Abode Hospice of Colorado

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the hospice did not ensure the initial comprehensive assessment was completed no later than five (5) calendar days after the election of hospice care. Clinical Record 10: This patient elected hospice care on 12/19/2023. A clinical record review revealed no evidence of a psychosocial assessment completed within five days of the election of hospice care. During an interview with the RN/Administrator on 02/15/2024, it was stated that the psychosocial assessment was missed (for clinical record 10) as the social worker was on vacation.”

“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 intervention to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the organization did not ensure that the individualized written plan of care (POC) included interventions to manage symptoms. Clinical Record 4: This patient elected hospice care on 11/03/2021. The Licensed Practical Nurse (LPN) visit note dated 02/01/2024 documented new signs and symptoms of a possible urinary tract infection (UTI), which included “Foul smelling urine and Foggy Brain.” The same day, the physician ordered: “Keflex 500 mg x7 days.” A clinical record review revealed no evidence that the plan of care dated 12/08/2023 was updated to include interventions to manage the symptoms of the suspected infection. During an interview and a joint review of the record on 02/16/2024, the Registered Nurse (RN)/Administrator agreed that the identified plan of care did not include interventions to manage symptoms identified in the nursing assessment.”

“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 measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 6 of 19 (32%) clinical records reviewed, the hospice did not ensure that the individualized written plan of care (POC) included measurable outcomes anticipated from implementing and coordinating the POC. Clinical Record 3: The patient elected hospice care on 07/03/2023. The patient’s individualized plan of care (POC) dated 12/15/2023 documented the patient’s goal, “Patient will maintain optimal cardiac function within constraints of disease.” The goal statement did not include a description of how the achievement of “optimal cardiac function” would be measured. Clinical Record 6: The patient elected hospice care on 11/28/2023. The patient’s individualized plan of care (POC) dated 11/28/2023 documented the patient’s goal, “Patient will maintain optimal cardiac function within constraints of disease, at time of admission and reinforced throughout hospice benefit.” The goal statement did not include a description of how the achievement of “optimal cardiac function” would be measured. Clinical Record 7: The patient elected hospice care on 01/12/2024. The patient’s individualized plan of care (POC) dated 01/12/2024 documented the patient’s goal, “Patient will maintain optimal cardiac function within constraints of disease.” The goal statement did not include a description of how the achievement of “optimal cardiac function” would be measured. Clinical Record 9: The patient elected hospice care on 05/18/2023. The patient’s individualized plan of care (POC) dated 05/18/2023 documented the patient’s goal, “Patient will maintain optimal cardiac function within constraints of disease.” The goal statement did not include a description of how the achievement of “optimal cardiac function” would be measured. Clinical Record 14: The patient elected hospice care on 11/21/2023. The patient’s individualized plan of care (POC) dated 11/21/2023 documented the patient’s goal, “Patient will maintain optimal cardiac function within constraints of disease, at time of admission and reinforced throughout hospice benefit.” The goal statement did not include a description of how the achievement of “optimal cardiac function” would be measured. Clinical Record 16: The patient elected hospice care on 04/28/2023. The patient’s individualized plan of care (POC) dated 07/19/2023 documented the patient’s goal, “Patient will maintain optimal cardiac function within constraints of disease.” The goal statement did not include a description of how the achievement of “optimal cardiac function” would be measured. During the daily wrap-up conference and a joint review of the records on 02/13/2024, the Registered Nurse (RN)/Administrator and the Senior Director of Compliance agreed that the identified POC goals were non-measurable.”

“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 3 of 15 (20%) clinical records reviewed of patients that received Hospice Aide services, the hospice did not ensure the Hospice Aide (HA) provided services included in the plan of care (POC). Clinical Record 1: This patient elected hospice services on 08/21/2023. The HA plan of care dated 11/21/2023 assigned the HA the relevant tasks, “Ear Care Weekly” and “Nail Care Weekly.” The HA documented ear and nail care were performed twice weekly during the weeks, including the visits dated 01/23/2024 and 01/25/2024, 02/06/2024, and 02/08/2024. Clinical Record 7: This patient elected hospice services on 01/12/2024. The HA plan of care dated 01/12/2024 assigned the HA the relevant task, “Change Linens Weekly.” The HA documented linen changes performed twice weekly during the weeks, including the visits dated 01/15/2024 and 01/18/2024; 01/22/2024 and 01/24/2024; 01/29/2024 and 02/01/2024; and 02/05/2024 and 02/08/2024. Clinical Record 14: This patient elected hospice services on 11/21/2023. The HA plan of care dated 11/21/2023 assigned the HA the relevant task, “Bathing (Bed/Bath) if patient declines shower” and “Bathing (Shower) two times a week.” The HA visit notes documented that both a shower and a bed bath were performed during every visit. During an interview on 02/14/2024, the RN/Administrator reviewed and acknowledged that the HA documentation did not follow the HA plans of care.”

“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 1 of 14 (7%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the hospice did not ensure the HA was supervised by a Registered Nurse (RN), making an on-site visit to the patient’s home no less frequently than every 14 days. Clinical Record 19: The patient elected hospice care on 08/15/2023 and received HA services once a week. A review of the clinical record revealed no evidence of HA supervision by a RN from 09/14/2023 through 10/12/2023, with 28 days outstanding. During an interview and a joint review of the record on 02/15/2024, the Registered Nurse (RN)/Administrator acknowledged that the above clinical record provided no evidence of HA supervision by the RN during the stated time frames.”

