St. Anthony Regional Hospital and Nursing Home

“The Iowa Code, Chapter 135C.33 requires hospice agencies to complete a criminal history, a dependent adult abuse, and child abuse record check on all prospective direct or contracted employees with the potential for direct patient contact, within 30 days prior to the date of hire, using either the Iowa Single Information Repository (SING), or using both the Iowa Department of Criminal Investigation (DCI) to conduct the criminal background check, and using the Iowa Department of Human Services to conduct the dependent adult abuse and child abuse background checks. The Iowa Administrative Code, Chapter 119, requires the hospice agency to obtain authorized clearance from the Department of Human Services (DHS) prior to hiring any prospective employee who DCI has reported has a criminal record for any conviction more severe than a simple misdemeanor. Based on review of employee personnel files and staff interview, the hospice failed to ensure completion of a dependent adult abuse or child abuse record checks for 4 of 7 sampled employees (Staff G, I, J and K) who began serving hospice patients since their last survey, dated 5/5/22. The hospice reported hiring 8 staff since the last survey. Failure to complete dependent adult and child abuse record checks as required by State regulation, increased the potential risk of harm to agency patients from staff who had direct patient contact. Findings include: According to the hospice policy titled Recruitment and Selection Process, last revised 3/2024, all offers of employment are contingent upon clear results of a thorough backgroun check. Background checks will be conducted on all final candidates. Background checks will include: Iowa Health Care Facility Record check, The Divistion of Criminal Investigation (DCI) at the Department of Public Safety to perform a criminal, child, and dependent adult abuse record check. If the person has been convicted of a crime under the law of any state or has a record of founded child or dependent adult abuse, the Department of Hyman Services will perform an evaluation to determine whether the crime or founded cheld or dependent adult abuse warrants prohibition of employment. During an interview on 4/3/25 at 10:40 AM, the Administrator stated Staff G, Staff I, Staff K had background checks completed when they previously worked at the hospital. Staff transfered to work for hospice. 1. Staff G, Hospice Aide, had a hire date of 8/10/23. A criminal background check, dependent adult abuse and child abuse checks were completed and dated 3/15/05. The hospice failed to complete dependent adult abuse and child abuse checks with the Iowa SING or the Iowa Department of health within 30 days prior to the date of hire. Hospice staff failed to complete dependent adult and child abuse record checks within 30 days prior to the date of hire on all staff prior to hiring. 2. Staff I, Hospice Volunteer, had a hire date of 8/17/23. A criminal background check, dependent adult abuse and child abuse checks were completed and dated 4/21/05. The hospice failed to dependent adult abuse and child abuse checks with the Iowa SING or the Iowa Department of Health within 30 days prior to the date of hire. Hospice staff failed to complete dependent adult and child abuse record checks within 30 days prior to the date of hire on all staff prior to hiring. 3. Staff J, Pastoral Care, had a hire date of 11/27/23. A criminal background check, dependent adult abuse and child abuse checks were completed and dated 10/6/23, 52 days prior to the date of hire. The hospice failed to complete an additional dependent adult abuse child abuse check with the Iowa SING or the Iowa Depertmant of Health within 30 days prior to the date of hire. Hospice staff failed to complete dependent adult and child abuse record checks within 30 days prior to the date of hire on all staff prior to hiring. 4. Staff K, Licensed Practical Nurse, had a hire date of 4/7/25. A criminal background check, dependent adult abuse and child abuse checks were completed and dated 4/21/05. The hospice failed to complete a dependent adult abuse and child abuse check with the Iowa SING or the Iowa Department of health within 30 days prior to the date of hire. Hospice staff failed to complete dependent adult and child abuse record checks within 30 days prior to the date of hire on all staff prior to hiring. The above findings were reviewed with the Administrator and Volunteer Coordinator.”

