Senior Hospice

“Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions: The hospice office contained a refrigerator that contained employee food. In addition, Medications where present for four different patients. These medications where: 1) Lorazepam 2mg/ml with an empty syringe in the same package, 2) Morphine Sulfate Oral Solution 100 mg/5ml, 3) Flu Shot, 5) Lorazepam 0.5 ml tabs - five tabs in bottle, 6) Morphine Sulfate Oral Solution 100mg/5ml - 3 bottles with two unopened and one empty syringe.”

“Upon personnel record review, 1 of 12 (Personnel #8) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement. Personnel #8 Aide competencies did not include: 1) Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. 2) Appropriate and safe techniques in personal hygiene and grooming that include - a) Sponge bath, b) Shampoo/ sink, tub, and bed.”

“Upon patient record review, 1 of 14 (Patient #5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient # 5 - aide POC did not have frequency for Perineal Care”

“Upon patient record review 2 of 14 (Patients #9, 10) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient # 9 - the aide documented repositioning on 2/25, 2/28, 3/4/2025. This task was not on the patient’s aide POC. Change of bed linens was ordered on the aide POC each visit. This was not done on visit dated 2/28/2025 Patient # 10-catheter care for foley ordered for aide to perform each visit on 12/10/2024, this was not completed on 1/10/2025 visit. Aide repositioned patient, not included on aide POC.”

“Upon patient record review 1 of 14 (Patient #10) did not have evidence in the patient record that the hospice aides report: • Changes in the patient’s medical, nursing, rehabilitative, and social needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities • Hospice aides must also complete appropriate records in compliance with the hospice’s policies and procedures. Patient #10 Aide documented a new finding for the patient, stating she had redness in the perineal area. There was no evidence of this finding being reported to the Registered Nurse.”

“Upon personnel record review, 1 of 14 (Personnel # 8) did not have evidence in the hospice aide personnel file that a registered nurse made an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while he or she is performing care. The supervising nurse must assess an aide’s ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include all required content. Personnel #8: Documentation of the on-site visit was not present in the Aide’s personnel file.”

“Upon observation, there was no evidence the hospice discussed the policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. Upon review of patient’s #13 and #14 there was not a discussion with the family regarding the destruction of the medications, including controlled drugs, or what decisions were made regarding the disposal of the medications no longer needed by the patient.”