Advisacare Hospice, LLC

“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 4 of 14 (29%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 1: The initial nursing assessment narrative dated 04/28/2025 stated “The patient has bladder incontinence”. The interdisciplinary group (IDG) POC dated 04/28/2025 lacked evidence of goal(s) and intervention(s) for bladder incontinence. CLINICAL RECORD 2: The nursing visit note narrative dated 07/02/2025 stated, “Patient reports increased struggle to walk and decreased balance”. The IDG POC dated 07/03/2025 lacked evidence of goal(s) and intervention(s) for increased fall risk. CLINICAL RECORD 3: The initial nursing assessment narrative dated 06/17/2025 stated “Patient is now bedbound when she was able to ambulate to the bathroom with her walker one month ago”. The IDG POC dated 06/17/2025 lacked evidence of goal(s) and intervention(s) for skin integrity. CLINICAL RECORD 8: The initial nursing assessment narrative dated 09/30/2024 stated “The patient has dysphasia”. The IDG POC dated 09/30/2024 lacked evidence of goal(s) and intervention(s) for dysphasia. The Vice President of Operations/Director of Clinical Services (DCS) designee, DCS, and Director of Hospice Operations stated in an interview on 07/17/20265 that the agency did not ensure that the POC reflected patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments.”

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 12 (8%) clinical records reviewed for patients that elected hospice aide services revealed that the agency did not ensure that the aide provided services included on the aide care plan. CLINICAL RECORD 7: The aide care plan dated 06/10/2025 ordered the task “Shower” at every visit. The aide frequency ordered was two (2) times per week. The aide visit note dated 06/18/2025 reported the task “Shower” was “Acknowledged” and “Completed”. The comments stated, “There was no hot water available so did a bed bath”. The aide did not provide services included in the aide care plan. The Vice President of Operations/Director of Clinical Services (DCS) designee, DCS, and Director of Hospice Operations stated in an interview on 07/17/20265 that the agency did not ensure that the aide provided services included on the aide care plan.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 2 of 5 (40%) clinical records reviewed for patients that elected hospice aide services that required the aide to report changes in the patient medical needs to the registered nurse (RN) revealed the agency did not ensure the aide reported changes in the patient’s medical needs to the RN as the changes related to the aide care plan. CLINICAL RECORD 3: The aide care plan dated 06/18/2025 ordered the task “Oral care” at every visit. The aide frequency ordered was two (2) times per week. The aide visit note dated 06/25/2025 reported the task “Oral care” was “Acknowledged” and “Not completed”. The record lacked evidence as to why “Oral care” was “Not completed”. The record also lacked evidence that the aide reported to the RN the change in the patient’s medical condition as it related to the above ordered task “Oral care” being “Not completed”. CLINICAL RECORD 7: The aide care plan dated 06/10/2025 ordered the task “Shower” at every visit. The aide frequency ordered was two (2) times per week. The aide visit note dated 06/18/2025 reported the task “Shower” was “Acknowledged” and “Completed”. The comments stated, “There was no hot water available so did a bed bath”. The record lacked evidence that the aide reported to the RN the change in the patient’s medical condition as it related to the above ordered task “Shower” being changed to a “Bed bath”. The Vice President of Operations/Director of Clinical Services (DCS) designee, DCS, and Director of Hospice Operations stated in an interview on 07/17/20265 that the agency did not ensure the aide reported changes in the patient’s medical needs to the RN as the changes related to the aide care plan.”

“It is required that hospice aides are supervised by a registered nurse (RN) 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 1 of 12 (8%) clinical records reviewed for patient’s that elected aide services revealed the agency did not ensure hospice aides were supervised by a RN who made 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 IDG meet the patient’s need. CLINICAL RECORD 2: The aide care plan dated 06/07/2025 (certification dates 06/07/2025 - 08/05/2025) ordered an aide frequency of two (2) times per week. There was evidence of aide visits completed on 06/09/2025, 06/13/2025, 06/16/2025, 06/19/2025, 06/23/2025, 06/26/2025, 06/30/2025, 07/03/2025, 07/07/2025, 07/10/2025, and 07/14/2025. There was evidence of an RN supervisory visit completed on 06/11/2025, 06/25/2025 and 07/16/2025 (21 days). The record lacked evidence of the RN supervisory visits having been completed no less frequently than every 14 days. The Vice President of Operations/Director of Clinical Services (DCS) designee, DCS, and Director of Hospice Operations stated in an interview on 07/17/20265 that the agency did not ensure that hospice aides were supervised by a RN who made 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 IDG meet the patient’s need.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation, the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary, and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical records reviewed for patients that revoked the hospice benefit revealed the agency did not ensure a copy of the discharge summary was forwarded to the patient’s attending physician. CLINICAL RECORD 6: The patient revoked the hospice benefit on 03/17/2025 to pursue aggressive treatment. The patient remained at the current place of residence. The record lacked evidence that the agency forwarded a copy of the discharge summary to the patient’s attending physician. The Vice President of Operations/Director of Clinical Services (DCS) designee, DCS, and Director of Hospice Operations stated in an interview on 07/17/20265 that the agency did not ensure that a copy of the discharge summary was forwarded to the patient’s attending physician.”