Orange City Hospice

“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 2 of 7 sampled employees (Staff E and L) who began serving hospice patients since their last survey, dated 5/12/22. The hospice reported hiring 7 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 Background Check Procedures, last revised 11/20/23, criminal history, sex offender, dependent adult abuse, and child abuse histories are conducted through the Single Contact Repository Site (SING) for all applicants following an initial offer of employment. During an interview on 5/6/25 at 11:05 AM, the Administrator stated Staff E and Staff L had background checks completed when they previously worked at the hospital. Staff transfered to work for hospice. 1. Staff E, Medical Director, had a hire date of 12/21/23. A criminal background check, dependent adult abuse and child abuse checks were completed and dated 2/3/2020. 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 L, Hospice Aide, had a hire date of 2/11/25. A criminal background check, dependent adult abuse and child abuse checks were completed and dated 7/3/19. 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. The above findings reviewed with the Administrator and Clinical Manager.”

“Based on clinical record review, hospice policy review, and staff interview, the hospice failed to ensure hospice aides provided care to patients only as directed by the Interdisciplinary Group (IDG) and according to the hospice aide care plan for 3 of 9 sampled patients receiving hospice aide services ( Patient #1, #4 and #6). Failure to ensure the hospice aide services are provided only as ordered by the physician and according to the hospice aide care plan increased the risk that patients personal care needs were not adequately met. Findings include: 3. Patient #4 had a start of care date of 4/26/25 and received hospice services while residing in a private residence. Clinical record review revealed the following: a. The POC, dated 4/26/25 to 7/23/25, included orders for hospice aide services 1 to 2 times a week. The POC identified the patient had a diagnosis of Acute kidney failure. b. The hospice aide care plan, dated 4/27/25, included the following RN assigned hospice aide tasks: apply lotion to legs and back, assist with ambulation, assist with dressing, assist with eating/feeding, assist patient with oral care, assist with repositioning patient, assist with shampoo and haircare, assist with shaving, provide routine catheter care according to policy, tidy room, provide companionship and entertainment, assist patient with partial/complete bed bath, perform back rub, remove trash, assist with transfers using gait belt and change bed linens. c. The hospice aide visit notes, dated 4/29/25 and 5/2/25, completed by Staff K, LPN, documented the tasks of assist patient with partial/complete bed bath accomplished. The documentation failed to include which of the tasks were accomplished. The above findings were reviewed with the Administrator and Clinical Manager. According to the agency policy titled, Hospice Aide Services, dated 2/5/24, home health aides are assigned to a patient assignment by the RN who determines the appropriate home health aide schedule for the patient based on their individual needs. During an interview on 4/29/25 at 3:06 PM, the Clinical Manager stated if the hospice aide unable to complete a task, the hospice aide would mark they didn’t complete it. If the task routinely not completed, the hospice aide would talk to the nurse and the task would be addressed and modified or removed. 1.Patient #1 had a start of care date of 8/8/24 and received hospice services while residing in a nursing home. Clinical record review revealed the following: a. The plans of care (POCs), dated 1/4/25 to 4/4/25 and 4/5/25 to 6/3/25, included orders for hospice aide services 1 to 2 times a week. The POC identified the patient had a diagnosis of Alzheimer’s disease. b. The hospice aide care plan, dated 4/28/25, the Registered Nurse (RN) assigned the following hospice aide tasks: apply compression stocking, apply lotion to patient’s skin, assist incontinence care, whirlpool baths on Mondays, assist with elimination with EZ stand, assist with dressing, assist with eating/feeding, assist with oral care, assist with repositioning, assist with shampoo and haircare, assist with shaving, partial/complete bed bath on Mondays if refuses whirlpool and collaborate with facility/agency staff, c. The hospice aide visit notes, dated 3/31/25 and 4/14/25, Staff K, Licensed Practical Nurse (LPN), documented the task of a whirlpool and partial/complete bed bath accomplished. She also documented the task of shampoo and/or using brush or comb accomplished. The documentation failed to include which of the task instructions were accomplished. d. The hospice aide visit note, dated 4/7/25, Staff L, Hospice Aide (HA), documented the task of shampoo and/or using brush or comb accomplished. The documentation failed to include which of the task instructions were accomplished. The hospice aide failed to identify which specific services were provided as instructed by the RN assignment. 2. Patient #6 had a start of care date of 9/3/24 and received hospice services while residing in a private home residence. Clinical record review revealed the following: a. The POCs, dated 3/2/25 to 4/30/25 and 5/1/25 to 6/29/25, included orders for hospice aide services 1 to 2 times a week. The POC identified the patient had a diagnosis of chronic obstructive pulmonary disease. b. The hospice aide care plan, dated 4/29/25, the RN assigned the following hospice aide tasks: remove trash, clean bathroom, clean/tidy room, perform nail filing, perform back rub, assist with dressing, apply lotion, assist with foot care, assist with shower, assist with bath-able to decide sponge or shower, prepare meal, apply compression stocking, assist with shampoo and haircare-and/or brush or comb, provide companionship and entertainment and assist with ambulation c. The hospice aide visit notes, dated 3/25/25 and 4/1/25, Staff K, LPN, documented the task of shampoo and/or using brush or comb accomplished. The documentation failed to include which of the task instructions were accomplished. d. The hospice aide visit note, dated 3/28/25, Staff L, HA, documented the task of both a shower and sponge bath accomplished. The hospice aide visit notes, dated 3/28/25 and 4/4/25, Staff L documented the task of shampoo and/or using brush or comb accomplished. The documentaion failed to include which of the task instructions were accomplished. The hospice aide failed to identify which specific services were provided as instructed by the RN assignment.”

