Accentcare of Colorado

“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, interview, and observation. In 1 of 4 (25%) clinical records reviewed, the agency did not ensure that the Registered Nurse provided the hospice aide with specific instructions on the hospice aide’s plan of care. CLINICAL RECORD 2/HOME VISIT 1: The most recent hospice aide plan of care, dated 03/13/2025, was reviewed, and bathing; shower was assigned for every visit. The physician’s order, effective 12/04/2025, ordered hospice aide services twice weekly. The hospice aide’s visit documentation revealed that the aide showered the patient once weekly. The hospice aide visit on 12/08/2025 documented shower-no; patient showers only 1x. A shower was also documented on 12/17/2025 and 12/22/2025. The hospice aide visit on 01/16/2026 documented shower-no; patient only takes one shower per week. During the home visit on 01/21/2026, the hospice aide stated, “she only gets showers one time weekly, it’s been this way for months, the RN knows but the plan still isn’t updated.” The Team Director was present for the home visit on 01/21/2026. During a joint record review and interview on 01/21/2026, the Director of Clinical Operations agreed that there was no documented evidence that the Registered Nurse updated the aide care plan to include the weekly showers. Additionally, the Director of Clinical Operations did not have any evidence that the hospice aide’s plan of care was updated after 03/13/2025. During an interview on 01/21/2026, the Team Director stated that the aide’s plan of care needs to be updated; it’s not up to date.”

“It is required that a hospice aide provide services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 2 (50%) home visits observed, the agency did not ensure the hospice aide followed the plan of care as ordered. CLINICAL RECORD 2/HOME VISIT 1: During the Home Visit on 01/21/2026, the Hospice Aide (PR#1) was observed using an electric shaver to shave the patient’s chin. The plan of care dated 03/13/2025 did not instruct the aide to shave the patient. After the visit, the Hospice Aide stated, “I thought shaving was ordered, but I see now that it wasn’t.” The Team Director observed the visit and agreed that shaving was not ordered on the plan of care. During an interview on 01/21/2026, the Team Director agreed that the hospice aide’s plan of care did not include shaving. Additionally, the Team Director stated that only the tasks ordered should be completed. The plan of care needs to be updated if the patient wants to be shaved. During a joint record review and interview on 01/21/2026, the Director of Clinical Operations agreed that the hospice aide’s plan of care did not include shaving.”

“It is required that a hospice aide provide services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 2 (50%) home visits observed, the agency did not ensure the hospice aide followed the plan of care as ordered. CLINICAL RECORD 2/HOME VISIT 1: During the Home Visit on 01/21/2026, the Hospice Aide (PR#1) was observed using an electric shaver to shave the patient’s chin. The plan of care dated 03/13/2025 did not instruct the aide to shave the patient. After the visit, the Hospice Aide stated, “I thought shaving was ordered, but I see now that it wasn’t.” The Team Director observed the visit and agreed that shaving was not ordered on the plan of care. During an interview on 01/21/2026, the Team Director agreed that the hospice aide’s plan of care did not include shaving. Additionally, the Team Director stated that only the tasks ordered should be completed. The plan of care needs to be updated if the patient wants to be shaved. During a joint record review and interview on 01/21/2026, the Director of Clinical Operations agreed that the hospice aide’s plan of care did not include shaving.”

“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 1 of 16 (6%) clinical records reviewed of patients that received Hospice Aide (HA) services, the hospice did not ensure that the Hospice Aide (HA) received written patient care instructions to meet the patient’s needs. CLINICAL RECORD 9: The patient elected the hospice benefit on 01/07/2025 with diagnoses of atherosclerotic heart disease of the native coronary artery without angina pectoris. The patient resided in a skilled nursing facility (SNF). The RN start-of-care visit note dated 01/07/2025 documented the patient’s unstageable coccyx wound. On 01/08/2025, the RN visit note documented a plan of care (POC) update order for the SNF to provide wound care to the coccyx three (3) times a week. The RN wound care assessments dated 01/07/2025 through 04/10/2025 documented the patient’s unstageable open coccyx wound. The plan of care dated 01/07/2025 ordered Hospice Aide (HA) services two (2) times a week. The HA care plan dated 01/07/2025, assigned the HA the relevant task of a shower every visit. The HA visit note dated 01/08/2025 (following the RN visit on the same date) documented that a shower was provided. The HA care plan was updated on 01/10/2025, changing the patient’s bath to a bed bath. The HA care plans dated 01/07/2025 through 04/10/2025 did not alert the HA to the coccyx wound and did not provide the HA with specific written instructions for managing the dressing during showers or baths, nor did they instruct the HA to notify the RN if the wound dressing became soiled, dislodged, or wet during the bath. During a joint record review and interview on 07/18/2025, the Director of Clinical Operations agreed there was no documented evidence that the RN provided the HA with patient-specific written care instructions on the aide care plan related to how to manage and what to report related to the “Coccyx” wound while performing the ordered task: “Shower” and “Bed bath.” Additionally, during an interview on 07/18/2025, the Director of Clinical Operations stated, “The RN missed it because the facility did the wound care. We need to be more specific with HA directives.””

“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, 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, document review, and interview. Agency policy #HOS 3-003 “Clinical Leadership Responsibilities and Supervision” stated in part, “The RN makes an on-site hospice aide supervisory visit to the patient’s home no less frequently than every 14 days to assess the quality of care, adequacy of services provided by the hospice aide, and ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. The aide does not have to be present during the RN supervisory visit every 14 days.” In 2 of 16 (12%) clinical records reviewed of patients who received Hospice Aide (HA) services, the hospice did not ensure that the Registered Nurse (RN) supervised the HA at least every 14 days. CLINICAL RECORD 1: The patient elected the hospice benefit on 12/04/2023. The plan of care dated 04/21/2025 through 05/12/2025 ordered HA services twice weekly, with a bed bath assigned every visit. The HA documented visits on 04/21/2025, 04/24/2025, 04/28/2025, 04/30/2025, 05/05/2025, and 05/08/2025. The RN completed supervisory visits on 04/20/2025 and 05/12/2025, with 22 days outstanding. There was no documented evidence of a supervisory visit by the RN between 04/21/2025 through 05/11/2025. CLINICAL RECORD 11: The patient elected the hospice benefit on 01/18/2025. The plan of care dated 05/06/2025 through 06/10/2025 ordered HA services once weekly. A clinical record review revealed documented HA visit notes dated 05/06/2025, and weekly through 05/27/2025. The RN completed a supervisory visit on 05/28/2025, with 22 days outstanding. There was no documented evidence of a supervisory visit by the RN between 05/06/2025 through 05/27/2025. During a joint record review and interview on 07/18/2025, the Director of Clinical Operations agreed that there was no documented evidence of supervisory visits during the identified period. Additionally, during an interview on 07/18/2025, the Director of Clinical Operations stated, “These were missed. We did not follow our own policy.””