Covenant Care Hospice

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current: prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review and interview. In 1 of 4 (25%) home visits revealed the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. Home Visit 1: The patient (clinical record 1) elected the hospice benefit on 02/20/2025 for a diagnosis of Parkinson’s disease. The patient resided in a skilled nursing facility (SNF). The last nursing comprehensive assessment was dated 04/18/2025. During the home visit with the Hospice Aide (Personnel Record 6) on 04/22/2025, the hospice medication profile (printed on 04/21/2025) was compared to the SNF medication profile (printed on 04/22/2025). The hospice list documented the following medications that were not documented on the SNF list: Lorazepam 0.5 mg tablet. Take one by mouth every 4 hours as needed for anxiety (ordered 02/25/2025). The SNF list documented the following medications that were not documented on the hospice list: Glucerna oral liquid. Take one can twice daily (ordered 04/10/2025). Multivitamin. Take one tablet by mouth daily (ordered 11/15/2024). There was also a discrepancy with the hospice listing Tylenol 325 mg. Take 1 tablet every 6 hours as needed for mild pain. The SNF had to take 2 tablets. There was no documented evidence that a medication reconciliation occurred and the medication profile was updated during the last comprehensive assessment dated 04/18/2025. An interview and joint clinical record review was conducted with the Administrator/DPCS (Director of Patient Care Services) on 04/23/2025, in which she stated, “the case managers should be reconciling medications with every visit.””

“It is required that 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 8 of 16 (50%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure the registered nurse provided specific written instructions for the hospice aide. CLINICAL RECORD 1: The patient’s election of the hospice benefit was 02/20/2025 with diagnosis of Parkinson’s disease. The hospice aide care plan dated 02/20/2025 included the following relevant tasks: “sponge bath, shampoo, shampoo tray disinfected, comb hair, lotion, assist with dressing and undressing, peri care, incontinence care, provide emotional support.” The aide visit frequency was twice weekly. The nursing assessment dated 03/11/2025 noted the following: “wound care to coccyx, apply Calmoseptine and cover with bordered gauze.” The aide’s plan of care was not updated to provide the aide with notification of the wound, nor instructions for the dressing during tasks. CLINICAL RECORD 2: The patient’s election of benefit was 10/08/2024 with diagnosis of Malignant neoplasm of prostate. The hospice aide care plan dated 10/08/2024, updated 04/01/2025, and 4/10/2025 included the following relevant tasks: “sponge bath, shower, and assist with bathing.” The aide visit frequency was three times weekly. The aide care plan did not have specific instructions for the aide on which bath type, nor the frequency for these tasks. CLINICAL RECORD 4: The patient’s election of benefit was 02/07/2025 with diagnosis of Heart failure. The hospice aide care plan dated 02/07/2025 included the following relevant tasks: “sponge bath, skin care-lotion and protective barrier, assist with dressing/undressing, peri care, incontinence care, change bed linens, remind patient to elevate legs.” The aide visit frequency was twice weekly. The initial nursing assessment dated 02/07/2025 noted the patient to have bilateral Unna boots. The aide care plan did not notify the aide of the Unna boots, nor provide specific instructions for the care of the Unna boots during aide tasks. CLINICAL RECORD 5: The patient’s election of benefit was 01/04/2025 with diagnosis of Pneumonia, unspecified. The hospice aide care plan dated 01/04/2025 included the following relevant tasks: “shower, sponge bath, shampoo, shampoo tray disinfected, comb hair, lotion, assist with dressing and undressing, peri care, incontinence care, provide emotional support, remind patient to elevate legs.” Aide visit frequency of twice weekly. A nursing assessment dated 02/27/2025 noted “Clean PEG tube site with N/S (normal saline), pat dry, apply lanolin to redness around site cover with bordered gauze.” The aide’s plan of care was not updated to provide the aide with notification of the PEG tube, nor instructions for the dressing during tasks. The aide care plan did not have specific instructions for the aide on which bath type, nor the frequency for these tasks. Aide visits dated 03/04/2025, 03/14/2025, and 04/08/2025 noted “shower given, but sponge bath not completed. RN (registered nurse) notified.” CLINICAL RECORD 7: The patient’s election of benefit was 12/10/2024 with diagnosis of Malignant neoplasm of prostate. The hospice aide care plan dated 12/10/2024, updated 02/08/2025, and 04/03/2025 included the following relevant tasks: “Shower, assist with bathing (other specify), change bed linens, oral care, assist/perform ROM (range of motion) exercises, turn and position.” The aide frequency was twice weekly. A nursing assessment dated 02/02/2025 noted “wound to left shin. Apply dry sterile dressing 3x week.” The aide’s plan of care was not updated to provide the aide with notification of the wound, nor instructions for the dressing during tasks. The aide’s care plan also did not specify a bath type and listed two choices. Aide visit dated 04/08/2025 noted: “Patient had shower yesterday so he only wanted sponge bath today. Reported to RN 4/8/2025.” CLINICAL RECORD 8: The patient’s election of benefit was 07/24/2025 with diagnosis of Alzheimer’s disease. The hospice aide care plan dated 07/25/2024, updated 09/25/24 and 01/21/2025 included the following relevant tasks: “sponge bath, skin care-lotion, protective barrier, incontinence care.” The aide frequency was twice weekly. A nursing assessment dated 01/13/2025 noted the following: “dressing to bilateral buttocks.” The aide’s plan of care was not updated to provide the aide with notification of the wound, nor instructions for the dressing during tasks. CLINICAL RECORD 15: The patient’s election of benefit was 08/19/2024 with diagnosis of Degenerative disease of nervous system. The hospice aide care plan dated 08/19/2024, updated 12/16/2024 and 02/03/2025 included the following relevant tasks: “sponge bath, shampoo, shave, peri care, incontinence care, skin care-lotion, change bed linens, turn and position.” A nursing assessment dated 08/20/2024 noted the following: “surgical wound to lateral thigh with non-adherent dressing.” The aide visit frequency was six times weekly. The aide’s plan of care was not updated to provide the aide with notification of the wound, nor instructions for the dressing during tasks. CLINICAL RECORD 18: The patient’s election of benefit was 01/03/2025 with diagnosis of Aspiration pneumonia. The hospice aide care plan dated 01/03/2025 included the following relevant tasks: “sponge bath, skin care, turn and position.” A nursing assessment dated 01/21/2025 noted the following:” Stage II right buttocks, covered with Calmoseptine and gauze.” The aide visit frequency was twice weekly. The aide’s plan of care was not updated to provide the aide with notification of the wound, nor instructions for the dressing during tasks. An interview and joint clinical record review was conducted with the”

