Caring Hospice Services

“Based on review of clinical records (CR) and interviews with staff the agency failed to ensure staff followed the visit schedule as ordered for by the physician on the plan of care for one (1) of three (3) records reviewed. CR #1 Findings include: Agency policies were reviewed on 1/24/25 at approximately 1:30 PM and revealed the following. Policy titled, “;Physician Orders” stated, “;Some of the reasons orders are obtained from physicians include, but are not limited to....change in visit frequency if not within the range specified in the patients plan of care...” Policy titled, “;Plan of Care” stated, “;The care and services provided to patients and their families are in accordance with an individualized, written plan of care established by the hospice IDG (interdisciplinary group) A review of clinical records (CR) were reviewed onsite on 1/24/25 starting at approximately 10:00AM which revealed the following: CR #1: Start of Care (SOC): 11/26/24. File contained a Hospice plan of care for the certification period of 11/26/24-2/23/25 that contained an order for a Chaplain evaluation. Chaplain visits were documented as conducted on 12/2/24 12/11/24, and 1/3/25. There was a note by the chaplain from the evaluation visit on 12/2/24 that listed a plan for visits to be conducted, “;1-2 month and 2 PRN (as needed).” There were no additional physician orders/notification to cover the additional chaplain visits. Interview with administration on 1/24/25 at approximately 2:00PM confirmed the above findings.”

“Based on review of clinical records (CR), hospice policies, staff interviews and additional hospice documentation, the hospice failed to ensure that the patient had the appropriate medications delivered in a timely manner to manage the patient’s symptoms for one (1) of three (3) CR reviewed. (CR #1). Findings include: Review of agency policies on 8/29/24 at approximately 2:00PM and 9/4/24 at approximately 11:00 AM revealed the following: Policy titled, “;Medication availability” stated, “;All medication will be dispensed by the Caring Hospice Services contracted pharmacy, with a physician order. The contracted pharmacy will utilize neighborhood pharmacies for immediate dispensing of medication.” Policy titled, “;Medication-Management” stated, “;Medications are provided on a timely basis and are available 24 hours a day and seven days a week as needed...” Clinical records were reviewed on 8/27/24, 9/3/24, 9/4/24, 9/6/24 and 9/9/24 at approximately 10:00AM, which revealed the following: CR #1: Start of Care (SOC): 4/16/24, Subject of the complainant. Passed away on 7/17/24. Certification periods reviewed: 4/16/24-7/14/24 and 7/15/24-10/12/24. There was a verbal order written by PF#1 for medication refills and medication changes on 7/16/24 for the following: morphine oral solution 20mg/mL take 0.5mL (10mg) P.O. (by mouth) every 2 hours as need for pain/SOB (shortness of breath). Lorazepam liquid 2mg/mL take 0.5 mL (1mg) P.O. (by mouth) every 6 hours as needed for anxiety. Atropine 1% solution take 1-2 drops every 6 hours as needed for secretions. Patient’s chart contained previous/different dosing of morphine (5mg every 3 hours). Patient already had Lorazepam but in pill form and the atropine was a new medication that was ordered. In email with the Director of Nursing on 9/4/24 she stated that the nurse educated the patient/family that they could crush the pill form of Lorazepam that they already had until the liquid form was delivered. Review of email between the Hospice and pharmacy was reviewed on 9/3/24 at approximately 10:00 and revealed the following: Pharmacy company that hospice agency uses utilized a non-local/national delivery company to deliver the medications to the patient. Paperwork notes a delivery date of 7/18/24 (after the patient passed away on 7/17/24). Pharmacy representative stated, “;Per (delivery company name), plane arrived late to the hub, making the package late in delivery.” Hospice representative then asked, “;Would we have received notification of the delay” and pharmacy responded, “;Unless it was part of a larger services failure where we were notifying clients, we would not have sent a notification.” Onsite interview conducted with regional director quality assurance and compliance on 8/29/24 at approximately 10:00AM. She stated the daughter never called the hospice to let them know that the medications ordered on 7/16/24 did not arrive in a timely matter so they had no way of knowing it did not arrive until after the patient passed away. During exit interview conducted on the phone with Director of Nursing on 9/9/24 at approximately 10:15 AM it was stated that the pharmacy/hospice could have communicated better as their policy states STAT medications will be delivered in a timely matter. She stated the pharmacy does partner with local pharmacies and it could have been obtained that way. An interview with the Hospice Director of Nursing on 9/9/24, at approximately 10:15 AM. confirmed the above findings.”

