Bristol Hospice - Eugene LLC

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 5 of 23 (22%) clinical records reviewed, the agency did not ensure that the hospice interdisciplinary group (IDG) completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. Clinical Record 3: The patient elected the hospice benefit on 03/13/2024. A clinical record review revealed evidence of a Chaplain’s initial comprehensive assessment dated 03/20/2024, which was six (6) days after the election of hospice care. There was no evidence that the patient and family/caregiver refused Chaplain services during the five (5) day period after the election of hospice care. Clinical Record 6: The patient elected the hospice benefit on 05/31/2024. A clinical record review revealed evidence of a Chaplain’s initial comprehensive assessment dated 06/06/2024, which was six (6) days after the election of hospice care. There was no evidence that the patient and family/caregiver refused Chaplain services during the five (5) day period after the election of hospice care. Clinical Record 13: The patient elected the hospice benefit on 05/02/2024. A clinical record review revealed evidence of a Chaplain’s initial comprehensive assessment dated 05/08/2024, which was six (6) days after the election of hospice care. There was no evidence that the patient and family/caregiver refused Chaplain services during the five (5) day period after the election of hospice care. Clinical Record 16: The patient elected the hospice benefit on 07/11/2024. A clinical record review revealed evidence of a Chaplain’s initial comprehensive assessment dated 07/18/2024, which was seven (7) days after the election of hospice care. There was no evidence that the patient and family/caregiver refused Chaplain services during the five (5) day period after the election of hospice care. Clinical Record 22: The patient elected the hospice benefit on 02/28/2024. A clinical record review revealed evidence of a Chaplain’s initial comprehensive assessment dated 03/05/2024, which was six (6) days after the election of hospice care. There was no evidence that the patient and family/caregiver refused Chaplain services during the five (5) day period after the election of hospice care. During an interview on 07/26/2024, the Executive Director, Director of Patient Care Services, Regional Director of Clinical Operations, and Clinical Supervisor/Alternate Director of Patient Care Services confirmed that the hospice IDG completed the initial comprehensive assessments more than five (5) calendar days after the election of hospice care.”

“It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The update of the comprehensive assessment includes information on the patient’s progress toward desired outcomes and reassessment of the patient’s response to care. The assessment update is completed as frequently as the condition of the patient requires and no less frequently than every 15 days. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed, the agency did not ensure that the comprehensive assessment was updated by the registered nurse (RN) no less frequently than every 15 days. Clinical Record 23: The patient elected hospice care on 10/25/2023 with a diagnosis of Alzheimer’s disease, unspecified. The POC ordered skilled nursing (SN) services two (2) times per week. There was evidence of Licensed Practical Nurse (LPN) visits dated 06/13/2014, 06/17/2024, 06/21/2024, 06/24/2024, and 06/28/2024. A clinical record review revealed RN comprehensive assessments dated 06/10/2024 and 07/01/2024, with twenty (20) days between the two (2) RN comprehensive assessment visits. During an interview on 07/26/2024, the Executive Director, Director of Patient Care Services, Regional Director of Clinical Operations, and the Clinical Supervisor/Alternate Director of Patient Care Services confirmed that the comprehensive assessment updates by the RN were completed less frequently than every 15 days.”

“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 4 of 23 (17%) clinical records reviewed, the agency did not ensure that 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 8: The patient elected hospice care on 05/23/2024 with the diagnoses of acute and chronic respiratory failure with hypoxia. The initial nursing assessment dated 05/23/2024 documented the patient’s dysphagia and use of oxygen. The medication profile dated 05/23/2024 documented, “Oxygen 4 liters per minute via nasal cannula continuous.” The POC dated 05/23/2024 ordered: “Oxygen, as ordered.” The POC dated 05/23/2024 did not document a planned intervention and goal based on the patient’s identified problem with dysphagia. Additionally, the POC did not include documentation of the flow rate, frequency, and route of administration for oxygen. Clinical Record 10: The patient elected hospice care on 06/19/2024 with a diagnosis of chronic respiratory failure with hypoxia. The initial nursing assessment dated 06/19/2024 documented in “Concerns noted” that the patient experienced shortness of breath (SOB). The medication profile dated 06/19/2024 documented, “Oxygen 2-5 liter per minute via nasal cannula, as needed for SOB.” The POC dated 06/19/2024 ordered: “Oxygen per physician order.” The POC did not include documentation of the flow rate, frequency, and route of administration for oxygen. Clinical Record 11: The patient elected hospice care on 03/04/2024 with a diagnosis of alcoholic cirrhosis of the liver with ascites. The initial nursing assessment dated 03/04/2024 documented, “The patient carries a new diagnosis of dysphasia w/ new difficulty swallowing food/liquids/ medication.” The POC dated 03/04/2024 did not document a planned intervention and goal based on the patient’s identified problem with dysphagia. Clinical Record 16: The patient elected hospice care on 07/11/2024 with a diagnosis of malignant neoplasm of the rectosigmoid junction. The initial nursing assessment dated 07/11/2024 documented, “The patient has Foley catheter in place.” The POC dated 07/11/2024 did not document a planned intervention and goal based on the patient’s identified genitourinary problem. During an interview on 07/26/2024, the Executive Director, Director of Patient Care Services, Regional Director of Clinical Operations, and the Clinical Supervisor/Alternate Director of Patient Care Services confirmed that the POC did not include all 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 who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a 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 1 of 14 (7%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the Registered Nurse (RN) provided the HA with written patient care instructions. Clinical Record 21: The patient elected hospice care on 04/15/2024 with a diagnosis of other symptoms and signs involving cognitive functions following cerebral infarction. The initial nursing assessment dated 04/15/2024 documented the patient was receiving tube feedings. The HA care plan dated 04/16/2024 assigned the HA the relevant task: “Gastrostomy tube (G-tube) feeding, family to do all feeding, thickened liquids, and seated shower.” The HA care plan did not provide the HA with instructions regarding managing the G-tube during the seated shower and what to report to the RN about the “G-tube site.” During an interview on 07/26/2024, the Executive Director (ED), Director of Patient Care Services (DPCS), Regional Director of Clinical Operations, and Clinical Supervisor/Alternate Director of Patient Care Services (Alt DPCS) confirmed that the HA did not receive specific written care instructions regarding the “G-tube site.””