“It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IDF representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 5 (40%) clinical records reviewed of patients residing in a skilled nursing facility (SNF), the hospice did not ensure the plan of care (POC) specified which provider was responsible for performing the functions included in the hospice POC. Clinical Record 1/Home Visit 1: The patient elected hospice care at home on 08/21/2023 and moved to a SNF on 02/01/2024 while under hospice care. The current written plan of care dated 12/04/2023 did not include documentation specifying which provider was responsible for performing the functions included in the plan of care. During the home visit with the Registered Nurse (RN) [Personnel Record 1] on 02/14/2024, the RN stated that they coordinate care with the facility nurses and staff during each patient visit. The SNF nurse confirmed this during an interview on 02/14/2024. Clinical Record 3/Home Visit 3: The patient elected hospice care on 07/03/2023 and resided in a SNF. The written plan of care dated 12/15/2023 did not include documentation specifying which provider was responsible for performing the functions included in the plan of care. During an interview and a joint review of the records on 02/16/2024, the Registered Nurse (RN)/Administrator confirmed that the plans of care did not identify which provider was responsible for performing the functions included in the plans of care.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the most recent hospice 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 of patients residing in a skilled nursing facility (SNF), the hospice did not ensure the designated IDG member provided the SNF with the patient’s most recent hospice plan of care. Home Visit 1/Clinical Record 1: The patient elected hospice care at home on 08/21/2023 and moved to a SNF on 02/01/2024 while under hospice care. During the home visit with the Registered Nurse (RN) [Personnel Record 1] on 02/14/2024, there was no evidence that the designated IDG member provided the SNF with the patient’s most recent hospice plan of care. During an interview and a joint record review with SNF staff in medical records, they acknowledged that they did not have the patient’s most recent hospice plan of care. The SNF staff member provided evidence of hospice team member visit notes being sent routinely to the facility. When asked about the hospice plan of care the SNF staff member stated they have requested this document from the hospice agency, but they have yet to receive it. During an interview on 02/16/2024, the RN/Administrator stated that the agency’s electronic medical record (EMR) automatically generates a fax to the facility for visit notes and plan of care updates. When asked about the current plan of care (and other required forms) being sent to the facility, it was stated that they were sent on 2/15/2024.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the hospice election form and any advance directives. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 2 (100%) home visits observed of patients residing in a skilled nursing facility (SNF), the hospice did not ensure the designated IDG member provided the SNF with the patient’s hospice election form. Home Visit 1/Clinical Record 1: The patient elected hospice care at home on 08/21/2023 and moved to a SNF on 02/01/2024 while under hospice care. During the home visit with the Registered Nurse (RN) [Personnel Record 1] on 02/14/2024, there was no evidence the designated IDG member provided the SNF with the patient’s hospice election form. During an interview and joint record review with SNF staff, they acknowledged that they did not have the patient’s hospice election form. The SNF staff member provided evidence of hospice team member visit notes being sent routinely to the facility. When asked about the hospice election form the SNF staff member stated they have requested this document from the hospice agency, but they have yet to receive it. Home Visit 3/Clinical Record 3: The patient elected hospice care on 07/03/2023 and resided in a SNF. During the home visit with the Certified Nursing Assistant (CNA) [Personnel Record 3] on 02/15/2024, there was no evidence the designated IDG member provided the SNF with the patient’s hospice election form. During an interview and joint record review with SNF staff, they acknowledged that they did not have the patient’s hospice election form. The SNF staff member provided evidence of hospice team member visit notes being sent routinely and updated plans of care. The SNF staff member stated they did not think the form was provided as it was not in their records. During the daily wrap-up conference on 02/15/2024, the RN/Clinical Supervisor, RN/Administrator, and Senior Director of Compliance agreed that the facilities had no evidence of the hospice election form being provided. The Senior Director of Compliance inquired about the agency using hospice binders within the facilities; however, the RN/Administrator answered that they had tried this previously, and the facilities discarded the binders.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the physician certification and recertification of the terminal illness. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 2 (100%) home visits observed, the hospice did not ensure that the designated IDG member provided the skilled nursing facility (SNF) with the physician’s certification and recertification of the terminal illness. Home Visit 1/Clinical Record 1: The patient elected hospice care at home on 08/21/2023 and was moved to a SNF while receiving hospice care on 02/01/2024. During the home visit on 02/14/2024, there was no evidence that the SNF was provided with the physician’s certification of terminal illness. During an interview and a joint record review with SNF staff in medical records, they acknowledged that they did not have the physician’s certification of terminal illness. The SNF staff member provided evidence of hospice team member visit notes being sent routinely to the facility. When asked about the hospice physician’s certification of terminal illness, the SNF staff member stated they had requested this document from the hospice agency, but they had yet to receive it. Home Visit 3/Clinical Record 3: The patient elected hospice care on 07/03/2023 and resided in a SNF. During the home visit on 02/15/2024, there was no evidence that the SNF was provided with the physician’s certification of terminal illness. During an interview and joint record review with facility staff in medical records on 02/15/2024, they acknowledged that they did not have the physician’s certification of terminal illness. The SNF staff member provided evidence of hospice team member visit notes being sent routinely to the facility. The facility staff member stated they do not believe they were provided with this form as it is not in their records. During the daily wrap-up conference on 02/15/2024, the Registered Nurse (RN)/Clinical Supervisor, RN/Administrator, and Senior Director of Compliance agreed that the facilities had no evidence of the physician’s certification of terminal illness being provided. The Senior Director of Compliance inquired about the agency using hospice binders within the facilities; however, the RN/Administrator answered that they had tried this in the past, and the facilities discarded the binders.”