“Based on clinical record review, hospice policy review, home visit observation, patient interview and staff interview, the hospice failed to ensure the provision of care in accordance with the patient’s plan of care (POC) for 6 of 14 sampled patients (Patient #2, #4, #5, #6, #8, and #12). Failure to follow the patient’s POC as directed by the Interdisciplinary Group (IDG) put the patients at risk for inconsistent care that may not meet the needs of the patients. Findings include: 5. Patient #2 had a start of care date of 5/8/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POC, dated 1/3/25 to 3/3/25, identified the patient had a diagnosis of Bladder cancer. The POC included orders for the skilled nurse to assess skin condition. b. The skilled nurse visit note, dated 2/11/25, completed by Staff D, LPN, identified the patient had a skin tear to the right forearm and noted the dressing was changed. The LPN failed to obtain wound care orders and failed to measure the wound. The hospice failed to provide weekly wound measurements and failed to provide services only as ordered by the physician. 6. Patient #6 had a start of care date of 2/24/25 and received hospice services while residing in a nursing home. Clinical record review revealed: a. The POC, dated 2/24/25 to 4/24/25, identified the patient had a diagnosis of Alzheimer’s disease. The POC included orders for skilled nurse to assess skin condition. b. The skilled nurse visit note, dated 2/25/25, completed by Staff D, LPN, identified the patient fell last night and had a laceration above his/her right eye. The LPN failed to document measurements of the laceration. c. The skilled nurse visit notes, dated 2/27/25, 3/6/25, 3/10/25, 3/13/25, 3/20/25 and 3/25/25, completed by Staff B, Clinical Manager, failed to include a wound assessment with wound measurements. The hospice failed to complete weekly wound assessments and measurements. The above findings were reviewed with the Administrator and Clinical Manager. Review of the hospice policy, titled Wound Care, last revised 8/2024, wounds should be pictured, assessed and measured (length, width, and depth) on a weekly basis and PRN (as needed) with wound care. This should be documented in the clinical record. During an interview on 4/15/25 at 10:30 AM the Clinical Manager stated the skin assessment included wound measurements completed weekly. The measurements expected to include length, width and depth. 1.Patient #4 had a hospice admission date of 2/20/25 and received hospice services while residing in a private residence. Clinical record review and home visit observation revealed the following: a. The plan of care (POC), dated 2/20/25 to 5/20/25, identified the patient had a diagnosis of lung cancer. The POC included orders for the skilled nurse to assess the patient’s weight and measurements. b. The skilled nurse visit notes, dated 2/18/25, 3/6/25, 4/1 and 4/5/25, Staff H, Registered Nurse (RN), failed to include documentation of the patient’s weight and measurements. c. The skilled nruse visit note, dated 3/14/25, by Staff D, Licensed Practical Nurse (LPN), failed to inlcude documentation of the patient’s weight and measurements. The hospice failed to follow all orders as written on the POC. 2. Patient #5 had a hospice admission date of 7/22/25 and received hospice services while residing in a private residence. Clinical record review and home visit observation revealed the following: a. The POCs, dated 1/18/25 to 3/18/25 and 3/19/25 to 5/27/25, identified the patient had a diagnosis of Parkinson’s disease. The POC included orders for the skilled nurse to assess the patient’s weight and measurements and assess skin condition. 1). The skilled nurse visit notes, dated 2/10, 2/13/25, 3/20, 3/24, 3/27, 4/7 and 4/10/25, by Staff L, RN, failed to include documentation of the patient’s weight and measurements. 2). The skilled nurse visit notes, dated 2/20, 2/27/25 and 4/3/25, by Staff D, LPN, failed to include documentation of the patient’s weight and measurements. b. The skilled nurse visit note, dated 3/20/25, Staff L, RN, identified the patient had a new small area opened to the coccyx. Staff L failed to document an assessment of the wound or document measurements of the wound. 1) The skilled nurse visit note, dated 3/24 and 3/27/25, Staff L, RN identified the patient’s wound healing. Staff L failed to document an assessment of the wound or document measurements of the wound. 2) The skilled nurse visit note, dated 3/31/25 and 4/3/25, Staff L, RN, identified the patient’s wound healing. Staff L failed to document an assessment of the wound or document measurements of the wound. 