Accent Care Hospice & Palliative Care of Hillsboro

“Observed in Regulatory Review. In 19 of 20 patient records reviewed, it was noted that the written plan of care was not individualized for each patient. For example, in 19 of 20 records the goals did not include time frames. For example, the goals were vague and not measureable such as: RRHV#1 Patient/caregiver experience positive positive interactions and build positive memories Insurance benefits clarified and secured and Patient exhibits reduction/relief of any cardiopulmonary symptoms.. RRHV#6 Provided wound care per orders. RRNHV#3 Pain is currently managed at a level acceptable to the patient. and Patient/caregiver experiences effective communication. RRNHV#12 Patient exhibits reduction /relief of any cardiopulmonary symptoms RRNHV#14 Patient/caregiver will verbalize/demonstrate understanding of applicable safety measures. Also, the frequency orders on the POCs were not individualized based on the patient’s needs. For example, in records RRNHV#3, #6 and #8 the frequency order in the POC for the SN included 8 as needed visits. In record RRNHV#5 frequency order for the SN included 13 as needed visits. In record RRHV#1, the frequency order for the SN included 7 as needed visits. In record RRHV#2 the frequency order for the SN included 6 as needed visits. In record RRHV#6 the frequency order for the SN included 11 as needed visits. In record RRNHV#13 the frequency order in the POC for the SN included 9 as needed visits. In record RRHV#5 the frequency order in the POC for the SN included 26 as needed visits and the MSW included 13 as needed visits.This was discussed and confirmed with the DPCS and Executive Director present.

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“Observed in Record Review. In 9 of 20 patient records reviewed, it was noted that care was not provided according to the plan of care. For example, in RRHV#1, RRHV#2 and RRHV#6 there was no documentation for 1 HHA visit being completed in the past month and no missed visit notes. In record RRNHV#5 there was no documentation for 1 HHA visit in the past two months and no missed visit note. In record RRNHV#6 there was no documentation for 1 nurse visit in the past month and no missed visit note. In record RRNHV#7 there was no documentation for 2 aide visits in the past 5 weeks and no missed visit notes. In record RRNHV#12 there was no documentation for 4 HHA visits in the past month and no missed visit notes. In record RRNHV#3 there was no documentation for 2 music therapy visits in the past month and no missed visit notes. In RRHV#5 the POC order stated the patient was to use oxygen 4 liters per nasal cannula continuously due to the patient’s cardiac and respiratory diagnosis’. However, during the home visit it was observed that the aide assisted the patient to remove the nasal cannula, place it on the patient’s chair, walk with the patient greater than 10 feet to the bathroom, complete a shower, and walk back to the chair. This was confirmed with the DPCS present.”

“Observed in Record Review. In 6 of 14 patient records reviewed, that included aide services it was noted that the staff were not supervised effectively, For example, in records RRHV#1, RRHV#2, RRHV#6, RRNHV#5, RRNHV#7 and RRNHV#12 the supervisory note was completed however the supervision was not effective. There was no indication that the nurse completing the supervision was aware that aide visits that were ordered in the POC had not been documented during the 14 days that were assessed. The supervisory area Does the aide follow the Plan of Care? was marked yes in each record. This was discussed and confirmed with the DPCS and Executive Director.”

“Observed in Document Review. Upon review of the data provided by the organization representing volunteer productivity for those volunteers providing both administrative and direct patient care services, the hospice pharmacy surveyor noted that the 12 month productivity reported from October of 2023 to September of 2024 to be at 2% as a percentage of the paid clinical hours of hospice employees and contract staff. In addition. in no month in the last twelve months did the organization achieve the 5% minimum requirement with 4% being the highest level achieved which was in November of 2023. The organization was documenting the dollar amounts saved by these percentages and recruitment and retention efforts. This issue was validated with the national director of volunteer services and local volunteer management at the time of the survey.”

“Observed in HR File Review. In 3 of 13 HR files reviewed, the hospice pharmacy surveyor noted that criminal background checks were not found in these employees’ HR files as required by organizational policy and for hospices electing the deemed status option. The files included a chaplain, a music therapist, and a volunteer. All of these individuals were hired in 2022 under a previous owner and the current organization leadership was not aware at the time of the survey that this required information had not transferred to the new owner with the employee files of these individuals. This omission was validated with the HR manager, the volunteer coordinator, and hospice leadership at the time of the survey.

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