“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 3 of 16 (19%) clinical records reviewed in which aides services were accepted revealed the agency did not ensure a registered nurse 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. CLINICAL RECORD 7: The hospice aide services were ordered for a frequency of twice weekly on 12/10/2024 . There was a registered nurse supervisory visit on 03/19/2025, and the next documented registered nurse supervisory visit was on 04/16/2025, 28 days. CLINICAL RECORD 8: The hospice aide services were ordered for a frequency of twice weekly on 07/25/2024. There was a registered nurse supervisory visit on 11/11/2024, and the next documented registered nurse supervisory visit was on 12/09/2024, 28 days. CLINICAL RECORD 12: The hospice aide services were ordered for a frequency of three times weekly on 06/21/2024 . There was a registered nurse supervisory visit on 07/31/2024, and the next documented registered nurse supervisory visit was on 08/22/2024, 22 days. There was a documented registered nurse supervisory visit on 10/21/2024 and the next documented registered nurse supervisory visit was 11/29/2024,39 days. There was a documented registered nurse supervisory visit on 12/11/2024 and the next documented registered nurse supervisory visit was 01/03/2025,23 days. There was a documented registered nurse supervisory visit on 02/17/2025 and the documented registered nurse supervisory visit was 03/12/2025, 23 days. An interview and joint clinical record review was conducted with the Administrator/DPCS (Director of Patient Care Services) on 04/24/2025, in which she stated, “there has been a performance plan in place to improve these missed supervisory visits.””

“It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. This standard was not met as evidenced by document review, interview, and personnel record review. In 6 of 9 (67%) personnel records reviewed revealed the agency did not ensure the hospice assessed the skills and competencies of all individuals providing care, including volunteers providing services. Agency policy titled “Competency Assessment Policy No 3-003 Dated 2003, Revised November 2024” stated in relevant part: “Policy: The competence of all organization clinical personnel (employed, contract or volunteer) will be assessed during orientation, during the probationary period, periodically throughout the course of the year and during the annual performance evaluation. Procedure: Competency assessments will be completed at least one (1) time per year; Using a competency skills performance checklist developed specifically for each clinical job category, the clinical supervisor will evaluate the competence in performing and rendering care.” Agency policy titled “Annual Core Competence. Policy No 3-005. Dated 2003, Revised November 2024” stated in relevant part: “1. Hospice personnel will demonstrate proficiency in the performance criteria/skills during the orientation period and at least annually thereafter as part of the annual performance evaluation.” Personnel Record 2: A review of the personnel record for the registered nurse with a hire date of 10/24/1994 did not have documentation of skills and competencies being assessed in 2023 or 2024 in accordance with agency policy. Personnel Record 3: A review of the personnel record for the licensed vocational nurse with a hire date of 07/26/2022 did not have documentation of skills and competencies being assessed in 2023 or 2024 in accordance with agency policy. . Personnel Record 4: A review of the personnel record for the social worker with a hire date of 01/11/2016 did not have documentation of skills and competencies being assessed since 2020 in accordance with agency policy. Personnel Record 6: A review of the personnel record for the hospice aide with a hire date of 10/21/2015 did not have documentation of skills and competencies being assessed in 2023 or 2024 in accordance with agency policy. Personnel Record 7: A review of the personnel record for the bereavement coordinator with a hire date of 08/25/2015 did not have documentation of skills and competencies being assessed since 2021 in accordance with agency policy. Personnel Record 8: A review of the personnel record for the volunteer coordinator with a hire date of 11/28/2016 did not have documentation of skills and competencies being assessed in 2023 or 2024 in accordance with agency policy. Personnel Record 9: A review of the personnel record for the volunteer with a hire date of 09/18/2024 did not have documentation of skills and competencies being assessed upon hire in accordance with agency policy. An interview and joint personnel record review was conducted with the Administrator/DPCS (Director of Patient Care Services) on 04/22/2025, in which she stated they “Switched processes and started doing in-services instead of competencies.””