3). The skilled nurse visit note, dated 4/7/25, Staff L, RN documented the patient’s wound with no drainage and no odor. The wound measurements documented 1 inch by 1 inch width and 0 depth. Staff L failed to document measurements of the wound depth. The hospice failed to follow all orders as written on the POC or complete wound assessment and measurements. 3. Patient #8 had a hospice admission date of 1/7/25 and received hospice services while residing in a private residence. Clinical record review and home visit observation revealed the following: a. The POCs, dated 1/7/25 to 4/6/25 and 4/7/25 to 7/5/25, identified the patient had a diagnosis of Gastrointestional bleeding with unknown orgin. The POC included orders for the skilled nurse to assess the patient’s weight and measurements and assess skin condition. 1). The skilled nurse visit note, dated 2/25/25, by Staff D, LPN, failed to inlcude documentation of the patient’s weight and measurements. b. The comprehensive assessment at recertification, dated 4/3/25, Staff F, RN identified the patient had a stage 1 irregular pressure ulcer on the left buttock. No open sore at this time. The area measured length 0.08 inches by width 0.04 inches and no depth observed. c. The skilled nurse visit note, dated 4/10/25, Staff F, RN identified the patinet had pressure ulcer described clean, pink with wound edges attached to the wound bed. The wound measured 0.08 inches by 0.04 inches and 0 depth identified. d. During an interview on 4/22/25 at 8:21 AM, Staff F, RN stated the wound open but had a very shallow depth. Stated she had not been able to get an accurate depth with the q-tip and identified the area had a break in the top layer of the skin. Staff failed to measure the depth of an open wound. The hospice failed to follow all orders as written on the POC or complete wound assessment and measurements. 4. Patient #12 had a hospice admission date of 7/2/24 and discharge date of 8/5/24 and received hospice services while residing in a private residence. Clinical record review and home visit observation revealed the following: a. The POC, dated 7/2/24 to 9/40/45, identified the patient had a diagnosis of Atherosclerotic heart disease. The POC included orders for the skilled nurse to assess the patient’s weight and measurements. a. The skilled nruse visit note, dated 8/22/24, by Staff D, LPN, failed to inlcude documentation of the patient’s weight and measurements. b. The skilled nurse visit notes, dated 8/29/24 and 9/18/24, by Staff M, Registered Nurse (RN) failed to include documentation of the patient’s weight and measurements. c. The skilled nurse visit note, dated 9/18/24, by Staff B, RN, failed to include documentation of the patient’s weight and measurements. The hospice failed to follow all orders as written on the POC.”

“Based on home observation visits, interviews, clinical record review and agency policy review, the hospice failed to ensure accurate completion of all components comprising the Plan of Care, including all medical supplies/equipment used by the patient for 4 of 14 sampled patients (Patients #1, #3, #4 and #14). Failure to maintain complete and accurate Plans of Care with current orders placed patients at risk to not receive services, supplies and/or treatments according to assessed needs and physician orders. 4. Patient #1 had a start of care date of 4/10/25 and received hospice services while residing in a nursing home. Clinical record review revealed: a. The POC, dated 4/10/25 to 7/8/25, identified the patient had a primary diagnosis of Alzheimer’s disease and required the use of the following medical equipment and supplies: call light, wheelchair, tray table, toilet riser, lift chair, incontinent supplies, hospital bed, grab bars and EZ stand lift aide. b. Home visit observation on 4/15/25 at 8:30 AM with Staff H, RN, revealed the patient had bolster supports in his/her wheelchair. c. During an interview at the same home visit observation the nursing home RN stated the patient utilized the bolster since the start of hospice services. d. The POC failed to identify the bolster supports used by the patient. The hospice failed to update the POC to identify all medical supplies and equipment used by the patient, including bolster supports. 5. Patient #4 had a start of care date of 2/20/25 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POC, dated 2/20/25 to 5/20/25, identified the patient had a primary diagnosis of lung cancer and required the use of the following medical equipment and supplies: wheelchair cushion, wheelchair, walker, shower bench, pulse oximeter, oxygen, lift chair and gaitbelt. b. The skilled nurse note, dated 3/4/25, Staff D, LPN, identified the following medical supplies and equipment ordered for the patient: hospital bed and lifeline. c. The IDG notes, dated 3/13, 3/27/25 and 4/10/25, failed to identify the lifeline used by the patient. The hospice failed to update the POC to identify all medical supplies and equipment used by the patient, including lifeline. The above findings were reviewed with the Administrator and Clinical Manager. The above findings reviewed with the Administrator and Clinical Manager. 