Advanced Hospice of Texas

“It is required that the hospice implements emergency preparedness (EP) policies and procedures, based on the emergency plan, the risk assessment, and the communication plan. The policies and procedures address the development and inclusion of a plan for each hospice patient during a natural or man-made disaster as part of a patient/family comprehensive assessment and the documented discussion of the plan provided to the patient/family and maintained by the hospice. This standard was not met as evidenced by clinical record review and interview. In 7 of 7 (100%) clinical records reviewed revealed the hospice did not ensure that patients received individualized emergency preparedness plan. Clinical Record 1: The patient elected the hospice benefit on 02/09/2024 with a diagnosis of Alzheimer’s. There was no documented evidence of an individualized emergency plan. Clinical Record 2: The patient elected the hospice benefit on 01/17/2024 with a diagnosis of senile degeneration of the brain. There was no documented evidence of an individualized emergency plan. Clinical Record 3: The patient elected the hospice benefit on 11/10/2021 with a diagnosis of malignant neoplasm of colon. There was no documented evidence of an individualized emergency plan. Clinical Record 4: The patient elected the hospice benefit on 09/30/2021 with a diagnosis of heart disease. There was no documented evidence of an individualized emergency plan. Clinical Record 5: The patient elected the hospice benefit on 01/24/2022 with a diagnosis of chronic obstructive pulmonary disease. There was no documented evidence of an individualized emergency plan. Clinical Record 6: The patient elected the hospice benefit on 02/13/2022 with a diagnosis of malignant wounds lower limbs. There was no documented evidence of an individualized emergency plan. Clinical Record 7: The patient elected the hospice benefit on 04/27/2022 with a diagnosis of Alzheimer’s. There was no documented evidence of an individualized emergency plan. The DON was interviewed on 02/21/2024 and confirmed that individualized emergency plans were not completed. No further information was provided.”

“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, document review, and interview. In 2 of 5 (40%) clinical records reviewed reveled the agency did ensure that the comprehensive assessment included an assessment of the patient’s psychosocial and spiritual needs. Document 1: POLICY # PE.5 titled Patient Assessment read in part “ The interdisciplinary Group/Team (IDG/IDT) in consultation with the patient’s attending Physician (if any) will complete the comprehensive assessment no later than five calendar days after the election of the Hospice Benefit.” Clinical Record 6: The patient’s election of the hospice benefit was dated 02/13/2021. The registered nurse (RN) initial assessment was dated 02/13/2021. There was no documented psychosocial assessment by the nurse or chaplain. The patient died on 03/08/2021, 12 days after the election of hospice benefit. There was no documented evidence why the initial psychosocial assessment was not completed. Clinical Record 7: The patient’s election of the hospice benefit was dated 04/27/2022. The registered nurse (RN) initial assessment was dated 04/27/2022. There was no documented evidence of a psychosocial assessment by the nurse or chaplain. The RN documented on the IDG note dated 05/12/2022 the that MSW and Chaplain were declined by the caregiver. This was 15 days after the pt was admitted. There was no documented physician order to d/c psychosocial and spiritual services prior to the IDG meeting. The DON was interviewed on 02/21/2024 and confirmed that the initial psychosocial and spiritual assessments were not completed.”

“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; 3. Herbal remedies; 4. Other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: 1. The effectiveness of drug therapy; 2. Drug side effects; 3. Actual or potential drug interactions; 4. Duplicate drug therapy; 5. Drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. 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 3 (33%) clinical records reviewed the agency did not ensure the medication profile included all of the patient’s current prescription and over the counter (OTC) drugs. Clinical Record 5: The initial registered nurse comprehensive assessment was dated 01/24/2022. The RN documented the patient was utilizing Oxygen at 3lpm via nasal cannula. The Oxygen was not included on the medication profile at the time of the clinical record review on 02/21/2024. The DON was interviewed on 02/21/2024 and confirmed that oxygen was not included on the medication profile. No further information was provided.”

