Georgia Hospice Care

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene and use of gloves. This standard was not met as evidenced by clinical record review, interview and observation. In 2 of 3 (67%) observed home visits conducted, the agency did not ensure staff performed hand hygiene in accordance with accepted standards of practice. Center for Disease Control guidelines “Hand Hygiene for Healthcare Workers”, February 27, 2024 states in relevant parts, “Know when to clean your hands: Immediately before touching a patient; Before performing an aseptic task such as placing an indwelling device or handling invasive medical devices; Before moving from work on a soiled body site to a clean body site on the same patient; After touching a patient or patient’s surroundings; After contact with blood, body fluids, or contaminated surfaces; (and) Immediately after glove removal.” and “Know when to wear (and change) gloves: Gloves are not a substitute for hand hygiene. If your task requires gloves, perform hand hygiene before donning gloves and touching the patient or the patient’s surroundings. Always clean your hands after removing gloves. Remember to remove gloves carefully to prevent hand contamination as dirty gloves can soil hands.” CLINICAL RECORD 1/HOME VISIT 1: This patient elected the hospice benefit on 12/11/2025 with a terminal diagnosis of malignant neoplasm of the cervix. A home visit was conducted on 07/29/2026 to observe the Registered Nurse (RN - Personnel Record 1) provide wound care. The RN washed her hands and donned gloves and then removed existing wound dressings. She then went into the patient’s bedroom to look for more supplies and a barrier to place under the patient’s feet for the dressing change. She returned to the patient and cleansed the wounds without removing gloves or sanitizing hands. After cleansing the wounds, the RN removed her gloves and donned a new pair of gloves without sanitizing hands. She went back to the patient’s bedroom and the patient’s bathroom to find cream and cotton-tipped applicators. She then applied the cream around the open areas and applied non-stick gauze without removing her gloves or sanitizing her hands. CLINICAL RECORD 3/HOME VISIT 3: This patient elected the hospice benefit on 02/20/2026 with a terminal diagnosis of senile degeneration of the brain. A home visit was conducted on 07/29/2026 to observe the Hospice Aide (HA - Personnel Record 3) provide personal care. The HA was observed to wash her hands and don gloves and take the patient to the bathroom. As the patient sat on the toilet the HA removed the patient’s pull-up, checked the water, and then removed gloves and replaced gloves without sanitizing her hands. The HA placed the patient in the shower and washed the patient’s upper and lower body and then washed the patient’s rectal area. She then washed the patient’s hair without changing her gloves or sanitizing her hands. An interview was conducted with the RN Manager of Accreditation and Regulatory Compliance on 07/30/2026. It was determined that the staff did not follow the standards of practice for hand hygiene would be re-educated on proper hand hygiene.”

“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 (registered nurse) 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 14 (7%) clinical records reviewed in which hospice aide services were provided, the agency did not ensure that written patient care instructions for the hospice aide were clear and complete. CLINICAL RECORD 10: This patient elected the hospice benefit on 06/26/2026 with a terminal diagnosis of Alzheimer’s Disease. The RN initial comprehensive assessment documented that the patient’s PPS (palliative performance scale) was 30% and he ambulated with an assistive device. The initial hospice plan of care dated 06/24/2026-08/22/2026 included orders for hospice aide visits 2W1, 4W1, 5W1 and safety measures for aspiration precautions and fall precautions. Review of the hospice aide care plan for the dates of 06/24/2026-08/22/2026 did not include directions for aspiration precautions or fall precautions. A joint review of clinical records and interview was conducted with the RN Manager of Accreditation and Regulatory Compliance on 07/30/2026, It was stated that the safety instructions were not present in the hospice aide care plan and these instructions should be there.”