Homecare Health Services Hospice

“Based on record review and interview, the agency staff failed to develop plans of care that were individualized to include measurable goals to meet the patients needs in 14 of 14 patient records reviewed (Patients #1, #2, #3, #4, #5, #6, #7, #8, #9 #10, #11, #12 #13, and #14.) Record review for Patient #9 revealed Patient #9 was admitted to the hospice 11/28/2023 with a primary diagnosis of End Stage Renal Disease. Patient #9s Plan of Care (POC) dated 11/28/2023-02/25/2024 revealed “;Patient #9 lives at Home. 22. Care Need: Caregiver Role Strain-Actual/High Risk for: Goal: Continued safe, appropriate care. Verbalization of difficulties in giving care. Caregiver’s physical/emotional needs not compromised. Caregiver provides safe/appropriate care. Caregiver role strain identified. Alterations in coping of Patient/Family/Caregiver: Goal: Promote use of appropriate resources. Promote/encourage healthy decisions/plans. Patient (Pt.)/Family will maintain adequate/appropriate social emotional adjustment. Pt/Family will stress reduced with improved coping abilities. Fall Risk: Goal: Pt will demonstrate ability to remain safe in home without falls. Pt will demonstrate ability to remain safe in home without incident. Financial Concerns: Goal: Pt have access to needed medical supplies. Pt/family have access to financial assistance. Pt can get needed medications. Hospice Aide: Goal: Personal care needs will be met. Able to perform ADLs safely. Anxiety/Agitation: Goal: Pt/Family/Caregiver: Pt/Family/Caregiver will identify and verbalize signs and symptoms of Anxiety. Bereavement/Grief: Pt will be able to express grief related to anticipatory dying. Bowel Elimination: Incontinence: Pt will maintain skin integrity. Pt will maintain dignity related to bowel incontinence. Injury/Risk for Injury: Goal: Pt will remain safe/free from injury. Pt will verbalize understanding of safety needs and injury prevention. Infection: Goal: Pt will remain free from infection. Pt will verbalize understanding of safety needs and injury prevention. Malnutrition/Anorexia: Goal: Pt will be allowed to refuse foods/fluids. Pt will verbalize understanding of decreased appetite in terminal patient. Pt will remain comfortable. Medication: Goal: Pt/primary caregiver will demonstrate and verbalize understanding of medication regimen. Pt/primary caregiver will verbalize understanding role of comfort medications. Pain: Goal: Pt will remain at an acceptable level of pain. Pt/primary caregiver will verbalize understanding of mediations. Psychosocial: Goal: Pt/Primary Caregiver will verbalize understanding of Psychosocial stressors. Integumentary: Goal: Pt will maintain skin integrity. Pt will verbalize signs/symptoms of skin breakdown. Pt will verbalize methods of maintaining skin integrity.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #9. Record review for Patient #10 revealed Patient #10 was admitted to the hospice 09/06/2023 with a primary diagnosis of Chronic Atrial Fibrillation. Patient #10s POC dated 12/05/2023-02/02/2024 revealed “;Patient #10 resides at home. 22. Care Need: Alterations in coping of Patient/Family/Caregiver: Goal: Coping abilities of pt/family increased. Promote use of appropriate resources. Promote/encourage healthy decisions/plans. Patient (Pt.)/Family will maintain adequate/appropriate social emotional adjustment. Pt/Family will have stress reduced with improved coping abilities. Fall Risk: Goal: Blank. Hospice Aide: Goal: Personal care needs will be met. Grieving, Anticipatory related to Terminal Illness: Goal: Blank. Cardiac Output Decreased: Pt/family/caregiver will verbalize causes of Cardiac Discomfort. Pt will have lessened Discomfort. Anxiety/Agitation: Goal: Pt/Family/Caregiver will have lessened signs and symptoms of Anxiety. Aphasia/Impaired Verbal Communication: Goal: Use Alternative methods of communication effectively. Patient will use effective communication techniques. Bowel Elimination: Goal: Pt will remain free from constipation/impaction. Cardiac: Goal: Pt/family/caregiver will verbalize understanding of signs of increased fluid retention. Wounds/Impaired Tissue Integrity: Goals: Facility staff/primary caregiver will notify hospice with any new wounds or changes in existing wound. Maximum effort will be made to heal or maintain status of wound without further breakdown. Patient will remain comfortable. Wounds will be prevented. Caregiver Role Strain for actual: Goal: Blank. Financial stress: Goal: Pt/family will understand resources available to them.