3.Patient #2 had a start of care date of 5/8/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POC, dated 3/4/25 to 5/2/25 identified the patient had a primary diagnosis of Bladder cancer and required the use of the following medical equipment and supplies: walker, shower chair/bench, incontinent supplies, handheld shower, grab bars, cell phone and cane. b. During a home observation visit on 4/15/25 at 10:00 AM with Staff F, RN, the surveyor observed the patient using a heating blanket. During an interview, the patient stated he/she has had the heating blanket for greater than three months and uses the heating blanket often due to always being cold. c. The IDG meeting notes, dated 3/13/25, 3/27/25 and 4/10/25, failed to identify the heating blanket used by the patient. The hospice failed to update the POC to identify all medical supplies and equipment used by the patient, including a heating blanket. Findings include: According to the policy titled Comprehensive Assessment and Plan of Care, dated 11/2024, the Hospice Interdisciplinary group (IDG), conducts and documents a patient-specific comprehensive assessment that identifies the patient’s needs for hospice care, including medical, nursing, psychosocial, emotional and spiritual care. The IDT uses information obtained from the comprehensive assessment tools to develop an effective plan of care with interventions that address the identified needs of the patient/caregiver. A patient’s progress towards desired outcomes and response to care is reassessed as often as required by the patient’s condition but no less frequently than every 15 days. 1.Patient #3 had a start of care date of 9/18/24 and received hospice services in the home. Clinical record review revealed the following: a. The Plan of Care (POC), dated 3/17/25 to 5/15/25, identified a primary diagnosis of colon and liver cancer, and required the use of the following medical equipment and supplies: cell phone, bed rails, wheelchair cushion, walker, shower chair bench, pill box, Incontinent supplies, hospital bed, handheld shower and grab bars. b. During a home observation visit with Staff L, Registered Nurse (RN), 4/15/25 at 10:30 AM, patient stated the chair lift is utilized to get up and down the stairs and the patient is weighed on routine basis, by spouse and by the skilled nurse. c. The Interdisciplinary Group (IDG) notes, dated 2/13/25, 2/27/25, 3/13/25 and 3/27/25, failed to identify the chair lift and the scale as medical supplies in the home used by the patient. The hospice failed to update the POC to identify all medical supplies and equipment used by the patient, including a chair lift and scale. 2. Patient #14 had a start of care date of 08/14/24 and received hospice services in a private home. Clinical record revealed the following: a. The POC, dated 8/14/24 to 11/11/24, included a primary diagnosis of Gastrointestinal hemorrhage, and required the use of the following medical equipment and supplies: Walker, Shower Bench and Shower Wand, Oxygen Concentrator and Supplies, Incontinent Supplies, Hospital Bed, Bedside Commode. b. The skilled nurse visit note dated 8/17/24, completed by Staff D, Licensed Practical Nurse (LPN), revealed patient needed a wheelchair for transfers and transportation related to patient weakness and decline. c. The IDG notes dated, 8/15/24 and 8/29/24, failed to identify the wheelchair as a medical supply in the home used by the patient. The hospice failed to update the POC to identify all medical supplies and equipment used by the patient, including a wheelchair.”

“Based on review of written hospice agreements for services under arrangements, the hospice failed to ensure the written agreements between the hospice agency and agencies providing services under arrangement included all required contract components for 1 of 3 samples services (Medical equipment/supply provider). Failure to include this provision within the contractual agreement increased the potential that hospice management and oversight failed to occur and the patient would not receive services as specified on the plan of care. Findings include: Review of the contract between the hospice and sampled medical equipment/supply provider, dated 11/7/2012, identified the contract lacked the following required components: a. The hospice retains administrative and financial management, b. The hospice retains oversight of staff and services and c. All services are approved by hospice and delivered in accordance with the patient’s plan of care. The above findings were reviewed with the Administrator and Clinical Manager.”

