American Hospice and Home Health Care Service Inc.

“It is required that each patient’s individualized written plan of care reflects patient and family goals, 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 19 (21%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) included planned interventions and goals based on problems identified in the initial and updated comprehensive assessments. Clinical Record 4: The patient’s date of election was 08/28/2024. The primary hospice diagnosis was Cerebral atherosclerosis. The Comprehensive Nursing Assessment dated 08/28/2024 documented a Braden Risk assessment of nine (high risk), incontinent of bowel and bladder, bedbound, epilepsy, history of a stroke with right sided hemiplegia. The Nursing Re-Certification Assessment dated 11/17/2024 documented a Braden Risk assessment of nine (high risk), incontinent of bowel and bladder, bedbound, epilepsy, and hemiplegia right dominant side. The Current Treatment/Medication/DME List reviewed 12/10/2024 revealed Levetiracetam 750mg twice daily for seizures with a start date of 08/28/2024. The Plan of Care/Interdisciplinary Group (POC/IDG) Reviews dated 08/29/2024, 11/20/2024, and 12/04/2024 lacked problems, interventions, and goals for increased risk for skin breakdown and risk for seizures. Clinical Record 8: The patient’s date of election was 04/23/2024. The primary hospice diagnosis was Alzheimer’s disease, unspecified. The Nursing Re-Certification Assessment dated 07/18/2024 documented a Braden Risk assessment of six (high risk), confined to bed or chair-w/c, and incontinent of bowel and bladder. The Nursing Re-Certification Assessment dated 10/07/2024 documented a Braden Risk assessment of six (high risk), non-ambulatory, incontinent of bowel and bladder, “Unable to answer simple yes/no questions appropriately... No longer able to make needs known even through use of nonverbal cues.” The Plan of Care/Interdisciplinary Group (POC/IDG) Reviews dated 07/17/2024, 07/31/2024, 10/09/2024, and 10/23/2024 lacked problems, interventions, and goals for increased risk for skin breakdown. Clinical Record 14: The patient’s date of election was 04/04/2024. The primary hospice diagnosis was unspecified severe protein-calorie malnutrition. The Comprehensive Nursing Assessment dated 04/04/2024 and the Nursing Re-Certification Assessment dated 05/23/2024 documented that the patient had unspecified convulsions. The Current Treatment/Medication/DME List reviewed 12/12/2024 revealed Depakote 125mg Delayed Release tablet, take one tablet three times a day for seizures with a start date of 04/04/2024. The Plan of Care/Interdisciplinary Group (POC/IDG) Reviews dated 04/10/2024, 05/22/2024, and 06/05/2024 lacked problems, interventions, and goals for and risk for seizures. Clinical Record 15: The patient’s date of election was 06/01/2023. The primary hospice diagnosis was Gastrointestinal stromal tumor, unspecified site. The Nursing Re-Certification Supervisory Assessments dated 05/15/2024 and 07/11/2024 documented aspiration precautions. The HA [Hospice Aide] Assignment documents dated 05/15/2024 and 07/11/2024 documented aspiration precaution. The Plan of Care/Interdisciplinary Group (POC/IDG) Reviews dated 05/08/2024, 05/22/2024, 07/17/2024, and 07/31/2024 lacked problems, interventions, and goals for increased risk for aspiration precautions. During a joint review of the record and an interview on 12/12/2024, the Director of Patient Care Services/Nurse Practitioner/Chief Executive Officer confirmed that there was no documented evidence that the plans of care included problems, goals, and interventions for the problems identified in the assessments.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 19 (5%) clinical records reviewed revealed the agency did not ensure a medication reconciliation was completed and medications were updated to the medication profile and plan of care. Home Visit 1/Clinical Record 5: The patient’s date of election was 01/25/2023. The Medication Profile printed on 12/10/2024 was reviewed during the home visit on 12/11/2024 with the Licensed Vocational Nurse (Personnel Record 14). The medications in the facility revealed Donepezil 10mg, one tablet by mouth at bedtime, with a start date of 10/25/2020. The facility Administrator/Director of Nursing verified that the patient is taking the Donepezil. During a joint review of the record and an interview on 12/11/2024/2024, the Director of Patient Care Services/Nurse Practitioner/Chief Executive Officer agreed there was no documented evidence the Donepezil was updated to the medication profile and plan of care. During a joint review of the record and an interview on 12/11/2024/2024, the Director of Patient Care Services/Nurse Practitioner/Chief Executive Officer agreed there was no documented evidence the Donepezil was updated to the medication profile and plan of care.”

“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 2 of 19 (11%) clinical records reviewed, in which aide services were accepted, revealed the agency did not ensure a Registered Nurse prepared written care instructions for the hospice aides to follow. Clinical Record 13: The patient’s date of election was 07/17/2023. The primary hospice diagnosis was anoxic brain damage, not elsewhere classified. The Comprehensive Nursing Assessment dated 07/17/2023 and the Nursing Re-Cert Assessment dated 10/05/2023 documented that the patient had seizures. The Current Treatment/Medication/DME List reviewed 12/12/2024 revealed Keppra 500mg tablet, give two tablets by mouth every 12 hours for convulsions started 07/17/2023 and Depakote 500mg Delayed Release tablet, give two tablets by mouth every 12 hours for convulsions started 07/17/2023. The hospice aide care plans, dated 07/17/2023 and 11/28/2024, lacked instructions for seizure precautions. Clinical Record 14: The patient’s date of election was 04/04/2024. The primary hospice diagnosis was unspecified severe protein-calorie malnutrition. The Comprehensive Nursing Assessment dated 04/04/2024 and the Nursing Re-Cert Assessment dated 05/23/2024 documented that the patient had unspecified convulsions. The Current Treatment/Medication/DME List reviewed 12/12/2024 revealed Depakote 125mg Delayed Release tablet, take one tablet three times a day for seizures with a start date of 04/04/2024. The hospice aide care plans dated 04/04/2024 and 11/22/2024 lacked instructions for seizure precautions. During a joint review of the record and an interview on 12/12/2024, the Director, of Patient Care Services/Nurse Practitioner/Chief Executive Officer agreed there was no documented evidence that a Registered Nurse coordinated care in the development of instructions for the hospice aide.”