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #10. Record review for Patient #11 revealed Patient #11 was admitted to the hospice 07/28/2023 with a primary diagnosis of Heart Failure. Patient #11s POC dated 10/26/2023-01/23/2024 last review date of 12/22/2023 revealed “;Patient #11 resides at a Skilled Nursing Facility (SNF.) Family Adaption Issues: Goal: Family will verbalize understanding of how disease process affects behavior and cognitive functioning. Family/caregiver will receive emotional support to adequately cope with pending death. Pain – Issues: Goal: Pt will remain pain controlled at acceptable level for Pt. Caregiver will verbalize understanding of non-verbal signs of pain. Musculo/Skeletal – Issues: Goal: Pt/Caregiver will understand disease process and endurance limitations. ADL needs are met. Neuro/Mental/Emotional – Issues: Goal: Pt/caregiver will verbalize understanding of how disease process affects behavior and cognitive function. Pt/caregiver will receive emotional support to adequately cope with pending death. Cardiopulmonary – Issues: Goal: Pt/caregiver educated regarding physical status and cardiac limitations. Pt/caregiver able to identify and report complications. Immunological/Infection – Issues: Goal: Client will remain without infection. Nutrition/hydration – Issues: Goal: Pt will have adequate food and fluids as tolerated to maintain comfort. Pt/caregiver will understand changes in nutritional needs related to the terminal diagnosis. Gastrointestinal – Issues: Goal: Skin integrity will be maintained. Pt will verbalize having elimination needs met at an acceptable level. Gastrourinary/Reproductive – Issues: Goal: Skin integrity will be maintained or improved as feasible. Safety – Issues: Goal: Pt will remain free of injury. Spiritual – Issues: Goal: Current. Grief/Bereavement – Issues: Goal: Family/caregiver will understand, and express feelings related to grief. The goals stated on the POC were generic not individualized to meet the specific needs of Patient 11. Record review for Patient #12 revealed Patient #12 was admitted to the hospice 05/03/2023 with a primary diagnosis of Cerebral Palsy. Patient #12s POC dated 12/29/2023-02/26/2024 last review date of 12/22/2023 revealed Patient #12 resides at a community-based residential facility (CBRF.) Family Adaptation – Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Pain – Issues: Goal: Pt will maintain pain controlled at an acceptable level for pt/caregiver. Musculo/Skeletal – Issue: Goal: Pt/caregiver will understand disease process and endurance limitations. ADL needs are met. Neuro/Mental/Emotional – Issues: Goal: Pt/caregiver will verbalize understanding of how disease process affects behavior and cognitive function. Pt/caregiver will receive emotional support to adequately cope with pending death. Cardiopulmonary – Issues: Goal: Pt/caregiver to identify and report complications. Immunological/infection – Issues: Goal: Client will remain free of sign/symptoms infection. Nutrition/Hydration – Issues: Goal: Pt will have adequate food and fluids as tolerated to maintain comfort. Safety – Issues: Goal: Pt will remain free of injury. Grief/bereavement – Issues: Goal: Family/Caregiver will express feeling supported by hospice team. The goals stated on the POC were generic not individualized to meet the specific needs of Patient 12. Record review for Patient #13 revealed Patient #13 was admitted to the hospice 10/14/2021 with a primary diagnosis of Chronic Congestive Heart Failure. Patient #13s POC dated 12/03/2023-01/31/2024 last review date of 12/22/2023 revealed Patient #13 resides at a CBRF. Family Adaptation – Issues: Goal: Family/caregiver will verbalize understanding of how disease process affects behavior and cognitive functioning. Pain – Issues: Goal: Pt will maintain pain controlled at an acceptable lever for Pt/caregiver. Musculo/Skeletal – Issues: Goal: Pt/caregiver will understand disease process and endurance limitations. ADL needs are met. Neuro/Mental/Emotional – Issues: Goal: Pt/caregiver will receive emotional support to adequately cope with pending death. Cardiopulmonary – Issues: Goal: Pt/caregiver able to identify and report complications. Immunological/infection – Issues: Goal: Client will remain free from sign/symptoms of infection. The goals stated on the POC were generic not individualized to meet the specific needs of Patient 13. Record review for Patient #14 revealed Patient #14 was admitted to the hospice 02/11/2021 with a primary diagnosis of Heart Failure. Patient #14s POC dated 11-28/2023-01/26/2024 last review date 12/22/2023 revealed Patient #14 resides at a CBRF. Family Adaptation – Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Pain – Issues: Goal: Pt will maintain pain controlled at an acceptable lever for Pt/caregiver. Musculo/Skeletal – Issues: Goal: Pt/caregiver will understand disease process and endurance limitations. ADL needs are met. Neuro/Mental/Emotional – Issues: Goal: Pt/caregiver will verbalize understanding of how disease process affects behavior and cognitive function. Cardiopulmonary – Issues: Goal: Pt/caregiver will verbalize satisfactory control of shortness of breath episodes. Immunological/infection – Issues: Goal: Client will remain free from sign/symptoms of infection. Nutrition/Hydration – Issues: Goal: Pt will have adequate food and fluids as tolerated to maintain comfort. Gastrointestinal – Issues: Goal: Skin integrity will be maintained. Pt will verbalize having elimination needs met an acceptable level. Genitourinary/Reproductive – Issues: Goal: Skin integrity will be maintained. Skin Integrity/Vascular Access – Issues: Goal: Skin will remain intact or maintained. Skin integrity will be maintained without breakdown or infection. Safety – Issues: Goal: Pt will remain free of injury. The goals stated on the POC were generic not individualized to meet the specific needs of Patient 14. During an interview with Director of Nursing A on 01/11/2024 at 10:30 AM, the above findings were reviewed. When asked about agency plans of care goals and expectations and process, Director of Nursing A replied, “We struggle with the plan of care. In the new system, we can pick a care need, but they are very rigid. You can pick goals based on discipline.” When asked about pain goals specifically and providing example of a patient remaining at an acceptable level, Director of Nursing A replied, “That is not our acceptable practice for pain. I know in our new system we should be able to free text.” Regarding use of the new computer system and process with goals, Director of Nursing A replied, “The nurse puts in generic goals for social work or chaplain as PRN (as needed) until the discipline has seen the patient. The discipline then has to pick it, the goals and interventions per discipline and customize it.” Findings include: The agency’s policy titled “Medical Supervision & POC (Plan of Care)” dated 07/12/2011, last reviewed 01/05/2018 revealed under Procedure; “P. Goal statements that are client specific: 1. Describe a projected change in the patient’s health status, clinical condition, or behavior as a result of the care to be provided. 2. Focus on resolution, improvement, stabilization, prevention, or delay of deterioration. 3. Detail the results expected to be achieved after delivery of all care/services. 4. Include and are based upon goals that are realistic, attainable, specific, and quantifiable. 5. Are measurable time-specific goals, with benchmark dates for review. 6. Are relevant to the patient’s conditions and abilities related to discharge.” The agency’s policy titled “Plan of Care - Comprehensive; Established & Update” dated 12/22/2008, last reviewed 02/03/2022, revealed under Policy “2. Each hospice patient plan of care includes B. Written goals, including short term and long term as indicated, with established timeframes and measurements for evaluating the effectiveness of the interventions as the interventions relate to the identified patient and family problems or needs and the expected outcomes. H. A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs including d. Measurable outcomes anticipated from implementing and coordinating the plan of care. Hospice data elements are utilized as part of the integrated plan of care and are used to see if Hospice is meeting the goals of care.” Record review for Patient #1 revealed Patient #1 was admitted to the hospice 08/19/2021 with a primary diagnosis of Senile Degeneration of the brain. Patient #1’s POC dated 12/22/2023 - 01/10/2024, last review date 12/22/2023, revealed “;Patient #1 resided in an ALF (Assisted Living Facility). Family Adaptation Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Musculo/skeletal Issues: Goal: Patient/caregiver will understand disease process and endurance limitations. Goal: ADL (Activities of Daily Living) needs are met. Neuro (Neurological)/Mental/Emotional Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Seizures will remain managed. Cardiopulmonary Issues: Goal: Patient/Caregiver able to identify and report complications. Immunological/Infection Issues: Client will remain free from infection. Nutrition/Hydration Issues: Goal: Patient will have adequate food and fluids as tolerated to maintain comfort. Aspiration risk minimized. Gastrointestinal