“Based on clinical record review and agency policy review, the hospice failed to ensure all documentation was completed and appropriately authenticated in accordance with accepted standards of practice and agency standards for 9 of 14 sampled patients (Patients #2, #3, #5, #6, #7, #9, #10, #11 and #14). Failure to ensure all documentation was completed, dated and signed in a timely manner decreased the ability of hospice staff to communicate and coordinate patient care effectively and to provide safe, effective hospice services to its patients. 9. Patient #5 had a start of care date of 7/22/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POCs, dated 1/8/25 to 3/18/25 and 3/19/25 to 5/27/25, identified the patient had a diagnosis of Bladder cancer and included orders for skilled nurse, social worker, hospice aide, massage therapy and chaplain. b. The Social Worker visit notes, dated 4/8/25, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. c. The hospice aide visit notes, dated 4/3, 4/7 and 4/10/25, completed by Staff G, Hospice Aide, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. The above findings were reviewed with the Administrator and Clinical Manager. 5.Patient #2 had a start of care date of 5/8/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POCs, dated 1/3/25 to 3/3/25 and 3/4/25 to 5/2/25, identified the patient had a diagnosis of Bladder cancer and included orders for skilled nurse, social worker, hospice aide and chaplain. b. The Social Worker visit notes, dated 2/13/25, 3/13/25 and 4/9/25, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. 6. Patient # 6 had a start of care date of 2/24/25 and received hospice services while residing in a nursing home. Clinical record review revealed: a. The POC, dated 2/24/25 to 4/24/25, identified the patient had a diagnosis of Alzheimer’s disease and included orders for skilled nurse, social worker, hospice aide and chaplain. b. The Social Worker visit notes, dated 2/25/25, 3/12/25 and 4/1/25, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. c. The Hospice Aide visit notes, dated 2/26/25 and 3/12/25, completed by Staff G, Hospice Aide, included a signature and date but lacked a title of the clinician completing the visits. The hospice failed to ensure all completed documentation included appropriate authentication. 7.Patient #9 had a start of care date of 12/3/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POCs, dated 12/3/24 to 3/2/25 and 3/3/25 to 5/31/25 identified the patient had a diagnosis of Retroperitoneum cancer and included orders for skilled nurse, social worker and hospice aide services. b. The Social Worker visit notes, dated 2/13/25, 3/12/25 and 4/6/25, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. 8.Patient #11 had a start of care date of 9/4/24, a discharge date of 11/6/25 and received hospice services while residing in a nursing home. Clinical record review revealed: a. The POC, dated 9/4/24 to 12/2/24, identified the patient had a diagnosis of Hypertensive heart disease with heart failure and included orders for skilled nurse, social worker, hospice aide and chaplain services. b. The Social Worker visit note, dated 11/1/24, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. Findings include: According to the agency policy titled Entries into Clinical Records, dated 7/2023, all agency employees, approved students and/or contractors have authority to make entries into theclinical record. Documentation in the clinical record will be timely, detailed, accurate and reflect the care or services provided. Home care personnel will document all care/service provided within a timely manner following provision of service and incorporated into the home care record within 7 days. The entries should be documented by the first initial of the given name, full surname, and initials or licensing credentials. 1.Patient # 3 had a start of care date of 9/18/24 and received hospice services in the home. Clinical record review revealed the following: a. The POCs, dated 12/17/24 to 3/16/25 and 3/17/25 to 5/15/25, identified the patient had a diagnosis of liver/colon cancer and included orders for skilled nurse, social worker, and hospice aide b. The Social Worker visit notes, dated 1/16/25, 2/24/25, 3/13/25, and 4/10/25 completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. 2.Patient # 7 had a start of care date of 3/12/25 and received hospice services in the home. Clinical record review revealed the following: a. The POC, dated 3/12/25 to 6/9/25, identified the patient had a diagnosis of bladder cancer and included orders for skilled nurse, social worker, chaplain and hospice aide b. The Social Worker visit notes, dated 3/14/25 and 4/10/25, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. 3.Patient # 10 had a start of care date of 12/202/4 and received hospice services in an assisted living facility. Clinical record review revealed the following: a. The POCs, dated 12/20/24 to 3/19/25 and 3/20/25 to 6/17/25, identified the patient had a diagnosis of congestive heart failure and included orders for skilled nurse, social worker, chaplain, music therapy and hospice aide. b. The Social Worker visit notes, dated 12/23/24, 1/14/25, 2/11/25, 3/11/25 and 4/2/25 completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit notes. The hospice failed to ensure all completed documentation included appropriate authentication. 4.Patient # 14 had a start of care date of 8/14/24 and received hospice services in the home. Clinical record review revealed the following: a. The POC, dated 08/14/24 to 11/11/24, identified the patient had a diagnosis of gastrointestinal hemorrhage and included orders for skilled nurse, social worker, and hospice aide. b. The Social Worker visit note, dated 8/14/24, completed by Staff C, Social Worker, included a signature and date but lacked a title of the clinician completing the visit note. The hospice failed to ensure all completed documentation included appropriate authentication.”

