Failure to Document and Communicate Hospice Care Details
Penalty
Summary
The facility failed to ensure an effective communication process between the hospice provider and the facility for a resident who was admitted to hospice care. The resident, who had diagnoses including malignant neoplasm of the breast and bones and severe cognitive impairment, was dependent on staff for most activities of daily living. The care plan documented the resident's admission to hospice and included general instructions for staff regarding pain management, family time, and notification of hospice for significant changes. However, the care plan did not include essential information such as the hospice provider's contact number, details about supplies, equipment, and medications to be provided by hospice, or the schedule and nature of hospice staff visits. Record review confirmed the absence of this critical information, and staff interviews verified that the care plan lacked documentation regarding hospice visits, phone numbers, and medical supplies. The facility's policy required coordination of a plan of care with the hospice provider, but this was not reflected in the resident's care plan. As a result, there was no clear documentation of the services hospice would provide or how to contact them, which could impact the resident's care.