Lifecare Hospice, LLC

“It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 3 of 8 (38%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The initial nursing assessment dated 05/14/2024 stated the patient had urinary incontinence and agitation. The POC dated 05/14/2024 lacked goal(s) and intervention(s) for urinary incontinence and agitation. Clinical Record 3: : The updated comprehensive nursing assessment dated 04/25/2024 stated the patient transitioned from being up in a Geri-chair to being bedbound and added medications for agitation in order for staff to be able to provide care. The POC dated 04/28/2024 lacked goal(s) and intervention(s) for skin integrity and agitation. Clinical Record 5: The initial nursing assessment dated 05/02/2024 stated the patient’s primary diagnosis was COPD with oxygen saturation of 84% at rest on room air as well as the patient exhibiting shortness of breath. The POC dated 05/02/2024 lacked goal(s) and intervention(s) for knowledge of disease process and Respiratory (shortness of breath). The Administrator/Director of Nursing (DON) and the Alternate Administrator/Alternate DON stated in an interview on 06/05/2024 that the agency did not ensure the POC reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse (RN) who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by an RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 3 of 6 (50%) clinical records reviewed with aide services provided, the agency did not ensure the hospice Registered Nurse (RN) provided the aide with patient specific written care instructions on the aide care plan. Clinical Record 1: The aide care plan dated 05/14/2024 ordered the tasks: “Seated shower”; “Bed bath”; “Complete bath”; and “Sponge bath”. The aide visit note dated 05/28/2024 reported the task “Seated shower” was completed. The aide visit note dated 05/30/2024 reported the task “Sponge Bath” was completed. The aide care plan, written by the RN, lacked evidence of specific written care instructions for the type of bathing task the aide should perform. During an interview with the RN, he confirmed a specific bathing task was not ordered for the aide. Clinical Record 3: The aide care plan dated 05/14/2024 ordered the tasks: “Seated Shower”; “Complete bath”; and “Assist with partial/complete bath”. The aide visit note dated 05/28/2024 reported the task “Seated shower” was completed. The aide care plan, written by the RN, lacked evidence of specific written care instructions for the type of bathing task the aide should perform. During an interview with the RN, he confirmed a specific bathing task was not ordered for the aide. Clinical Record 6: The aide care plan dated 08/28/2023 ordered the task: “Assist with ambulation”. The certification of terminal illness dated 08/28/2023 stated the patient was bedbound. The aide care plan, written by the RN, lacked appropriate specific written care instructions based on the patient current bedbound status. During an interview with the RN, he confirmed the task “Assist with ambulation” was not a reasonable order since the patient was bedbound. The Administrator/Director of Nursing (DON) and the Alternate Administrator/Alternate DON stated in an interview on 06/05/2024 that the agency did not ensure the hospice RN provided the aide with accurate and patient-specific written care instructions on the aide care plan.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The hospice documents the cost savings achieved through volunteers. Documentation includes: The identification of each position that is occupied by a volunteer; The work time spent by volunteers occupying those positions; Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions noted in Item 1 and for the durations noted in Item 2. This standard was not met as evidenced by document review and interview. The review of the Hospice Volunteer Requirement Report revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. Document 1: The review of the 2024 Hospice Volunteer Requirement Report revealed the volunteer percentage of hours worked for January 2024 thru May 2024 was 1.56%. The Administrator/Director of Nursing (DON) and the Alternate Administrator/Alternate DON stated in an interview on 06/05/2024 that the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The review of the Hospice Volunteer Requirement Report revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: Hospice election form and any advance directives. This standard was not met as evidenced by interview and observation. In 2 of 2 (100%) home visit observations of patients residing in a facility and receiving routine hospice services, the agency did not ensure that the Skilled Nursing Facility (SNF) was provided the Hospice election form and any advance directives. Home Visit 2: The patient’s election of benefit was dated 05/13/2024 with a diagnosis of unspecified severe protein-calorie malnutrition. The patient (Clinical Record 2) resided in SNF. During the home visit (Home Visit 2) with the hospice aide (Personell Record 2) on 06/04/2024, a review of the patient’s facility records lacked evidence of the patient’s Hospice election form and any advance directives. The Chaplain(Personnel Record 4) reviewed and agreed the patient’s Hospice election form and any advance directives were missing from the facility records. Home Visit 3: The patient’s election of benefit was dated 01/29/2024 with a diagnosis of Sarcopenia. The patient (Clinical Record 3) resided in a SNF. During the home visit (Home Visit 3) with the Chaplain ( Personnel Record 4) on 06/04/2024, a review of the patient’s facility records lacked evidence of the patient’s Hospice election form and any advance directives. The Chaplain reviewed and agreed the patient’s Hospice election form and any advance directives were missing from the facility records. The Administrator/Director of Nursing (DON) and the Alternate Administrator/Alternate DON stated in an interview on 06/05/2024 that the agency did not ensure that the SNF was provided with the patient’s Hospice election form and any advance directives.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: Physician certification and recertification of the terminal illness. This standard was not met as evidenced by interview and observation. In 2 of 2 (100%) home visit observations of patients residing in a facility and receiving routine hospice services, the agency did not ensure that the Skilled Nursing Facility (SNF) was provided with the initial physician certification of the terminal illness (CTI), and/or the recertification of terminal illness. Home Visit 2: The patient’s election of benefit was dated 05/13/2024 with a diagnosis of unspecified severe protein-calorie malnutrition. The patient(Clinical Record 2) resided in SNF. During the home visit (Home Visit 2) with the hospice aide (Personell Record 2) on 06/04/2024, a review of the patient’s facility records lacked evidence of the of the patient’s initial CTI. The Chaplain (Personnel Record 4) reviewed and agreed the patient’s initial CTI was missing from the facility records. Home Visit 3: The patient’s election of benefit was dated 01/29/2024 with a diagnosis of Sarcopenia. The patient (Clinical Record 3) resided in a SNF. During the home visit (Home Visit 3) with the Chaplain ( Personnel Record 4) on 06/04/2024, a review of the patient’s facility records lacked evidence of the patient’s initial and recertification of the terminal illness. The Chaplain (Personnel Record 4) reviewed and agreed the patient’s initial, and recertification of terminal illness were missing from the facility records. The Administrator/Director of Nursing (DON) and the Alternate Administrator/Alternate DON stated in an interview on 06/05/2024 that the agency did not ensure that the SNF was provided with the patient’s initial CTI and/or the recertification of terminal illness.”