“Based on staff interview and clinical record review, the hospice failed to maintain documentation in the patient clinical records as evidence patients received a copy of the hospice policy concerning the disposal of controlled medications and hospice staff discussed this policy with the patient/caregiver for 3 of 3 sampled patients who received routine home care while living in a private residence and received orders for controlled medications after the start of care (Patients #8, #9 and #13). Failure to ensure patients and/or caregivers received adequate education on the use and disposal of controlled substances increased the risk of inappropriate use of narcotics and other controlled substances by individuals other than the patient for who the medication was prescribed. Findings include: 3. Patient #8 had a start of care date of 1/7/25 and received hospice services while residing in a private residence. Clinical record review revealed: a. The initial POC, dated 1/7/25 to 4/6/25, included physician orders for medications, but no narcotic medications. The POC identified the patient had a diagnosis of gastrointestinal bleed with unknown orgin. b. The interim physician’s order, dated 3/4/25, included orders for the following controlled substance narcotic medications: oxycodone 5 milligrams (mg), q tablet every 8 hours as needed for pain and morphine concentrate 20 mg/milliliters (ml), give 0.25 ml every 4 hours as needed for pain/breathing. b. A skilled nurse visit note, dated 3/4/25, completed by the Staff F, Registered Nurse (RN), identified the physician ordered Morphine and Oxycocone. Staff failed to provide education on the hospice policy for the disposal of controlled medications. c. A skilled nurse visit date, dated 3/6/25, completed by Staff F, RN, identified patient had new medications Morphine and Oxycodone, however had not taken the medication. Staff failed to provide education on the hospice policy for the disposal of controlled medications. d. An IDG meeting note, dated 3/13/25, included physician orders for Morphine and Oxycodone; controlled medications. The clinical record lacked documentation hospice staff reviewed the policy for the disposal of controlled medications at the time when the physician first ordered the controlled medications. The above findings reviewed with the Administrator and Clinical Manager. During an interview on 4/22/25 at 11:10 AM, the Administrator stated the hospice gives the drug disposal policy and education to the patient at admission. Moving forward, the Administrator reported it will also be an expectation for the nurse to document in the patient’s clinical record that the written policies and procedures for managing the controlled substances was provided and discussed at the time a narcotic is first ordered. 1.Patient #9 had a start of care date of 12/3/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The initial plan of care (POC), dated 12/3/24 to 3/2/25, included physician orders for medications, but no controlled medications. The POC identified the patient had a diagnosis of Retroperitoneum cancer. b. A skilled nurse visit note, dated 2/16/25, completed by the Administrator identified the physician ordered Morphine and Ativan that would be delivered later on this date. c. A skilled nurse visit date, dated 2/17/25, completed by Staff D, Licensed Practical Nurse (LPN), identified patient took his/her first dose of morphine. d. An Interdisciplinary Group (IDG) meeting note, dated 2/27/25, included physician orders (effective 2/16/25) for Morphine and Ativan; controlled medications. The clinical record lacked documentation hospice staff reviewed the policy for the disposal of controlled medications at the time when the physician first ordered the controlled medications. 2.Patient #13 had a start of care date of 6/21/24, a death date of 7/13/24, and received hospice services while residing in a private residence. Clinical record review revealed: a. The initial POC, dated 6/21/24 to 9/18/24, included physician orders for medications, but no controlled medications. The POC identified the patient had a diagnosis of Pancreatic cancer. b. A skilled nurse visit note, dated 7/5/24, completed by Staff H, Registered Nurse (RN), identified the physician ordered Hydrocodone Acetaminophen (controlled medication) as needed and the RN educated the patient on how to take the medication. The clinical record lacked documentation hospice staff reviewed the policy for the disposal of controlled medications at the time when the physician first ordered the controlled medications.”

“Based on review of written contracts, the hospice failed to ensure the written agreements for short-term inpatient services specified the provider would have patient care policies consistent with hospice policies for 2 of 2 sampled contracts (Hospital A and Hospital B). Failure to ensure the patient care provider had policies consistent with the hospice’s own policies increased the potential for services to be provided in a manner contradictory to hospice policies. Findings include: 1.A contractual agreement with Hospital A, dated 8/25/22, lacked the provision that the patient care provider will have policies consistent with the hospice provider’s policies and the patient care provider will abide by the plan of care established by the hospice for its patients. 2. A contractual agreement with Hospital B, dated, 8/25/22, lacked the provision that the patient care provider will have policies consistent with the hospice provider’s policies. The above findings were reviewed with the Administrator and Clinical Manager.”

