Choice Hospice

“It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the patient’s individualized written plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 12: The patient elected the hospice benefit on 08/13/2025. The nursing recertification assessment dated 10/01/2025 read in part “Patient is at risk for falling”. The plans of care dated 08/13/2025 through 10/11/2025, 10/12/2025 through 12/10/2025, and 12/11/2025 through 02/08/2026 did not include fall precautions or interventions related to the patient being at risk for falling. During a joint record review and interview on 12/18/2025, the Administrator confirmed the above finding, stating “Fall precautions are not on the plan of care but they should be”.”

“It is required that Hospice Aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a Hospice Aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 3 of 17 (18%) clinical records reviewed with hospice aide services provided, the agency did not ensure that all written patient care instructions were included in the hospice aide care plan. CLINICAL RECORD 4: The patient elected the hospice benefit on 04/27/2025. A physician’s order dated 04/28/2025 read in part “Oxygen 2 liters via nasal cannula continuously”. The plans of care dated 04/27/2025 through 06/25/2025, 06/26/2025 through 08/24/2025, 08/25/2025 through 10/23/2025, and 10/24/2025 through 12/22/2025 ordered “Hospice aide (HA) 2 times per week”. The current hospice aide care plan dated 04/27/2025 included relevant instructions of “Shower every visit”. The hospice aide care plan was not updated to include instructions on what the Hospice Aide should do with the patient’s oxygen during the shower. CLINICAL RECORD 12: The patient elected the hospice benefit on 08/13/2025. The plans of care dated 08/13/2025 through 10/11/2025, 10/12/2025 through 12/10/2025, and 12/11/2025 through 02/08/2026 ordered seizure precautions. The plans of care also ordered “HA 4 times per week”. The hospice aide care plan dated 08/15/2025 did not include instructions for seizure precautions. CLINICAL RECORD 17: The patient elected the hospice benefit on 06/26/2025. A physician’s order dated 08/30/2025 ordered wound care with a wound dressing to a wound on the patient’s left thigh. The plan of care dated 06/26/2025 through 09/17/2025 ordered “HA 2 times per week”. The hospice aide care plan dated 06/27/2025 included relevant instructions of “Bed Bath every visit”. The Hospice Aide care plan was not updated to include instructions on what the hospice aide should do if the wound dressing becomes wet or dislodged during the bed bath. During joint record reviews and interview on 12/18/2025, the Administrator confirmed the above finding, stating “There are no instructions for the patient’s oxygen, seizure precautions, or wound dressing instructions on the aide care plans”.”

“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 and interview. In 2 of 17 (12%) clinical records reviewed with hospice aide services provided, the agency did not ensure that hospice aide supervisory visits were completed no less frequently than every 14 days. CLINICAL RECORD 2: The patient elected the hospice benefit on 01/15/2025. The plans of care dated 01/15/2025 through 04/14/2025 and 04/15/2025 through 07/13/2025 ordered “ hospice aide 1 time weekly”. The first hospice aide visit was dated 01/16/2025. Hospice aide supervisory visits were dated 01/22/2025, 02/03/2025, 02/17/2025, 02/24/2025, 03/03/2025, 03/17/2025, and 03/25/2025. The next hospice aide supervisory visit was dated 04/10/2025, a total of 16 days later and 2 days outstanding. CLINICAL RECORD 4: The patient elected the hospice benefit on 04/27/2025. The plans of care dated 06/26/2025 through 08/24/2025 and 08/25/2025 through 10/23/2025 ordered “ hospice aide 2 times weekly”. The first hospice aide visit was dated 06/27/2025. Hospice aide supervisory visits were dated 07/05/2025 and 07/10/2025. The next hospice aide supervisory visit was dated 07/25/2025, a total of 15 days later and 1 day outstanding. Hospice aide supervisory visits were then dated 08/07/2025, 08/21/2025, 09/04/2025, 09/18/2025, and 09/30/2025. The next Hospice Aide supervisory visit was dated 10/20/2025, a total of 20 days later and 6 days outstanding. During joint record reviews and interview on 12/18/2025, the Administrator confirmed the above findings that hospice aide supervisory visits were completed no less frequently than every 14 days.”