Harbor Hospice of Central San Antonio LP

“Observed in Record Review. In 6 of 10 patient records reviewed, it was noted that the organization did not ensure that the comprehensive assessment was updated at least every 15 days. For example, during a review of the medical record for RRHV#1, it was noted that 33 days had elapsed since the last update to the comprehensive assessment was documented during benefit period #7. In addition, during benefit period #8, 23 days had elapsed since the start of care date, and an update to the comprehensive assessment had not been documented.Example #2: During a review of the medical record for RRHV#2, 57 days had elapsed since the start of the 2nd benefit period, and an update to the comprehensive assessment had not been documented, in addition, it was noted that a Registered Nurse comprehensive assessment for the interdisciplinary team was completed during week 2 of services. The subsequent Registered Nurse comprehensive assessment was completed 17 days later. Example #3: During a review of the medical record for RRHV#3, 29 days had elapsed since the start of the first benefit period, and an update to the comprehensive assessment had not been documented. Example #4: During a review of the medical record for RRNHV#2 and RRNHV#4, 56 days had elapsed since the last update to the comprehensive assessment was documented during benefit period #2.Example #5: During a review of the medical record for RRNHV#3, 28 had elapsed since the last update to the comprehensive assessment was documented during benefit period #4. In addition, 28 days had elapsed since the start of the 5th benefit period, and an update to the comprehensive assessment had not been documented. This observation was reviewed with the leadership team.”

“Observed in Tracer Activities. In 3 of 3 individual tracers, the organization did not ensure that nursing services were routinely provided directly by hospice employees. For example, during interviews with the patient’s and/or the patient’s caregiver for RRHV#1, RRHV#2, and RRHV#3, it was noted that the patient and/or the patient’s caregiver was not aware of the Registered Nurse visit schedule. The patient’s caregiver for RRHV#2 stated, the Registered Nurse is always changing, and I am not sure when the Registered Nurse will visit. During interviews with the RN/Administrator and the Regional Director it was noted that nursing services were routinely provided by contract nurses for the last 6 months. The contract nurses are not directly employed by the hospice organization. This observation was reviewed with the leadership team.”

“Observed in Record Review. In 2 of 2 patient records reviewed, for patients receiving Hospice Aide services, it was noted that the organization did not ensure Hospice Aide supervision was effective. For example, during the review of the medical record for RRHV#2, it was noted that Hospice Aide services started during week 2. A Hospice Aide supervision visit was documented by the Registered Nurse 24 days after Hospice Aide services started. Example #2: During a review of the medical record for RRNHV#3, it was noted that Hospice Aide services started during week 6 of the 4th benefit period. A Hospice Aide supervision visit was documented by the Registered Nurse 21 days after Hospice Aide services started. This observation was reviewed with the leadership team.”

“Observed in Record Review. In 1 of 10 patient records reviewed, it was noted that the organization did not ensure the plan of care goals included outcome measures for specific care activities. For example, a review of the medical record for RRHV#3, revealed that the patient’s terminal illness diagnosis was Atherosclerotic Heart Disease. The plan of care did not include a goal statement to evaluate the response to the delivery of care, treatment, and services related to the terminal illness diagnosis of Atherosclerotic Heart Disease. This observation was reviewed with the leadership team.”

“Observed in Record Review. In 2 of 10 patient’s records, it was noted that the plan of care did not include interventions based on the problems identified in the comprehensive assessment. For example, the plan of care for RRHV#2, identified potential for fall as a problem. The plan of care included the following interventions for this problem: Assess for history of falls and/or injury. The plan of care did not include interventions to maintain patient safety, and strategies to prevent injury. In addition, the patient experienced a fall without injury during week 7, and week 8 of services. The plan of care was not updated with interventions to maintain patient safety, and strategies to prevent injury. Example #2: During a review of the medical record for RRHV#3, it was noted that the patient’s terminal illness diagnosis was Atherosclerotic Heart Disease. The plan of care did not include interventions to address the delivery of care, treatment, and services related to the terminal illness diagnosis of Atherosclerotic Heart Disease. In addition, the plan of care identified potential for fall as a problem. The plan of care included the following interventions for this problem: Assess cognitive status for sensory limitation, impairments. The plan of care did not include interventions to maintain patient safety, and strategies to prevent injury. This observation was reviewed with the leadership team.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization did not ensure its policy titled Certification of Terminal Illness was implemented. For example, a review of the Certification of Terminal Illness statement(s) for benefit period #8, and benefit period #6 for RRHV#1, revealed that the Certifying Physician Summary documenting clinical information to support the medical prognosis and support for recertification of hospice services was not present in the medical record. Example #2: A review of the Certification of Terminal Illness statement for benefit period #1, for RRHV#3, revealed that the Certifying Physician Summary documenting clinical information to support the medical prognosis and support for certification of hospice services was not present in the medical record. This observation was reviewed with the organization leadership team.”