“Based on review of the written agreements between the hospice and inpatient facilities (hospitals), the hospice failed to ensure the written agreement identified the hospital would send a copy of the hospice patient’s discharge summary to the hospice at the time of discharge from the hospital for 1 of 2 sampled written agreements reviewed (Hospital B). Failure to ensure the hospital provided the hospice with a discharge summary upon hospital discharge of a hospice patient decreased the possibility of continuity of care when the patient returned home. Findings include: The hospice had a contractual agreement with Hospital B, dated 8/25/22. The contractual agreement failed to specify the hospital would provide the hospice agency with a copy of the discharge summary at the time of discharge and failed to specify a copy of the inpatient clinical record is available to the hospice at the time of discharge. The above findings were reviewed with the Administrator and Clinical Manager.”

“The Iowa Code, Chapter 135C.33 requires hospice agencies to complete a criminal history, a dependent adult abuse, and child abuse record check on all prospective direct or contracted employees with the potential for direct patient contact, within 30 days prior to the date of hire, using either the Iowa Single Information Repository (SING), or using both the Iowa Department of Criminal Investigation (DCI) to conduct the criminal background check, and using the Iowa Department of Human Services to conduct the dependent adult abuse and child abuse background checks. The Iowa Administrative Code, Chapter 119, requires the hospice agency to obtain authorized clearance from the Department of Human Services (DHS) prior to hiring any prospective employee who DCI has reported has a criminal record for any conviction more severe than a simple misdemeanor. Based on review of employee personnel files and staff interview, the hospice failed to ensure completion of a criminal background check for 4 of 7 sampled employees (Staff G, I, J & K) who began serving hospice patients since their last survey, dated 5/5/22. The hospice reported hiring 8 new staff since the last survey. Failure to complete criminal background checks as required by Federal regulation, increased the potential risk of harm to agency patients from hospice employees who had direct patient contact. Findings include: According to the hospice policy titled Recruitment and Selection Process, last revised 3/2024, all offers of employment are contingent upon clear results of a thorough backgroun check. Background checks will be conducted on all final candidates. Background checks will include: Iowa Health Care Facility Record check, The Divistion of Criminal Investigation (DCI) at the Department of Public Safety to perform a criminal, child, and dependent adult abuse record check. If the person has been convicted of a crime under the law of any state or has a record of founded child or dependent adult abuse, the Department of Hyman Services will perform an evaluation to determine whether the crime or founded cheld or dependent adult abuse warrants prohibition of employment. During an interview on 4/3/25 at 10:40 AM, the Administrator stated Staff G, Staff I, Staff K had background checks completed when they previously worked at the hospital. Staff transfered to work for hospice. 1. Staff G, Hospice Aide, had a hire date of 8/10/23. A criminal background check was completed and dated 3/15/05. The hospice failed to complete a criminal background check with the Iowa SING or the Iowa DCI within 30 days prior to the date of hire. Hospice staff failed to ensure the completion of a criminal history background check per Iowa law on personnel prior to allowing that person direct contact with hospice patients. 2. Staff I, Hospice Volunteer, had a hire date of 8/17/23. A criminal background check was completed and dated 4/21/05. The hospice failed to complete a criminal background check with the Iowa SING or the Iowa DCI within 30 days prior to the date of hire. Hospice staff failed to ensure the completion of a criminal history background check per Iowa law on personnel prior to allowing that person direct contact with hospice patients. 3. Staff J, Pastoral Care, had a hire date of 11/27/23. A criminal background check was completed and dated 10/6/23, 52 days prior to the date of hire. The hospice failed to complete an additional criminal background check with the Iowa SING or the Iowa DCI within 30 days prior to the date of hire. Hospice staff failed to ensure the completion of a criminal history background check per Iowa law on personnel prior to allowing that person direct contact with hospice patients. 4. Staff K, Licensed Practical Nurse, had a hire date of 4/7/25. A criminal background check was completed and dated 4/21/05. The hospice failed to complete a criminal background check with the Iowa SING or the Iowa DCI within 30 days prior to the date of hire. Hospice staff failed to ensure the completion of a criminal history background check per Iowa law on personnel prior to allowing that person direct contact with hospice patients. The above findings were reviewed with the Administrator and Volunteer Coordinator.”