Compassus - Greater Philadelphia

“It is required that each patient’s individualized written plan of care: includes all services necessary for the palliation and management of the terminal illness, including the following: intervention to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 1 of 27 (4%) clinical records reviewed, the agency did not ensure that the plan of care (POC) included interventions to manage the patient’s documented pain and symptoms. Clinical Record 4: The patient elected hospice care on 04/25/2022 with a diagnosis of pulmonary hypertension. The Registered Nurse (RN) recertification assessment dated 08/20/2024 documented that the patient had increasing pain, requiring increased analgesics. The plan of care dated 09/11/2024 through 11/09/2024 did not document interventions to address the patient’s pain and symptoms. On 09/16/2024, the POC was updated to include interventions to address the patient’s pain. During an interview on 10/09/2024, the Regional Executive of Clinical Operations confirmed the finding, stating, “I understand it should be on the plan of care since they knew about it before the plan of care was created.””

“It is required that each patient’s individualized written plan of care: Includes all services necessary for the palliation and management of the terminal illness, including the following: medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 8 of 27 (30%) clinical records reviewed of patients requiring medical supplies and appliances, the agency did not ensure that the medical supplies and appliances necessary for the palliation and management of the terminal illness were included in the patient’s plan of care (POC). Clinical Record 12: The patient elected hospice care on 08/06/2024 with a diagnosis of unspecified protein-calorie malnutrition. The skilled nursing (SN) initial assessment dated 08/06/2024 documented that the patient had a colostomy and the patient suffered from decreased muscle coordination and ambulated with an assistive device. The assessment did not specify the type of assistive device. The POC dated 08/06/2024 did not include documentation of colostomy supplies. The POC documented “none” for DME and supplies. Clinical Record 13: The patient elected hospice care on 09/30/20204 with a diagnosis of end-stage renal disease and congestive heart failure (CHF). The SN’s initial assessment dated 09/30/2024 documented that the patient required continuous oxygen. The POC ordered: “Oxygen 3 Liters (L) continuous. The POC did not include documentation of oxygen supplies. The POC documented “none” for DME and supplies. Clinical Record 14: The patient elected hospice care on 10/02/2024 with a diagnosis of malignant neoplasm of the lung. The SN’s initial assessment dated 10/02/2024 documented the patient was short of breath and that breathing more comfortably was important to the patient. The POC dated 10/02/2024 ordered oxygen. The POC did not include documentation of oxygen supplies. Clinical Record 15: The patient elected hospice care on 09/09/2024 with a diagnosis of malignant neoplasm of the frontal lobe. The SN’s initial assessment dated 09/09/2024 documented that the patient required a walker and oxygen. The POC documented “none” for DME and supplies. Clinical Record 18: The patient was admitted on 08/28/2024 with diagnoses acute respiratory failure and malignant neoplasm of the colon. The SN initial assessment dated 08/28/2024 documented that the patient had a colostomy and would need a nebulizer with a mask, an oxygen concentrator, and portable oxygen in addition to colostomy supplies. The POC documented “none” for DME and supplies. Clinical Record 22: The patient elected hospice care on 09/08/2024 with a diagnosis of malignant neoplasm of the rectosigmoid junction. The SN’s initial assessment dated 09/08/2024 documented that the patient had a long-term indwelling Foley catheter, last changed on 09/06/2024. The POC dated 09/08/2024 did not include documentation of Foley catheter supplies. Clinical Record 25: The patient elected hospice care on 02/21/2024 with a diagnosis of malignant neoplasm of the colon. The SN’s initial assessment dated 02/21/2024 documented the patient had a bilateral nephrostomy and colostomy. The POC dated 02/21/2024 documented the DME and supplies: hospital bed, oxygen supplies, and shower/tub equipment under DME and supplies. The POC did not document nephrostomy and colostomy supplies. Clinical Record 26: The patient elected hospice care on 04/01/2024 with a diagnosis of heart failure. The SN’s initial assessment dated 04/01/2024 documented that the patient had a Foley catheter and used oxygen. The POC dated 04/01/2024 ordered oxygen and Foley catheter care and maintenance. The POC documented “none” for DME and supplies. During an interview and a joint record review on 10/10/2024, the Regional Executive of Clinical Operations confirmed the findings, stating, “We are going to have to figure out where to enter the supplies in the software so it shows up on the plan of care.””

“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 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 2 of 21 (10%) clinical records reviewed of patients with Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions to meet the needs of the patient. Clinical Record 12: The patient elected hospice care on 08/06/2024 with a diagnosis of unspecified protein-calorie malnutrition. The skilled nurse (SN) assessment dated 08/06/2024 documented that the patient had a colostomy. The plan of care ordered Hospice Aide services “1 wk1, 2 wk 12.” The HA care plan documented by the Registered Nurse (RN) on 08/06/2024 assigned the HA the relevant task of a bed bath every visit. The HA care plan did not inform the HA of the presence of the colostomy or document instructions for the HA regarding the care of the colostomy during the bed bath. Clinical Record 20: The patient elected hospice care on 08/15/2024 with a diagnosis of cerebral infarction. The SN assessment dated 08/15/2024 documented that the patient was weak, had multiple recent falls, and required the assistance of a rollator plus one person to ambulate short distances. The plan of care ordered Hospice Aide services “2 wk 12, 1 wk1.” The HA care plan dated 08/15/2024 assigned the HA the relevant tasks: bathing (bed) every visit and bathing (shower) every visit. The HA care plan did not specify which type of bathing should be provided by the HA. During an interview and joint record review, the Regional Executive of Clinical Operations confirmed the findings, stating, “I can’t say I am surprised. This problem aligns with what we are focusing education on.””