Gateway Hospice Providers, LLC

“It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient’s family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 14 (7%) records reviewed the agency did not ensure the comprehensive assessment included an initial bereavement assessment. Agency Policy: Bereavement PC.130 read in part ‘1. The Hospice will perform an initial bereavement assessment of the needs of the patient’s family and other care individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death as part of the Initial Comprehensive Assessment. A. The bereavement assessment will be completed by the Hospice’s Spiritual Counselor, Social worker, and/or the Registered Nurse (RN). Clinical Record 4: The hospice election of benefit was dated 12/01/2023. The RN comprehensive assessment was dated 12/01/2023. The spiritual and psychosocial initial assessments were dated 12/05/2023. The initial bereavement risk assessment was not documented as completed until 12/07/2023 by the social worker, which exceeded the initial comprehensive assessment completion timeline requirement. During interview 01/05/2024, the Administrator reviewed the associated record and stated that the social worker had not been able to speak to family until 12/07/2023. Upon review of the agency policy, the Administrator did agree the assessment was part of the comprehensive assessment and should have been completed earlier and also agreed that the assessment could have been completed by the nurse or chaplain.”

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over the counter (OTC) drugs. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 14 (7%) records reviewed the agency did not ensure the drug profile contained the patient’s current prescription drugs. Agency Policy: Medication List and Monitoring PC.185 read in part ‘1. The Hospice will maintain a current, accurate list of all prescription and over the counter (OTC) medications taken by the patient. (Medication Prolife). Clinical Record 8: The hospice election of benefit was dated 10/06/2023. A review of the nursing visit notes during the benefit period 11/15/2023 through 01/02/2024 included the “patient use of Oxygen @2lpm via NC as needed.” A physician order dated 10/6/2023 and signed by the physician included ‘Oxygen 2-5Lpm as needed for comfort/dyspnea.’ At the time of the review on 01/04/2024, Oxygen was not included on the medication profile. The interdisciplinary team meeting documentation dated 11/22/2023, 12/06/2023, 12/20/2023 and 01/03/2024 included completion of medication profile review.”

“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 drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 14 (21%) records reviewed the agency did not ensure the plan of care included all of the treatments necessary to meet the needs of the patient. Agency Policy: Plan of Care Process PC.30 read in part ‘VI. The POC includes but is not limited to: D. Drugs and treatments necessary to meet the needs of the patient.” Clinical Record 4: The hospice election of benefit was dated 12/01/2023. A review of physician orders dated 12/27/2023 read in part, “Skilled Nurse (SN) may insert 16Fr 10cc foley catheter for comfort using aseptic technique. SN may maintain and change foley catheter prn” and physicians order dated 1/3/2024 read in part, “SN may insert 20Fr 10cc foley catheter for urination/comfort using aseptic technique. SN may maintain and change foley catheter prn.” The physicians’ orders did not contain as needed (prn) qualifiers at the time of the review on 01/04/2024. Clinical Record 9: The hospice election of benefit was dated 12/15/2023. The physician’s order dated 12/15/2023 read in part, “begin wound care to pubic area, SN using aseptic technique will cleanse pubic area wound with wound cleanser, pat dry with gauze, apply 4x4 gauze pads soaked in Dakin’s solution and wrap with Coban self-adhesive dressing. Wound care to be done 2xweek and as needed until wound is healed.” The physician’s order did not contain as needed (prn) qualifiers at the time of the review on 01/04/2024. Clinical Record 14: The hospice election of benefit was dated 12/15/2023. The physician’s order dated 12/15/2023 read in part, “Left heel wound care, cleanse with wound cleanser, pat dry with gauze and apply CA alginate and cover with foam dressing 2xweek and as needed until wound is healed.” The physician’s order did not contain as needed (prn) qualifiers at the time of the review on 01/04/2024. During interview on 01/05/2024, the Administrator reviewed the associated records and agreed the orders were incomplete and stated that the orders had since been corrected with the addition of as needed instructions/parameters.”