Affinity Care of Sarasota

“It is required that 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 5 (20%) clinical records reviewed in which Hospice Aide services were accepted, the agency did not ensure that the Hospice Aide (HA) received written patient care instructions to meet the patient’s needs.. CLINICAL RECORD 4: The patient elected hospice care on 11/19/2025 with a diagnosis of Alzheimer’s disease. The patient resided in an assisted living facility (ALF). Aide frequency of 5 times a week.The plan of care ordered HA services 5 times a week. The HA care plan dated 11/19/2025 assigned the HA the relevant tasks: “Bathing- shower 2x week; haircare 2x week; oral care every visit; pericare every visit; transfer client from bed/chair every visit; transfer client from chair bed every visit; change linens weekly; companionship every visit; notify nurse of change of condition every visit.” On 01/06/2026, the physician ordered: “Wound care to right lower extremity. Apply xerofoam to area with flap to wound bed and cover with foam dressing.” On 01/12/2026, the physician ordered:: “Left iliac crest unstageable wound. Apply medihoney and cover with foam dressing.” A physician’s order dated 02/23/2026 noted: “Left hip pressure ulcer. Pack with calcium alginate and cover with foam dressing.” A physician’s order dated 04/20/2026 noted: “Left hip wound. Apply Medihoney and calcium alginate to wound bed and cover with foam dressing.” The HA care was not updated to notify the HA of the wound(s) nor to notify the nurse if the dressing(s) became soiled, dislodged or wet during bathing. During an interview and joint clinical record review on 06/02/2026, the Clinical Director agreed the HA care plan should have been updated to include notification to the HA of the wounds and specific instructions for care of the dressing during tasks.”

“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. This standard was not met as evidenced by clinical record review, document review and interview. Agency policy #7044 “Supervision Human Resources” (effective 03/01/2019) stated in relevant part(s): “2. Hospice aide services will be supervised by a registered nurse every 14 days when aide services are being provided to assess the quality of care and services provided by the hospice aide...Supervising the services of the hospice aide.” In 2 of 5 (40%) clinical records reviewed in which Hospice Aide (HA) services were accepted, the agency did not ensure the quality of the aide supervisory visits. CLINICAL RECORD 3: The patient elected hospice care on 05/03/2026 with a diagnosis of senile degeneration of the brain. The patient resided in an assisted living facility (ALF). The patient was placed on daily transitioning nursing visits on 05/11/2026, and nursing documented the patient “was no longer ambulatory and unable to eat.” The hospice aide care plan dated 05/05/2026 included the following relevant tasks: “Transfer client to/from bed/chair-stand/pivot, use gait belt; assist to toilet; assist to bedside commode; assist with feeding; shampoo-two times weekly; brush hair; skin care-apply lotion; peri care-pull-ups; oral care-brush teeth; bathing-shower, use shower chair-two times weekly; dressing assistance; offer fluids; empty trash; change linens-two times a week; companionship.” All tasks were to be performed at each visit unless otherwise specified. The aide frequency was five times weekly. The aide was documenting “Not completed” for all tasks that included ambulation, transfers, feeding, offering fluids, showering, and marking “Patient refused or not able.” Notified RN.” This continued through the patient’s death on 05/15/2026. The Registered Nurse supervisory visit conducted on 05/12/2026 noted the following: “Does the aide follow the POC? Yes. Any changes needed to the POC? No.” CLINICAL RECORD 5: The patient elected hospice care on 02/20/2026 with a diagnosis of senile degeneration of the brain. The patient resided in an ALF. The patient was placed on daily transitioning nursing visits on 03/04/2026, and nursing assessments documented the patient “was no longer ambulatory or eating.” The hospice aide care plan dated 02/20/2026 included the following relevant tasks: “Transfer client to/from bed/chair-stand/pivot; assist with feeding; shampoo-two times weekly; brush hair; skin care-apply lotion; peri care-apply brief; oral care-brush teeth; nail care-clean and file; ear care; dressing assistance; offer fluids; change linens-two times a week; companionship; wound precautions.” All tasks were to be performed at each visit unless otherwise specified. The aide frequency was five times weekly. The aide was documenting “Not completed beginning on 03/02/2026 to all tasks that included ambulation, transfer, feeding, offer fluids and marking “Patient transitioning. Notified RN.” This continued through the patient’s death on 03/10/2026. The Registered Nurse supervisory visit conducted on 03/06/2026 noted the following: “Does the aide follow the POC? Yes. Any changes needed to the POC? No.” An interview and joint clinical record review was conducted with the Clinical Director on 06/02/2026 during which time it was agreed the “nurses should have updated the plans of care to match the needs of the patients.””

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes including the care and services provided. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #8060 “Information Services” (effective 03/01/2019) stated in relevant part(s): “6. Entries into the clinical/service record will be made on the day care/service is provided to the patient. All documentation will be turned in to the office by the end of the workday.” In 2 of 5 (40%) clinical records reviewed, the agency did not ensure that the patient’s clinical record included clinical notes, including the care and services provided per agency policy. CLINICAL RECORD 3: The patient elected hospice care on 05/03/2026 with a diagnosis of senile degeneration of the brain. The patient resided in an assisted living facility (ALF). The weekend on-call nurse (SN) visited the patient on 05/10/2026, in the morning and evening. A review of the clinical record on 06/02/2026 revealed that the documentation for the SN visits dated 05/10/2026 was completed and submitted in the electronic medical record (EMR) on 05/18/2026, with seven (7) days outstanding. CLINICAL RECORD 5: The patient elected hospice care on 02/20/2026 with a diagnosis of senile degeneration of the brain. The patient resided in an ALF. The on-call SN for the weekend visited the patient on 03/01/2026. A review of the clinical record on 06/02/2026 revealed that the documentation for the SN visit dated 03/01/2026 was completed and submitted in the EMR on 03/05/2026, with 3 days outstanding. Additionally, an on-call visit to the patient was conducted on 02/28/2026. The documentation for the SN visit dated 02/28/2026 was completed and submitted in the EMR on 03/03/2026, with two (2) days outstanding. During an interview and joint clinical record review on 06/02/2026, the Clinical Director advised, “A report had been emailed to the team regarding the events of the weekend; however, they agreed this was not the same as completing the documentation in the clinical record. We usually expect the documentation to be completed within 24 hours; however, we really start asking about it when it’s over three (3) days late on our morning stand-up call.””