“It is required that each patient’s individualized written plan of care reflects a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. The documentation in the patient’s record is in accordance with the hospice’s policies and procedure. This standard was not met as evidenced by clinical record review, document review, and interview. In 1 of 7 (14%) clinical records reviewed revealed that the agency did not ensure that the scope and frequency of services necessary to meet specific patient and family needs were documented. Document 4: POLICY # PC.30 titled “PLAN OF CARE PROCESS .” REVIEWED 11/01/2021. Stated in part: A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs.” Clinical Record 7: The patient’s election of the hospice benefit was dated 04/27/2022 with a diagnosis Alzheimer’s Disease. The plan of care dated 04/27/2022 did not include evidence of scope and frequencies for the nurse, social worker, or chaplain. The DON was interviewed on 02/21/2024 and confirmed that scope and frequencies for the nurse, social worker, or chaplain were not documented.”

“It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review, document review and interview. In 5 of 5 (100%) clinical records reviewed with the provision of bereavement services, the agency did not ensure a bereavement plan of care included the types of bereavement services to be offered and the frequency of service delivery was not completed post death. Document 2: Policy PC.130 Titled Bereavement read in part, “The Bereavement Coordinator will follow-up assessment and develop a POC for bereavement services based on the re-assessment and the family and /or caregiver’s willingness to receive services. The POC will be discussed at the next IDG/IDT meeting.” Clinical Record 3: The hospice election of hospice benefit was dated 11/10/2021. The patient expired on 12/26/2021 and bereavement services were initiated on 12/26/2021 by the chaplain. A post death bereavement risk assessment was completed. However, at the time of this review on 02/21/2024, a post death bereavement plan of care had not been created. Clinical Record 4: The hospice election of hospice benefit was dated 12/10/2021. The patient expired on 12/26/2021 and bereavement services were initiated on 12/26/2021 by the chaplain. A post death bereavement risk assessment was completed. However, at the time of the review on 02/21/2024, a post death bereavement plan of care had not been created. Clinical Record 5: The hospice election of hospice benefit was dated 01/24/2022. The patient expired on 01/31/ 2022 and bereavement services were initiated on 01/31/2022 by the chaplain. .A post death bereavement risk assessment was completed. However, at the time of the review on 02/21/2024, a post death bereavement plan of care had not been created. Clinical Record 6: The hospice election of hospice benefit was dated 02/13/2022. The patient expired on 03/08/2022 and bereavement services were initiated on 03/08/2022 by the chaplain. A post death bereavement risk assessment was completed. However, at the time of the review on 02/21/2024, a post death bereavement plan of care had not been created. Clinical Record 7: The hospice election of hospice benefit was dated 04/27/2022. The patient expired on 05/08/2022 and bereavement services were initiated on 05/08/2022 by the chaplain. A post death bereavement risk assessment was completed. However, at the time of the review on 02/21/2024, a post death bereavement plan of care had not been created. The DON was interviewed on 02/21/2024 and confirmed that bereavement plans of care had not been created.”

“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 3 of 6 (50%) clinical records in which a hospice aide was accepted reviewed revealed that the agency did not ensure that the aide plan of care included specific care instructions for the assigned patients, thus leaving the aide to make decisions outside of the aide scope of practice. Clinical Record 3: The patient election of the hospice benefit was dated 11/10/2021 with a diagnosis of chronic obstructive pulmonary diseases (COPD). The Aide Care Plan dated 11/10/2021 included the following interventions: shower and change linen “as needed”. There was no documented evidence of specific frequency for the assigned tasks. Clinical Record 4: The patient election of the hospice benefit was dated SOC 12/10/2021 with a diagnosis of heart disease. The Aide Care Plan dated 12/10/2021 included the following interventions shave and shower patient “as needed.” “. There was no documented evidence of specific frequency for the assigned tasks. Clinical Record 6: The patient’s election of the hospice benefit was dated 02/13/2022 with a diagnosis of malignant wounds bilateral lower limbs. The Aide Care Plan dated 02/13/2022 included the following interventions shave and shower patient “as needed”. There was no documented evidence of specific frequency for the assigned tasks. The DON was interviewed on 02/21/2024 and confirmed that the aide plan of care did not include specific care instructions and frequencies for the assigned patients,”

“It is required that a hospice aide provides services, ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed of patients receiving Hospice Aide services revealed that the agency did not ensure that the aide followed the plan of care established by the IDG. Clinical Record 3: The plan of care order dated 11/10/2021 stated aide frequency as 3 times a week. There was no documented evidence of aide visits for the week of 11/10/2021 and no documentation to support why the visits did not occur. During interview on 02/21/2024, The DON reviewed the patient’s record and confirmed that the aide did not follow the plan of care as ordered by the IDG relating to the visit frequency. No further information was provided.”