Ancora Home Health & Hospice, LLC

“Based on record review, observation, and interview, the hospice agency failed to ensure nursing care that optimized dignity and personal privacy at one of three skilled nurse home visits with hospice patients (Patient #16) was completed at an assisted living facility (ALF). This failed practice placed Patient #16 at risk for psychological harm from feelings of poor self-esteem and/or self-worth and a potential for a poor quality of life. Findings: Record review from 3/6-13/25 of Record #16 revealed a start of care (SOC) date of 2/26/25 with a benefit period of 2/26/25-5/26/25. The patient’s terminal diagnosis was Parkinson’s Disease. During an observation on 3/7/25 at 8:30 AM, Licensed Nurse (LN) #1 was observed to locate Patient #16 at his/her residence: an Assisted Living Facility (ALF). LN #1 went to Patient #16’s room and found the patient was not present in his/her room. LN #1 proceeded to the ALF dining room and located the patient, who was seated alone at a small table. Patient #16 was finishing breakfast. The patient agreed, when LN #1 asked, to be assessed. LN #1 did not offer a choice of returning to the patient’s room for privacy. LN #1 stated, “I heard you were short of breath yesterday.” LN #1 proceeded to take the patient’s vital signs with a rolling vital sign tower. LN #1 obtained the patient’s oxygen saturation rate and found the oxygen saturation rate to be 93%. LN #1 asked Patient #16 if he/she wanted oxygen. Patient #16 agreed to the oxygen, and LN #1 stated he/she would get the oxygen concentrator. There were four ALF dining room attendants from the ALF in the dining room as well as seven patients sitting at nearby tables with one patient about ten feet from Patient #16. LN #1 took the patient’s blood pressure. “Your blood pressure is good,’ LN #1 stated. LN #1 palpated Patient #16’s abdomen and asked the patient, “Are you constipated? How is your appetite?” LN #1 stated, “The abdomen feels soft and does not appear full.” Patient #16 denied being constipated and stated his/her appetite was good. LN #1 looked at both feet by removing his/her socks and sandals. LN #1 asked, “Do you feel anxious at all?” Patient #16 denied any anxiety. LN #16 proceeded to listen to Patient #16’s abdomen with the stethoscope and stated the abdomen sounded fine. “Do you want to work on breakfast?” LN #1 asked. The patient stated, “Yes.” LN #1 applied gloves and disinfected the vital sign tower and rolled it to the supply room. After obtaining the oxygen concentrator and rolling that to the dining room, LN #1 placed the oxygen tubing onto the patient. During an interview on 3/12/25 at 2:38 PM, the Administrator stated, when asked if a home visit should be conducted in a public place like an ALF dining room, “If patient is able to give consent we would allow this, but otherwise it should be private.” The undated Admission folder included a section titled “Patient Rights and Responsibilities” revealed, “Your rights: Respect and Consideration - You have the right to ... be treated with respect and consideration, recognition of your individuality and dignity...have an environment that preserves dignity and contributes to a positive self-image... Privacy and Security - You have the right to personal privacy and security during home care visits.” Review of the policy “Patient Bill of Rights,” revised July 2020, revealed, “Hospice protects and promotes the rights of each individual in its care.””

“Based on record review and interview, the hospice agency failed to include the physician certification of terminal illness in two of 20 records (#15 and #16) reviewed. This failed practice had the potential to delay hospice care that was consistent with the patient and family needs. Findings: Record #15 Record review on 3/6-13/25 revealed Patient #15 was admitted to the hospice with a terminal diagnosis of malignant neoplasm of the right breast. The start of care (SOC) date and election date were 2/7/25. Further review of the record revealed a lack of a written certification of terminal illness completed by the physician in the record. Record #16 Record review on 3/6/25 - 3/13/25 revealed Resident #16 was admitted to the hospice with a terminal diagnosis of Parkinson’s Disease. The SOC date and election date were 2/26/25. Further review of the record revealed a lack of a written certification of terminal illness in the record completed by the physician in the record. During an interview on 3/6/25 at 3:30 PM, the Executive Director (ED) stated the past medical director was having difficulty getting the written certificates of terminal illness completed. Another physician has taken over the role of Medical Director. The ED stated that these CTIs were not completed and not found in the clinical records for patients #15 and #16. Review of the hospice policy titled “Certification/Recertification of Terminal Illness, Brief Narrative Statement and Face-to-face evaluations,” revised July 2020, revealed, “In order to be eligible to elect Hospice care under Medicare, a patient must be certified as terminally ill ... Hospice will obtain written certification of terminal illness for each of the periods listed, even if a single election continues in effect for two, three or four periods. Hospice will obtain the written or verbal certification no later than two (2) calendar days after the period begins. If Hospice cannot obtain the written certification within the two (2) calendar days, it will obtain oral certification within two (2) calendar days, and written certification prior to submitting a claim for payment. The initial certification may be completed up to 15 days before hospice care is elected ...””

“Based on record review and interview, the hospice agency failed to ensure clinical record documentation was legible, clear, complete and appropriately authenticated and dated in accordance with hospice policy and currently accepted standards of practice for one of 20 records reviewed (#6). This failed practice resulted in the potential for the patient needs not to be met or incorrect care to be provided. Findings: Record review on 3/6-13/25 revealed Patient #6 had an election date and start of care date on 1/8/25. Patient #6’s terminal diagnosis was hypertensive chronic kidney disease. Further record review revealed a “Plan of Care Order,” dated 2/4/25 for the Benefit Period of 1/8/25-3/8/25 with an order for hospice aide one times a week. Record review revealed an “Aide Supervisory Visit,” completed by Licensed Nurse (LN) #1 on 1/27/25. This aide supervisory visit reviewed care given by Hospice Aide #1. There were no aide visits noted in the record on 1/27/25 or before this date. There was no aide care to be supervised at this aide supervisory visit. Further record review revealed the first Hospice Aide visit found in the clinical record. This aide visit was completed 2/5/25 by Hospice Aide #1 and was signed by Hospice Aide #1. The aide comments were as follows: “Patient was asleep. CG[caregiver] said, [he /she] was told not to disturb [him/her] on [his]her] sleep, checked patient and asked the caregiver what is the best time [he/she] could get [his/her] shower. CG said [he/she] just got [his/her] bed bath yesterday. RN notified about the visit and task declined. Thank you.” During an interview on 3/13/25 at 11:50 AM, the Administrator and Branch Administrator, when asked why the aide supervisory visit had been completed before an aide visit had occurred stated that it must have been an error. Review of the agency’s policy, “Patient Record Content,” revised July 2020, revealed, “Hospice will provide an accurate and current patient record for every patient seen by Hospice ... Hospice will initiate and maintain an individual and accurate patient record containing past and current findings for each patient receiving care in compliance with all federal/state laws and regulations.” Review of the agency’s policy, “Hospice Aide Supervision,” revised July 2020 revealed, “Hospice aides are closely supervised to ensure their competence in providing care. At least every 14 days the registered nurse[RN] makes an onsite home supervisory visit to assess relationships and determine whether goals are being met .. the RN must assess an aide’s ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include, but is not limited to following the patient’s plan of care for completion of tasks assigned to the hospice aide by the RN, creating successful interpersonal relationships with the patient and family, demonstrating competency with assigned tasks...””