Emerald Care Hospice LLC

“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. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] 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 5 of 5 (100%) clinical records reviewed, the agency did not ensure the patient’s medication profile included the patient’s current medications. Agency Policy # PC. MSS “Medication Profile” read in part, “The medication profile must include... All current patient’s medications...The patient’s medication profile is reviewed by the IDG whenever there is a significant change and at a minimum, every 15 days.”` Clinical Record 1: The patient elected hospice care on 06/07/2023. On 06/07/2023, the physician ordered, “Oxygen at 2-5 liters per minute (lpm) via nasal cannula as needed for dyspnea/respiratory distress.” The interdisciplinary team meeting documentation dated 06/07/2023, 06/16/2023, 06/30/2023, 07/14/2023, 07/28/2023, 08/11/2023, 08/25/2023, 09/08/2023, 09/22/2023, 10/06/2023, 10/20/2023, 11/03/2023, 11/17/2023, 12/01/2023 and 12/15/2023 included medication profile review. A clinical record review on 12/28/2023 revealed oxygen was not documented in the patient’s medication profile. Clinical Record 2: The patient elected hospice care on 06/13/2023. On 06/13/2023, the physician ordered, “Oxygen at 2-5 lpm via nasal cannula as needed for dyspnea/respiratory distress.” The interdisciplinary team meeting documentation dated 06/13/2023, 06/16/2023, 06/30/2023, 07/14/2023, 07/28/2023, 08/11/2023, 08/25/2023, 09/08/2023, 09/22/2023, 10/06/2023, 10/20/2023, 11/03/2023, 11/17/2023, 12/01/2023 and 12/15/2023 included medication profile review. A clinical record review on 12/28/2023 revealed oxygen was not documented in the patient’s medication profile. Clinical Record 3: The patient elected hospice care on 06/07/2023. On 06/07/2023, the physician ordered, “Oxygen at 2-5 lpm via nasal cannula as needed for dyspnea/respiratory distress.” The interdisciplinary team meeting documentation dated 06/07/2023, 06/16/2023, 06/30/2023, 07/14/2023, 07/28/2023, 08/11/2023, 08/25/2023, 09/08/2023, 09/22/2023, 10/06/2023, 10/20/2023, 11/03/2023, 11/17/2023, 12/01/2023 and 12/15/2023 included medication profile review. A clinical record review on 12/28/2023 revealed oxygen was not documented in the patient’s medication profile. Clinical Record 4: The patient elected hospice care on 06/08/2023. On 06/08/2023, the physician ordered, “Oxygen at 2-5 liters per minute (lpm) via nasal cannula as needed for dyspnea/respiratory distress.” The interdisciplinary team meeting documentation dated 06/07/2023, 06/16/2023, 06/30/2023, 07/14/2023, 07/28/2023, 08/11/2023, 08/25/2023, 09/08/2023, 09/22/2023, 10/06/2023, 10/20/2023, 11/03/2023, 11/17/2023, 12/01/2023 and 12/15/2023 included medication profile review. A clinical record review on 12/28/2023 revealed oxygen was not documented in the patient’s medication profile. Clinical Record 5: The patient elected hospice care on 08/14/2023. On 08/14/2023, the physician ordered, “Oxygen at 2-5 liters per minute (lpm) via nasal cannula as needed for dyspnea/respiratory distress.” The interdisciplinary team meeting documentation dated 08/15/2023, 08/25/2023, 09/08/2023, 09/22/2023, 10/06/2023, 10/20/2023 and 11/03/2023 included medication profile review. A clinical record review on 12/28/2023 revealed oxygen was not documented in the patient’s medication profile. During an interview and a joint review of the records on 12/29/2023, the Alternate Administrator confirmed the findings and stated that oxygen had since been added to the patient medication profiles.”