Issues: Goal: Skin integrity will be maintained. Genitourinary/Reproductive Issues: Goal: Skin integrity will be maintained. Safety Issues: Goal: Patient will remain free of injury. Grief/Bereavement: Goal: Family/caregiver will express feeling supported by hospice team.” The goals stated on the POC were generic and not individualized to meet the specific needs of Patient #1. Record review for Patient #2 revealed Patient #2 was admitted to the hospice 06/28/2023 with a primary diagnosis of Senile Degeneration of the brain. Patient #2’s POC dated 12/22/2023 - 01/10/2024, last review date 12/22/2023, revealed “;Patient #2 resided in an ALF. Family Adaptation Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Pain-Issues: Goal: Patient will maintain pain controlled at an acceptable level for patient/caregiver. Musculo/skeletal Issues: Goal: Patient/caregiver will understand disease process and endurance limitations. ADL needs are met. Neuro/Mental/Emotional Issues: Goal: Care will be provided in a safe and trusting environment. Cardiopulmonary Issues: Goal: Patient/Caregiver able to identify and report complications. Immunological/Infection Issues: Goals: Client will remain free from signs and symptoms of infection. Nutrition/Hydration Issues: Patient will have adequate food and fluids as tolerated to maintain comfort. Gastrointestinal Issues: Goal: Client will verbalize having elimination needs met at acceptable level. Genitourinary/Reproductive Issues: Goal: Skin integrity will be maintained. Skin Integrity/Vascular Access Issues: Goal: Skin will remain intact or maintained. Safety Issues: Goal: Patient will remain free from injury. Spiritual Issues: Patient will discuss spiritual conflicts. Grief/Bereavement Issues: Goal: Family/caregiver will express feelings supported by hospice team.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #2. Record review for Patient #3 revealed Patient #3 was admitted to the hospice 07/13/2023 with a primary diagnosis of Neurocognitive Disorder with Lewy Bodies. Patient #3’s POC dated 12/22/2023 - 01/10/2024, last reviewed 12/22/2023, revealed “;Patient #3 resided in an ALF. Family Adaptation Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Musculo/skeletal Issues: Goal: ADL needs are met. Cardiopulmonary Issues: Goal: Patient/Caregiver able to identify and report complications. Immunological/Infection Issues: Goals: Client will remain free from signs and symptoms of infection. Gastrointestinal Issues: Goal: Skin integrity will be maintained. Genitourinary/Reproductive Issues: Goal: Skin integrity will be maintained. Skin Integrity/Vascular Access Issues: Goal: Skin integrity will be maintained and improved as feasible. Skin will remain intact. Safety Issues: Goal: Patient will remain free from injury. Grief/Bereavement Issues: Goal: Family/caregiver will express feeling supported by hospice team.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #3. Record review for Patient #4 revealed Patient #4 was admitted to the hospice 02/03/2023 with a primary diagnosis of Senile Degeneration of the brain and discharged 06/19/2023. Patient #4’s POC dated 06/09/2023 - 06/19/2023, last review date 06/09/2023, revealed “;Patient resided in an ALF. Family Adaptation Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Musculo/skeletal Issues: Goal: ADL needs are met. Neuro/Mental/Emotional Issues: Goal: Patient/caregiver will receive emotional support to adequately cope with pending death. Cardiopulmonary Issues: Goal: Patient/Caregiver able to identify and report complications. Immunological/Infection Issues: Goals: Client will remain free from signs and symptoms of infection. Nutrition/Hydration Issues: Goal: Aspiration risk minimized. Gastrointestinal Issues: Goal: Skin integrity will be maintained. Genitourinary/Reproductive Issues: Goal: Skin integrity will be maintained. Skin Integrity/Vascular Access Issues: Goal: Skin will remain intact. Safety Issues: Goal: Patient will remain free from injury. Grief/Bereavement Issues: Goal: Family/caregiver will express feeling supported by hospice team.