Aseracare Hospice

“Upon patient record review, 4 of 19 (Patients #6, 9, 13, and 14) did not contain documented evidence that a Registered Nurse had been designated to ensure continuous assessment of the patient and family’s needs: Patient #6: The 06/10/24 RN SOC assessment reflected, “Some redness on coccyx.” On the next two subsequent SN visits (06/11 and 06/17/24) there was no documentation of the nurse having re-assessed for this area of concern. Patient #9: The 06/05/24 RN SOC assessment reflected, “Redness under breasts and in peri-area.” On the next two subsequent SN visits (06/06 and 06/10/24) there was no documentation of the nurse having re-assessed for this area of concern. Patient #13: The 05/03/24 (Friday) RN SOC assessment reflected, “Pain of 5 moderate, with a patient goal of “0”. Back pain is continuous.” The nurse obtained a Physician order for multiple pain medication options. On (Saturday) 05/04/24, a Hospice nurse made a return home visit which reflected, “Pain of 4, with a revised patient goal of “2”. The patient reported to the nurse that she had not been able to obtain the ordered pain medications. “H” Pharmacy was not able to access some of the ordered medications until (Monday) 06/06/24. The Hospice nurse contacted H Pharmacy and told them to cancel the previous order, and then contacted “W” Pharmacy to re-order those same pain medications. There was not documented evidence that a Hospice nurse had then re-contacted the patient on (Sunday) 06/05/24, in order to confirm that the patient had indeed obtained her needed pain medications, and pain status. Patient #14: A verbal order was obtained on 06/07/24 for, “May straight catheterize patient in order to obtain a UA.” There was documentation of the Hospice RN and the SNF nurse discussing this need/order. However, there was not documented evidence of the Hospice having followed up to ascertain that a urine sample had been obtained, and forwarded to lab.”

“Upon patient record review, 1 of 19 (Patient #8) did not contain evidence that the Hospice had developed an individualized written Plan of Care for each patient. The Plan of Care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The Plan of Care must include all services necessary for the palliation and management of the terminal illness and related conditions: Patient #8: The RN SOC assessment reflected, “Implanted Vascular Access Device. (Not using).” However, this implanted port was not included on the initial Hospice POC.”

“Upon patient record review, 5 of 19 (Patients #5, 7, 8, 9, and 10) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including the following: A detailed statement of both the scope and frequency of the services necessary to meet the specific patient and family needs: Patients #5, 7, 8, 9, and 10: The most recent IDG Plan(s) of Care for each of these patients contained a Chaplain entry of, “Chaplain services declined. Chaplain available as needed for visits per patient/family request”. A PRN visit frequency is not allowable without a baseline frequency in place.”

“Upon client record review, 1 of 19 (Patient #2) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #2: On 06/21/24 the Aide reported to the Hospice nurse, “Left armpit red and raw, skin peeling and sore.” An order was obtained that same date for, “Left armpit excoriation. Apply antifungal topically BID.” The next subsequent SN visit was not made until 06/25/24. The Hospice nurse documented, “Excoriation left armpit.” There was no documentation that the Hospice nurse had care coordinated with the SNF nurse to ascertain that the SNF nurses had indeed been providing such BID treatment, nor how the area was progressing/not progressing toward healing over the past 4 days.”

“Upon patient record review, 1 of 19 (Patient #2) did not contain evidence that the Hospice Plan of Care identified the care and services that are needed, and specifically identify which provider (Nursing Facility or Hospice) is responsible for performing the respective functions that have been agreed upon and included in the Hospice Plan of Care: Patient #2: On 06/21/24 the Aide reported to the Hospice nurse, “Left armpit red and raw, skin peeling and sore.” An order was obtained for, “Left armpit excoriation. Apply antifungal topically BID.” This order did not include ‘who’ would be providing such BID treatment, Hospice staff or SNF staff.”

“Upon personnel record review, 1 of 13 (Personnel #11) did not contain evidence of Criminal Background Checks having been obtained in accordance with Iowa State requirements: Personnel #11: DOH was 03/11/19, and she had worked for the Iowa-based Hospice location for the last 2-3 years, per the Regional VP OPS. There was no documented evidence that the Hospice had obtained/was in compliance with the following Iowa requirement: There is evidence in the personnel files (direct care personnel, contract direct care personnel, direct care volunteers and employees with access to patient protected information) for an Iowa Hospice agency of the following background checks, these checks must be performed within 30 days prior to employee’s date of hire. If the employee has a break in employment, of any length of time (excluding vacations or illness while the employee maintains their employment), and later returns to the employer, the three required background checks must be repeated as if the employee was a brand new employee. If an employee received a conviction or has a founded abuse during their employment the employee is required to notify the employer within 48 hours of either occurrence. These checks must be done through the State of Iowa Single Information Repository (SING), or that the criminal background check is completed through the Iowa Dept. of Criminal Investigation (DCI,) and the abuse background checks be completed through the Iowa Dept. of Human Services (DHS): • Dependent adult abuse background check • Child abuse background check • Criminal background check”