Mozaic Hospice

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on review of the clinical record, review of agency policy and interview with agency personnel for two of ten patients (Patient’s #1 and # 2) in the survey sample, the agency licensed personnel failed to provide the ordered services. The findings include: a. Patient #1 had a start of care date of 3/4/25 and diagnoses that included endometrial cancer, left heel pressure injury, Diabetes Mellitus Type II, Neuroplastic disorder, hypertension. The physician orders dated 3/4/25 through 5/2/25 included nursing services twice a week for health assessment and wound care to left heel unstageable pressure ulcer, apply betadine followed by clean dry dressing once daily and physical therapy services twice a week for mobility and strength, Occupational Therapy once a week for decreased strength and bed mobility, and Medical Social Work evaluation for resources and home supports. Interview and review of the nursing clinical notes dated 3/11/25, 3/13/25, and 3/26/25 with the Administrator and Clinical Manager/CM on 4/3/25 at 1:25pm identified missed visit notes were entered by the nurse identifying the patient was not available for a nursing visit but failed to identify documentation of a physician notification within the missed visit note, and failed to ensure nursing services were provided weekly as ordered. b. Patient #2 had a start of care date of 11/9/24 and diagnoses that included Atrial fibrillation, s/p Atrio Ventricular node ablation, lymphoma, hx. of stroke, hypertension, Lupus and cardiomyopathies. The physician’s orders dated 3/9/25 to 5/7/25 included nursing services once weekly for cardiac complications, neuro checks, and medication management and a speech language pathology evaluation for swallowing difficulties and cognitive decline. Interview and review of the nursing clinical note dated 3/28/25 with the Administrator and CM on 4/3/25 at 1:25pm identified a missed visit note was entered in the clinical chart identifying the patient was unavailable for the nursing visit, but failed to identify documentation of a physician notification within the missed visit note and failed to ensure nursing services were provided weekly as ordered. Review of agency policy for Missed Visit directed a missed visit note type is entered to represent a visit that should have occurred but did not and will not. The missed visit entry is designed to account for a physician approved visit frequency that was missed, i.e. you were unable to follow the physician’s orders.”

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on review of the clinical record, and interview with agency personnel for one of ten patients (Patient #1) in the survey sample, the agency licensed personnel failed to follow the agency procedure for weekly wound measurements. The findings include: Patient #1 had a start of care date of 3/4/25 and diagnoses that included endometrial cancer, left heel pressure injury, Diabetes Mellitus Type II, Neuroplastic disorder, hypertension. The physician orders dated 3/4/25 through 5/2/25 included nursing services twice a week for health assessment and assessment of wound status, signs and symptoms of healing and complications, daily wound care to a left heel unstageable pressure ulcer, apply betadine followed by clean dry dressing once daily, and physical therapy services twice a week for mobility and strength, Occupational Therapy once a week for decreased strength and bed mobility, and Medical Social Work evaluation for resources and home supports. Review of the nursing clinical notes for the week of 3/9/25 through 3/15/25 with the Administrator and CM on 4/3/25 at 1:15pm identified 2 missed nursing visits for 3/11/25 and 3/13/25, and a skilled nursing visit with wound care on 3/12/25 by LPN #1 but failed to identify weekly wound measurements were completed for the week of 3/9/25 through 3/15/25, per the agency procedure and best practice standard. The CM further identified it is the agency expectation that the patient wound/s are measured weekly, close to the same day as previously measured for wound assessment consistency and best practice. Training is completed at hire and during agency in-service trainings. Review of the agency pressure injury and wound assessment protocol identified the steps the agency clinical staff would perform for the assessment of wound healing as it relates to the patient’s care plan, including clinical visit documentation on wound location, type of wound, extent of tissue involvement, type and percentage of tissue in wound base, wound size, including length, width, and depth measurements, wound exudate, odor, peri wound assessment, and patient pain level.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on clinical record reviews, review of agency documentation, interviews with agency personnel, for two of ten patient’s (Patient’s #1 and # 2) in the survey sample, the agency failed to communicate a missed skilled nursing visit with the patient’s physician. a. Patient #1 had a start of care date of 3/4/25 and diagnoses that included endometrial cancer, left heel pressure injury, Diabetes Mellitus Type II, Neuroplastic disorder, hypertension. The physician orders dated 3/4/25 through 5/2/25 included nursing services twice a week for health assessment and wound care to left heel unstageable pressure ulcer, apply betadine followed by clean dry dressing once daily and physical therapy services twice a week for mobility and strength, Occupational Therapy once a week for decreased strength and bed mobility, and Medical Social Work evaluation for resources and home supports. Interview and review of the nursing clinical notes dated 3/11/25, 3/13/25, and 3/26/25 with the Administrator and CM on 4/3/25 at 1:25pm identified missed visit notes were entered by the nurse identifying the patient was not available for the nursing visit but failed to identify documentation of a physician notification within the missed visit note. b. Patient #2 had a start of care date of 11/9/24 and diagnoses that included Atrial fibrillation, s/p Atrio Ventricular node ablation, lymphoma, hx. of stroke, hypertension, Lupus and cardiomyopathies. The physician’s orders dated 3/9/25 to 5/7/25 included nursing services once weekly for cardiac complications, neuro checks, and medication management and a speech language pathology evaluation for swallowing difficulties and cognitive decline. Review of the nursing clinical note dated 3/28/25 with the Administrator and CM on 4/3/25 at 1:25pm identified a missed visit note was entered in the clinical chart identifying the patient was unavailable for a nursing visit on 3/28/24 but failed to identify documentation of a physician notification within the missed visit note. Review of agency policy for Missed Visit directed a missed visit note type is entered to represent a visit that should have occurred but did not and will not. The missed visit entry is designed to account for a physician approved visit frequency that was missed, i.e. you were unable to follow the physician’s orders, and the actions of the clinicians that the physician was made aware of the missed visit.”