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #4. Record review for Patient #5 revealed Patient #5 was admitted to the hospice 01/03/2023 with a primary diagnosis of Disease of Intestine, unspecified and discharged 01/8/2023. Patient #5’s POC dated 01/03/2023 - 01/08/2023, last review 01/04/2023, revealed “;Patient #5 resided at home. Family Adaptation Issues: Goal: Family/caregiver will demonstrate improved coping skills. Musculo/skeletal Issues: Goal: ADL needs are met. Neuro/Mental/Emotional Issues: Goal: Patient/caregiver will understand disease process. Cardiopulmonary Issues: Goal: Patient/Caregiver able to identify and report complications. Immunological/Infection Issues: Goals: Client will remain free from signs and symptoms of infection. Nutrition/Hydration Issues: Patient will have food and fluids as tolerated to maintain comfort. Gastrointestinal Issues: Goal: Skin integrity will be maintained. Genitourinary/Reproductive Issues: Goal: Skin integrity will be maintained. Skin Integrity/Vascular Access Issues: Goal: Skin integrity will be maintained or improved as feasible. Client’s skin will remain intact. Safety Issues: Goal: Patient will remain free from injury. Grief/Bereavement Issues: Goal: Family/caregiver will understand, and express feelings related to grief.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #5. Record review for Patient #6 revealed Patient #6 was admitted to the hospice 07/31/2023 with a primary diagnosis of Chronic Diastolic Heart Failure and discharged 12/30/2023. Patient #6’s POC dated 12/22/2023 - 12/30/2023, last reviewed 12/22/2023, revealed “;Patient #6 resided at home. Family Adaptation Issues: Goal: Family/caregiver will receive emotional support to adequately cope with pending death. Pain-Issues: Goal: Patient will maintain pain controlled at an acceptable level for patient/caregiver. Musculo/skeletal Issues: Goal: Patient/caregiver will understand disease process and endurance limitations. ADL needs are met. Neuro/Mental/Emotional Issues: Goal: Patient/caregiver will understand disease process. Care will be provided in a safe and trusting environment. Cardiopulmonary Issues: Goal: Patient/Caregiver able to identify and report complications. Goal: Patient will have optimum levels of oxygenation. Immunological/Infection Issues: Goals: Client will remain free from signs and symptoms of infection. Nutrition/Hydration Issues: Goal: Patient will have adequate food and fluids as tolerated to maintain comfort. Gastrointestinal Issues: Goal: Skin integrity will be maintained. Client will verbalize having elimination needs met at an acceptable level. Genitourinary/Reproductive Issues: Goal: Skin integrity will be maintained. Skin Integrity/Vascular Access Issues: Goal: Skin will remain intact or maintained. Safety Issues: Goal: Patient will remain free of injury. Spiritual Issues: Goal: Patient will discuss spiritual conflicts. Grief/Bereavement Issues: Goal: Family/caregiver to will understand and express feelings related to grief. Family/caregiver will express feeling supported by hospice team.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #6. Record review for Patient #7 revealed Patient #7 was admitted to the hospice 07/11/2023 with a primary diagnosis of Heart Failure, unspecified, and discharged 11/21/2023. Patient #7’s POC dated 11/17/2023 - 02/14/2024 revealed “;Patient #7 resided at home. 22. Care Need: Hospice SN (Skilled Nurse). Cardiac Output Decreased: Goal: Patient will have lessened discomfort. Bowel Elimination/Incontinence: Goal: Patient will maintain skin integrity. Communication: Goal: Patient will express thoughts/feelings. Dyspnea: Patient will be able to breathe comfortably. Genitourinary/Incontinence Issues: Goal: Patient will be provided with frequent toileting/brief changes. Patient will remain free from skin breakdown. Impaired ADLS: Goal: Patient will remain safe during completion of ADLS. Infection: Goal: Patient will have infection resolved. Injury/Risk for Injury: Goal: Patient will remain safe/free from injury. Integumentary: Patient will maintain skin integrity. Knowledge Deficit-Terminal Care: Goal: Caregiver aware of signs of impending death. Anticipates physical changes as disease progresses. Patient/caregiver understands hospice services. Patient/family demonstrate understanding of signs and symptoms of impending death. Neurological/Memory/Confusion: Goal: Patient will remain free of harm. Have minimal episodes of agitation. Pain: Goal: Patient will remain at acceptable level of pain. Need: Hospice Aide. Care Plan Goal: Personal care needs will be met.