“It is required that each patient’s individualized written plan of care: identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. CONTINUING PRIOR REQUIRED ACTION This standard was not met as evidenced by clinical record review, document review, and interview. In 3 of 5 (60%) clinical records reviewed, the agency did not ensure the hospice plan of care (POC) included interventions and goals based on problems identified in the initial and updated comprehensive assessments. Agency policy #PC.P55 “Plan of Care” read in part, “The IDT must develop an individualized plan of care for each client.The plan of care must reflect client and family goals and interventions based on the problems identified in the initial comprehensive and updated comprehensive assessments.” Clinical Record 1: The patient elected hospice care on 06/07/2023. The POC dated 12/04/2023 ordered hospice aide services three times a week. The hospice aide documented visits and care provided from 12/04/2023 through 12/26/2023. A review of the clinical record on 12/28/2023 revealed the POC did not include documentation of interventions and goals for hospice aide services based on the patient’s inability to perform activities of daily living (ADL) independently as documented in the comprehensive assessments dated 12/01/2023 and the 12/25/2023. Clinical Record 2: The patient elected hospice care on 06/13/2023. The POC dated 12/10/2023 ordered hospice aide services once a week. The hospice aide documented visits and care provided from 12/12/2023 through 12/26/2023. A review of the clinical record on 12/28/2023 revealed the POC did not include documentation of interventions and goals for hospice aide services based on the patient’s inability to perform activities of daily living independently as documented in the comprehensive assessments dated 12/01/2023 and the 12/25/2023. Clinical Record 5: The patient elected hospice care on 08/14/2023. The POC dated 08/14/2023 ordered hospice aide services three times a week. The hospice aide documented visits and care provided from 08/14/2023 through 10/24/2023. A review of the clinical record on 12/28/2023 revealed the POC did not include documentation of interventions and goals for hospice aide services based on the patient’s inability to perform activities of daily living (ADL) independently as documented in the comprehensive assessments dated 08/14/2023, 08/25/2023, 09/08/2023, 09/22/2023, 10/06/2023, and 10/20/2023. During an interview and joint review of the records on 12/29/2023, the Alternate Administrator stated that the interventions and goals had been included on the hospice aide task assignment sheet but had been inadvertently omitted from the POC and had since been corrected.”

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review, document review, and interview. In 1 of 3 (33%) clinical records reviewed of patients that received hospice aide services, the agency did not ensure hospice aide supervision was completed no less frequently than every 14 days. Agency policy #PC. H40 “Hospice Aide Supervision” read in part, “A registered nurse makes an on-site visit to the patient’s home no less frequently than every 14 days to ensure the services ordered by the IDG and provided by the hospice aide are meeting the patient’s need.” Clinical Record 2: The patient elected hospice care on 06/13/2023. The plans of care dated 09/11/2023 and 12/10/2023 ordered hospice aide services one time a week. The hospice aide documented hospice aide services provided as ordered from 09/11/2023 through 12/26/2023. A clinical record review revealed that as of 12/28/2023, there was no documented evidence of hospice aide supervisory visits conducted by the registered nurse (RN) for 11/20/2023 through 12/11/2023 and 12/11/2023 through 12/28/2023. There was no evidence the RN made an on-site visit to the patient’s home any less frequently than every 14 days, 11/20/2023 through 12/11/2023. During an interview and a joint record review on 12/29/2023, the Alternate Administrator identified that the aide supervision was not completed timely and plans to have nursing staff complete every visit moving forward.”

“It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. This standard was not met as evidenced by clinical record review, document review, and interview. In 5 of 5 (100%) clinical records reviewed, the agency did not ensure that all entries in the patient record were appropriately authenticated. Agency policy #PC. D25 “Documentation Requirements” read in part, “All documentation is signed using complete first and last name, credentials and title.” Clinical Record 1: The patient elected hospice care on 06/07/2023. The spiritual assessment dated 06/12/2023 and the bereavement risk assessments dated 06/12/2023 and 12/27/2023 did not include documentation of credentials with the associated signatures and dates. Clinical Record 2: The patient elected hospice care on 06/13/2023. The spiritual assessment dated 06/15/2023 and the bereavement risk assessments dated 06/15/2023 and 12/22/2023 did not include documentation of credentials with the associated signatures and dates. Clinical Record 3: The patient elected hospice care on 06/07/2023. The spiritual assessment dated 06/10/2023 and the bereavement risk assessments dated 06/10/2023 and 12/17/2023 did not include documentation of credentials with the associated signatures and dates. Clinical Record 4: The patient elected hospice care on 06/08/2023. The spiritual assessments dated 06/10/2023 and 07/10/2023 did not include documentation of credentials with the associated signatures and dates. Clinical Record 5: The patient elected hospice care on 08/14/2023. The spiritual assessments dated 08/15/2023, 08/17/2023, 09/20/2023, and 10/20/2023, and the bereavement risk assessment dated 08/15/2023 did not contain credentials with the associated signatures and dates. During an interview on 12/29/2023, the Alternate Administrator reviewed the associated records and stated that the missing credentials had since been added.”