Pure Heart Hospice

“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; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed revealed that the agency did not ensure that all current medications were documented on the drug profile. Clinical Record 1: The patient election of hospice was 01/24/2024. The initial registered nurse (RN) assessment dated 01/24/2024 read in part “Patient is dependent on oxygen at 2-4l/m”. The drug profile dated 1/24/2024 did not include oxygen. Clinical Record 3: The patient election of hospice was 11/20/2023. The initial RN assessment dated 11/20/2023 read in part “Patient oxygen continuously at 2-4l/m”. The drug profile dated 11/20/2023 did not include oxygen.”

“IIt is required that each patient’s individualized written plan of care includes drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed revealed that the agency did not ensure that all drugs and treatments necessary to meet the needs of the patient were included in the plan of care. Clinical Record 1: The initial RN assessment dated 1/24/2024 read in part “Patient is dependent on oxygen at 2-4l/m”. The plan of care dated 1/24/2024 did not include oxygen. Clinical Record 2: The initial RN assessment dated 12/19/2023 read in part “Patient has a JP drain to left flank area”. The plan of care dated 12/19/2023 did not include interventions for the care of the JP drain. Clinical Record 3: The initial RN assessment dated 11/20/2023 read in part “Patient oxygen continuously at 2-4l/m”. The plan of care dated 11/20/2023 did not include oxygen. Clinical Record 12: The initial RN assessment dated 8/1/2023 read in part “Patient s/p left leg below the knee amputation. The surgical site has +2 wound area. 1cm x 1cm. Patient has 4 staples in place”. The plan of care dated 8/1/2023 did not include treatment of the surgical site. In an interview on 2/14/2024, the administrator reviewed the records and confirmed the findings.”

“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 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 1 of 14 (7%) clinical records reviewed revealed that the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the plan of care. Clinical Record 12: The initial RN assessment dated 8/1/2023 read in part “Patient s/p left leg below the knee amputation. The surgical site has +2 wound area. 1cm x 1cm. Patient has 4 staples in place”. The plan of care dated 8/1/2023 did not include any supplies or DME. In an interview on 2/14/2024, the administrator reviewed the record and confirmed the findings.”

“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 4 of 12 (33%) clinical records with aide services ordered reviewed revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 1: The initial RN assessment dated 1/24/2024 read in part “Patient is dependent on oxygen at 2-4l/m”. The aide care plan dated 1/25/2024 did not include any care or safety instructions for the oxygen. Clinical Record 2: The RN assessment dated 12/19/2023 read in part “Patient has a JP drain to left flank area”. The aide care plan dated 12/19/2023 did not include instructions to the aide related to JP drain and when to alert the nurse. Clinical Record 3: The initial RN assessment dated 11/20/2023 read in part “Patient oxygen continuously at 2-4l/m”. The aide care plan dated 11/20/2023 did not include any care or safety instructions for the oxygen. Clinical Record 12: The initial RN assessment dated 8/1/2023 read in part “Patient s/p left leg below the knee amputation. The surgical site has +2 wound area. 1cm x 1cm. Patient has 4 staples in place”. The aide care plan dated 8/1/2023 did not include any instructions to the aide related to the amputation site. In an interview on 2/14/2024, the administrator reviewed the records and stated, “OK, I will make sure everything is on the care plan from now on.”.”

“It is required that a hospice aide provides services ordered by the interdisciplinary group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 12 (33%) clinical records with aide services ordered reviewed revealed that the agency did not ensure that aide services were provided as ordered in the plan of care. Clinical Record 2: The plan of care dated 12/19/2023 read in part “ Hospice Aide: 2 per week”. During the week of 12/17/2023-12/23/2023 there was one missed aide visit and on the week of 12/24/2023-12/30/2023 there were two missed aide visits. There was no documentation in the record as to why the visits were missed. Clinical Record 3: The plan of care dated 12/4/2023 read in part “ Hospice Aide: 1 per week”. During the weeks of 12/10/2023-12/16/2023, 12/17/2023-12/23/2023, 12/24/2023-12/30/2023, 12/31/2023-1/6/2024, and 1/7/2024-1/13/2024 there was one missed aide visit each week. There was no documentation in the record as to why the visits were missed. Clinical Record 6: The plan of care dated 12/4/2023 read in part “ Hospice Aide: 2 per week”. During the week of 12/17/2023-12/23/2023 and the week of 12/24/2023-12/30/2023 there were two missed aide visits each week. There was no documentation in the record as to why the visits were missed. Clinical Record 13: The plan of care dated 5/24/2023 read in part “ Hospice Aide: 3 per week”. During the week of 5/21/2023-5/27/2023 there were two missed aide visits and on the week of 5/28/2023-6/3/2023 there were three missed aide visits. There was no documentation in the record as to why the visits were missed. In an interview on 2/13/2024, the Administrator reviewed the record and stated, “the aide did the visits but did not document them”.”

“It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services, and, as necessary, provides in-service training and education programs where required. This standard was not met as evidenced by interview and personnel record review. In 3 of 10 (30%) personnel records reviewed revealed that the agency did not ensure that competencies were performed and documented. Personnel Record 5: A review of the personnel record for Assistant Director of Nursing/Volunteer Coordinator with a date of hire 3/9/2023 did not include documented evidence of a competency assessment. Personnel Record 6: A review of the personnel record for the hospice aide with a date of hire 12/6/2023 did not include documented evidence of a competency assessment. Personnel Record 8: A review of the personnel record for the Social Worker with a date of hire 6/23/2023 did not include documented evidence of a competency assessment. In an interview on 2/14/2024, the office manager reviewed the records and confirmed the findings.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff including physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed revealed that the agency did not ensure that the patient’s clinical records included correct clinical information. Clinical Record 3: The initial registered nurse assessment dated 11/20/2023 stated in part “Patient oxygen continuously at 2-4l/m”. There was no physician order for oxygen in the clinical record. In an interview on 2/14/2024, the administrator reviewed the record and stated, “I will make sure all orders for the patient are in the patient record”.”