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #7. Record review for Patient #8 revealed Patient #8 was admitted to the hospice 10/19/2023 with a primary diagnosis of Senile Degeneration of the brain. Patient #8’s POC dated 10/19/2023 - 01/16/2024, last reviewed 12/22/2023, revealed “;Patient #8 resided in an ALF. 22. Care Need: Patient/Family Goals: Alterations in Coping of Patient/Family/Caregiver: Goal: Coping abilities of patient/family/caregiver increased. Improved communication skills within limits of disease. Hospice SN. Bowel Elimination: Constipation/Impaction: Goal: Patient will remain free from constipation/impaction. Incontinence: Patient will maintain skin integrity. Genitourinary Issues: Goal: Patient will be provided with frequent toileting/brief changes. Patient will remain free from skin breakdown. Patient will remain free from urinary tract infections. Impaired ADLS: Goal: Patient will be assisted with completion of ADLS. Patient will remain safe during completion of ADLS. Injury/Risk for Injury: Goal: Patient will remain safety/free from injury. Integumentary: Patient will maintain skin integrity. Patient Mobility: Patient will maintain maximum mobility functions. Neurological/Memory/Confusion: Goal: Patient will remain free from harm. Function at maximum cognitive level. Pain: Goal: Patient will remain at an acceptable level of pain. Safety/Patient/Family: Goal: Caregiver able to maintain patient in safe environment. Patient/caregiver able to adhere to universal precautions. Hospice Chaplain: Spiritual Concerns: Goal: Patient experiences spiritual comfort. Patient/family will utilize spiritual resources. Patient/family will receive spiritual support.” The goals stated on the POC were generic not individualized to meet the specific needs of Patient #8.”

“Based on record review and interview this agency’s Interdisciplinary group (IDG) failed to maintain a system of communication, and integration in the Plan of Care (POC) to show patient’s progress towards outcomes and goals in 12 of 12 eligible patient records reviewed Patient’s (#1, #2, #3. #4, #6, #8, #9, #10, #11, #12, #13, and #14) in a total of 14 patient records reviewed. Record review for Patient #9 revealed Patient #9 was admitted to hospice 11/28/2023 with a primary diagnosis of End Stage Renal Disease and had services of SN, SW, Chaplain, volunteer, and Hospice Aide. Patient #9s POC dated 11/28/2023-02/25/2024 revealed IDG meeting were conducted on 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SN, SW, Chaplin, Volunteer, and Aide services and how they collaborated towards Patient #9s individualized POC. Record review for Patient #10 revealed Patient #10 was admitted to hospice 09/06/2023 with a primary diagnosis of Chronic Atrial Fibrillation and had services of SN, SW, Chaplain, and Hospice Aide. Patient #10s POC dated 12/05/2023-02/02/2024 revealed IDG meeting were conducted on 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SN, SW, Chaplin, and Aide services and how they collaborated towards Patient #10s individualized POC. Record review for Patient #11 revealed Patient #11 was admitted to hospice 07/28/2023 with a primary diagnosis of Heart Failure and had services of SN, SW, Chaplain, volunteer, and Hospice Aide. Patient #11s POC dated 10/26/2023-01/23/2024 revealed IDG meeting were conducted on 11/24/2023, 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SN, SW, Chaplin, Volunteer, and Aide services and how they collaborated towards Patient #11s individualized POC. Record review for Patient #12 revealed Patient #12 was admitted to hospice 05/03/2023 with a primary diagnosis of Cerebral Palsy and had services of SN, SW, Chaplain, and volunteer. Patient #12s POC dated 12/29/2023-02/26/2024 revealed IDG meeting were conducted on 11/24/2023, 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SN, SW, Chaplin, and Volunteer and how they collaborated towards Patient #12s individualized POC. Record review for Patient #13 revealed Patient #13 was admitted to hospice 10/14/2021 with a primary diagnosis of Chronic Congestive Heart Failure and had services of SN, SW, Chaplain, and Hospice Aide. Patient #13s POC dated 12/03/2023-01/31/2024 revealed IDG meeting were conducted on 11/24/2023, 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SN, SW, Chaplin, and Aide services and how they collaborated towards Patient #13s individualized POC. Record review for Patient #14 revealed Patient #14 was admitted to hospice 02/11/2021 with a primary diagnosis of Heart Failure and had services of SN, SW, Chaplain, and Hospice Aide. Patient #14s POC dated 11/28/2023-01/26/2024 revealed IDG meeting were conducted on 11/24/2023, 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SN, SW, Chaplin, and Aide services and how they collaborated towards Patient #14s individualized POC. Records for Patients #1 through #14 were reviewed during an interview with Director of Nursing A on 01/11/2024 from 10:30 AM to 11:45AM. When asked about the agency’s IDG process for meetings and documentation, Director of Nursing A replied, “They all meet in person every other Friday, the RN (Registered Nurse), SW, Chaplain, SC, the