“It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and document review. In 2 of 14 (14%) clinical records reviewed for patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA provided services included in the care plan. Clinical Record 2: The patient elected hospice care on 01/03/2024 with a diagnosis of atherosclerotic heart disease of the native coronary artery without angina pectoris. The HA care plan dated 07/10/2024 assigned the HA the relevant task: “seated shower (while being treated for shingles give bed bath only).” The HA visit note dated 07/10/2024 documented that the patient refused the “seated shower” and that a “sponge bath” was performed. The HA care plan did not assign the HA the task “sponge bath.” Clinical Record 21: The patient elected hospice care on 04/15/2024 with a diagnosis of other symptoms and signs involving cognitive functions following cerebral infarction. The HA visit note dated 07/15/2024 documented, “Applied gait belt around her prior to transferring the patient.” During a phone interview with the HA on 07/25/2024, the HA stated, “A gait belt was used for this patient every visit.” The HA care plan dated 07/15/2024 did not assign the HA to use a gait belt during patient transfers. There was no documented evidence of HA communication with the Registered Nurse (RN) regarding using the gait belt for transfers. During an interview on 07/26/2024, the Executive Director (ED), Director of Patient Care Services (DPCS), Regional Director of Clinical Operations, and the Clinical Supervisor/Alternate Director of Patient Care Services (Alt DPCS) confirmed that the HA provided services that were not included on the HA care plan.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse (RN) as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met, as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the HA reported changes in the patient’s needs to the Registered Nurse (RN) as changes related to the HA care plan. Clinical Record 2: The patient elected hospice care on 01/03/2024 with a diagnosis of atherosclerotic heart disease of the native coronary artery without angina pectoris. The HA care plan dated 07/10/2024 assigned the HA the relevant task: “seated shower (while being treated for shingles give bed bath only).” The HA visit note dated 07/10/2024 documented that the patient refused the “seated shower” and that a “sponge bath” was performed. A clinical record review revealed no evidence that the HA notified the RN of the change in the patient’s care plan needs related to the assigned task “seated shower.” Clinical Record 21: The patient elected hospice care on 04/15/2024 with a diagnosis of other symptoms and signs involving cognitive functions following cerebral infarction. The HA visit note dated 07/15/2024 documented, “Applied gait belt around her prior to transferring the patient.” During a phone interview with the HA on 07/25/2024, the HA stated, “A gait belt was used for this patient every visit.” The HA care plan dated 07/15/2024 did not assign the HA to use a gait belt during patient transfers. A clinical record review revealed no evidence that the HA notified the RN of the need to utilize a gait belt during patient transfers. During an interview on 07/26/2024, the Executive Director (ED), Director of Patient Care Services (DPCS), Regional Director of Clinical Operations, and the Clinical Supervisor/ Alternate Director of Patient Care Services (Alt DPCS) confirmed that the HA did not report changes in the patient’s care needs to the RN as the changes related to the HA care plan.”

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 2 of 10 (20%) clinical records reviewed for patients receiving Hospice Aide (HA) services for 14 or more days, the agency did not ensure that the HA was supervised by a Registered Nurse (RN) on-site no less frequently than every 14 days. Clinical Record 1: The patient elected hospice care on 04/19/2024 with a diagnosis of atherosclerotic heart disease of the native coronary artery without angina pectoris. A review of the clinical record and HA supervisory visits for 05/24/2024 through 06/19/2024 revealed RN supervisory visits dated 05/24/2024 and 06/19/2024, with twenty-six (26) days outstanding. There was no evidence that the Hospice Aide supervisory visits were completed no less frequently than every 14 days. Clinical Record 23: The patient elected hospice care on 10/25/2023 with a diagnosis of Alzheimer’s disease, unspecified. A review of the clinical record and HA supervisory visits for 06/10/2024 through 07/01/2024 revealed RN supervisory visits dated 06/10/2024 and 07/01/2024, with twenty (20) days outstanding. There was no evidence that the Hospice Aide supervisory visits were completed no less frequently than every 14 days. During an interview on 07/26/2024, the Executive Director (ED), Director of Patient Care Services *DPCS), Regional Director of Clinical Operations, and the Clinical Supervisor/Alternate Director of Patient Care Services (Alt DPCS) confirmed that the aide supervisory visits were completed less frequently than every 14 days.”