“Based on review of clinical records (CR) and interviews with staff the agency failed to ensure staff followed the visit schedule as ordered for by the physician on the plan of care for one (1) of three (3) records reviewed. CR #1 Findings include: Review of agency policies on 8/29/24 at approximately 2:00PM and 9/4/24 at approximately 11:00 AM revealed the following: Policy titled, “;Plan of Care” stated, “;The care and services provided to patients and their families are in accordance with an individualized written plan of care established by the hospice IDG (interdisciplinary team) in collaboration with the patients attending physician (if any) and if appropriate the patient and/or his or her representative...” Policy titled, “;Missed Visit Note” stated, “;All services are provided according to the physicians plan of care including scope and frequency of services to meet the needs of the patient and family...in the event a visit is not completed according to the patients plan of care and is unable to be assigned to another clinician and/or replacement refused, a missed visit form will be completed. Notification will be made to the patient/family, physician and facility (if applicable). Documentation of the missed visit will be included in the patient record.” A review of Clinical records completed 8/29/24, 9/3/24, 9/4/24, 9/6/24 and 9/9/24, at approximately 10:00AM and revealed the following: CR #1: Start of Care (SOC): 4/16/24, Passed away on 7/17/24. Certification periods reviewed: 4/16/24-7/14/24 and 7/15/24-10/12/24. Both certification periods contained nursing orders for 1-2 times per week for 2 weeks and 1 visit PRN (as needed), and Hospice Aides for five (5) times per week for 2 weeks. The hospice orders were reviewed by the Interdisciplinary Team (IDT) and continued throughout the certification periods above. During the following weeks No Hospice Aides were provided by the hospice: 4/16/24-4/20/24, 4/21/24-4/27/24, 4/28/24-5/4/24, 5/5/24-5/10/24, 5/12/24-5/18/24, 6/9/24-6/15/24, 6/30/24-7/6/24, 7/7/24-7/13/24, 7/14/24-7/17/24. During the following weeks only one hospice aide visit was conducted: 5/19/24-5/25/24, 5/26/24-6/1/24, 6/2/24-6/8/24, 6/16/24-6/22/24, and 6/23/24-6/29/24. There were only two (2) “;Hospice Aide Missed Visit notes” completed for 5/27/24 and for 6/12/24 but not for any of the other missed visits noted above and no orders to change the frequency. Interview with Director of Nursing on 9/9/24 at approximately 10:00AM confirmed the above findings.”

“Based on a review of personnel files (PF), agency policy, and interview with agency staff, it was determined that the Governing Body failed to ensure that initial competency evaluations were completed for one (1) of five (5) PF reviewed. (PF #1) Findings include: Review of agency policies on 8/29/24 at approximately 2:00PM and 9/4/24 at approximately 11:00 AM revealed the following: Policy titled, “;Competency Assessment” stated, “;Caring Hospice implements a systematic competency assessment program to assure that all staff and volunteers are competent to perform their jobs effectively...As a component of the orientation process, new staff and volunteers complete a competency assessment evaluation prior to providing care or assuming administrative responsibilities. Competency evaluations are specific to the skills needed for each job category and specific competencies are delineated in job descriptions and performance evaluations. The competency of staff and volunteers is assessed through self-evaluations and checklists, supervised visits, interviews, simulated practice and written tests. Policy titled, “;Personnel File Contents” stated, “;employee/volunteer personnel documentation must include at a minimum but not limited to the following items...at least one in-home visit...skills/competency evaluation...” A review of PFs on 8/29/24 at approximately 11:30 AM and on 9/5/24 and 9/6/24 at approximately 2:00PM which revealed the following: PF #1: Date of Hire: 3/2/23, Personnel file is a Registered Nurse. File contained initial in-home evaluation completed after hire on 8/9/23. An interview with the director of nursing on 9/9/24, at approximately 10:00 AM. confirmed the above findings.”