MSW (Masters of Social Worker), and Medical Director. We also have a family member or volunteer meet if necessary.” When asked if they all provide an individual report, Director of Nursing replied, “Yes”, then stated, “The Nurse reports off first and then every discipline contributes. After the meeting they will sit at their desk and add to it.” When asked if there is a way for the IDG to free text into the IDG part of the software, Director of Nursing replied, “In the new system, yes. I think there is, I will have to check.” Findings include: The agency’s policy titled “Interdisciplinary Group Staffing” dated 12/22/2008, last reviewed 12/21/2023 revealed under Procedure; “3. Prior to Interdisciplinary Group (IDG) staffing, IDG members who are involved in providing direct care and services to the patient/family: B. Gathers information as part of updating the comprehensive assessment, and C. Gathers information related to the patients progress toward outcomes and goals specified in the plan of care. 4. IDG members, in addition to role specific IDG functions noted above, during staffing: A. Review each patient scheduled for plan of care review including newly admitted patients: a. reviewing any changes since the last updating of IDG related to the comprehensive assessment. B. Addressing any new problems, goals and interventions related to the new problem. D. Document the above in the patients medical record on appropriate forms the review and revisions, if warranted, to the individualized plan of care for each patient reviewed at the particular staffing.” Record review for Patient #1 revealed Patient #1 was admitted to hospice 08/19/2021 with a primary diagnosis of Senile Degeneration of Brain and had services of SN (Skilled Nurse), SW (Social Work), and Hospice Aide. Patient #1’s POC dated 11/12/2023 to 01/07/2024 revealed IDG meetings were conducted on 11/25/2023, 12/09/2023, 12/23/2023, and 01/05/2024 and have no documentation present to show updates provided by the SW and Aide services and how they collaborated towards Patient #1’s individualized plan of care. Record review for Patient #2 revealed Patient #2 was admitted to hospice 06/28/2023 with a primary diagnosis of Senile Degeneration of Brain and had services of SN, SW, and Hospice Aide. Patient #2’s POC dated 11/12/2023 to 01/07/2024 revealed IDG meetings were conducted on 11/24/2023, 12/08/2023, 12/22/2023, and 01/05/2024 and have no documentation present to show updates provided by the SW and Aide services and how they collaborated towards Patient #2’s individualized plan of care. Record review for Patient #3 revealed Patient #3 was admitted to hospice 07/13/2023 with a primary diagnosis of Neurocognitive Disorder with Lewy Bodies and had services of SN, SW, and Hospice Aide. Patient #3’s POC dated 11/11/2023 to 12/22/2023 revealed IDG meetings were conducted on 11/11/2023, 11/25/2023, 12/09/2023, and 12/22/2023 and have no documentation present to show updates provided by the SW and Aide services and how they collaborated towards Patient #3’s individualized plan of care. Record review for Patient #4 revealed Patient #4 was admitted to hospice 02/03/2023 with a primary diagnosis of Senile Degeneration of Brain and had services of SN, SW, SC (Spiritual Counselor), and Hospice Aide. Patient #4’s POC dated 04/23/2023 to 06/19/2023 revealed IDG meetings were conducted on 05/12/2023, 05/26/2023, 06/09/2023, and 06/19/2023 and have no documentation present to show updates provided by the SW, SC, and Aide services and how they collaborated towards Patient #4’s individualized plan of care. Record review for Patient #6 revealed Patient #6 was admitted to hospice 07/31/2023 with a primary diagnosis of Chronic Diastolic Heart Failure and had services of SN, SW, SC, and Hospice Aide. Patient #6’s POC dated 10/23/2023 to 12/30/2023 revealed IDG meetings were conducted on 11/24/2023, 12/08/2023, and 12/22/2023 and have no documentation present to show updates provided by the SW, SC, and Aide services and how they collaborated towards Patient #6’s individualized plan of care. Record review for Patient #8 revealed Patient #8 was admitted to hospice 10/19/2023 with a primary diagnosis of Senile Degeneration of Brain and had services of SN, SW, Chaplain, Volunteer, and Hospice Aide. Patient #8’s POC dated 10/19/2023 to 01/16/2024 revealed IDG meetings were conducted on 10/27/2023, 11/10/2023, 12/08/2023, and 12/22/2023 and have no documentation present to show updates provided by the SW, Chaplain, Volunteer, and Aide services and how they collaborated towards Patient #8’s individualized plan of care.”