement and tracking of performance improvement projects being sustained in 2023.”

“Based on a record review and interview, the governing body failed to ensure a QAPI program was maintained and evaluated annually. This failed practice had the potential to place all 102 patients on service at risk for poor outcomes due to the lack oversight and governing body involvement. A review of administrative records showed no governing body review of the surveyed hospice QAPI program for calendar years of 2023. On 05/16/24 at 2:15 pm, staff A stated the governing body minutes did not show review of the surveyed hospice QAPI for the hospice in 2023.”

“Based on record review and interview, the hospice failed to ensure governing body oversight of ongoing operations of the patient care delivery systems for calendar years 2022 and 2023 effecting all 102 patients and all current staff. A review of administrative records showed no governing body oversight of ongoing operations of the patient care delivery systems specific to the hospice in the calendar years of 2022 and 2023. On 05/16/24 at 2:25 p.m., Staff A stated there was no documentation which showed evidence of governing body oversight of ongoing operations of the patient care delivery systems specific to the surveyed hospice in calendar years 2022 and 2023.”

“Based on record review and interview, the hospice failed to the ensure plans of care was coordinated with the long-term care facility for four (Patients #9, 10, 11 and 12) of 19 patients reviewed. Patient #9 A plan of care dated 04/11/24 to 06/09/24 documented a primary diagnosis of Parkinson’s disease with dyskinesia and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #10 A plan of care dated 03/21/24 to 05/19/24 documented a primary diagnosis of hemiplegia and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. A plan of care dated 01/27/24 to 03/26/24 documented a primary diagnosis of dysphasia following cerebral infarction and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #12 A plan of care dated 04/14/24 to 06/12/24 documented a primary diagnosis of Alzheimer’s disease with heart failure and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. On 05/16/24 at 1:40 pm, Staff A stated the plan of care for Patients #9, 10, 11 and 12 did not outline the patient specific interventions to be to be provided by the nursing home or the hospice for the palliation and management of the terminal illness.”

“Based on record review and interview, the hospice failed to ensure wound assessments were coordinated with the long-term care facility for one (Patients #5) of 19 patients reviewed. Patient #5 A plan of care dated 02/22/24 to 04/21/24 showed a skilled nurse frequency of one visit per week for one week and two visits per week for eight weeks. A review of the clinical record showed the following with no coordination of wound care with the long term care facility: A skilled nurse assessment dated 02/22/24 for the week of 02/22/24 to 02/24/24 documented no assessment of stage II pressure ulcer. A skilled nurse assessment dated 02/26/24 and 02/29/24 for the week of 02/25/24 to 03/02/24 documented no assessment of stage II pressure ulcer. A skilled nurse assessment dated 03/04/24 and 03/08/24 for the week of 03/03/24 to 03/09/24 documented no assessment of stage II pressure ulcer. A skilled nurse assessment dated 03/12/24 and 03/14/24 for the week of 03/10/24 to 03/16/24 documented no assessment of stage II pressure ulcer. A skilled nurse assessment dated 03/19/24 and 03/21/24 for the week of 03/17/24 to 03/23/24 documented no assessment of stage II pressure ulcer. A skilled nurse assessment dated 04/09/24 and 04/11/24 for the week of 04/07/24 to 04/13/24 documented no assessment of stage II pressure ulcer. A skilled nurse assessment dated 04/16/24 and 04/18/24 for the week of 04/14/24 to 04/20/24 documented no assessment of stage II pressure ulcer. On 05/16/24 at 1:45 pm, Staff A stated the hospice failed to show coordination with the nursing home regarding wound assessment for Patient #5.”