“Based on review of written hospice agreements for services under arrangement, the hospice failed to ensure written agreements between the hospice agency and agencies providing services under arrangement included all required contract components for 2 of 3 sampled services (Massage therapy provider and Pharmacy 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: 1.Review of the contract between the hospice and sampled therapeutic massage provider, dated 2/6/23, identified the contract lacked the following required components: a. The hospice retains administrative and financial management and b. The hospice retains oversight of staff and services. 2. Review of the contract between the hospice and sampled pharmacy provider, dated 5/13/14, 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, c. All services are delivered in a safe and effective manner by qualified personnel and d. All services are delivered in accordance with the patient’s plan of care. The hospice failed to include all required contract components in written agreements between the hospice agency and agencies providing services under arrangement. The above findings were reviewed with the Administrator and Clinical Manager.”

“Based on clinical record review and agency staff interview, the hospice failed to ensure all documentation was completed and appropriately authenticated in accordance with accepted standards of practice and agency standards for 7 of 14 sampled patients (Patients #1, #2, #6, #7, #8, #9 and #12). 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. Findings include: 5. Patient #2 had a start of care date of 1/8/25 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POCs, dated 1/8/25 to 4/7/25 and 4/8/25 to 7/6/25, identified the patient had a diagnosis of Alzheimer’s disease and included orders for skilled nurse, social worker, chaplain, massage therapy and music therapy services. b. The chaplain visit notes, dated 3/8/25, 4/3/25 and 4/17/25, completed by Staff C, Chaplain, included a signature and date but lacked a title of the clinician completing the visit notes. c. The massage therapist visit notes, dated 3/13/25 and 3/28/25, completed by Staff H, Massage Therapist, included a signature but lacked a title of the clinician completing the visit notes and date of signature. The hospice failed to ensure all completed documentation included appropriate authentication. 6. Patient #9 had a start of care date of 1/21/25 and received hospice services while residing in a private residence. Clinical record review revealed: a. The POC, dated 1/21/25 to 4/20/25, identified the patient had a diagnosis of Heart disease and included orders for skilled nurse, social worker, hospice aide, chaplain, music therapy, massage therapy and volunteer services. b. The chaplain visit note, dated 2/19/25, completed by Staff C, Chaplain, included a signature and date but lacked a title of the clinician completing the visit note. c. The massage therapist visit notes, dated 3/12/25 and 3/27/25, completed by Staff H, Massage Therapist, included a signature but lacked a title of the clinician completing the visit notes and date of signature. The hospice failed to ensure all completed documentation included appropriate authentication. 7. Patient #12 had a start of care date of 10/4/24 and received hospice services while residing in a nursing home. Clinical record review revealed: a. The POC, dated 2/1/25 to 4/1/25, identified the patient had a diagnosis of Alzheimer’s disease and included orders for skilled nurse, social worker, chaplain, music therapy, massage therapy and volunteer services. b. The chaplain visit note, dated 2/2/25, completed by Staff C, Chaplain, included a signature and date but lacked a title of the clinician completing the visit note. c. The massage therapist visit notes, dated 2/25/25 and 3/25/25, completed by Staff H, Massage Therapist, included a signature but lacked a title of the clinician completing the visit notes and date of signature. The hospice failed to ensure all completed documentation included appropriate authentication. The above findings were reviewed with the Administrator and Clinical Manager. During and interview on 5/6/25 at 2:30 PM the Administrator stated the expectation for the written staff signature to include the name, credentials and date of completion of the documentation of services provided. 1.Patient # 1 had a start of care date of 8/8/24 and received hospice services in a nursing home. Clinical record review revealed the following: a. The Plan of Cares (POCs), dated 1/4/25 to 4/4/25 and 4/5/25 to 6/3/25, identified the patient had a diagnosis of Alzhiemer’s Disease and included orders for skilled nurse, social worker,chaplain, massage therapy, music therapy and hospice aide. b. The chaplain visit notes, dated 3/7/25 and 4/13/25, completed by Staff C, Chaplain, 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 # 6 had a start of care date of 9/3/24 and received hospice services in a private home setting. Clinical record review revealed the following: a. The POCs, dated 3/2/25 to 4/30/25 and 5/1/25 to 6/29/25, identified the patient had a diagnosis of chronic obstructive lung disease and included orders for skilled nurse, social worker,chaplain, massage therapy, music therapy and hospice aide. b. The chaplain visit notes, dated 3/26/25, completed by Staff C, Chaplain, included a signature and date but lacked a title of the clinician completing the visit notes. c. The massage therapist notes, dated 2/11/25 and 3/12/25, completed by Staff H, Massage Therapist, included a signature but lacked a title of the clinician completing the visit notes and date of signature. The hospice failed to ensure all completed documentation included appropriate authentication. 3. Patient # 7 had a start of care date of 12/12/24 and received hospice services in a private home setting. Clinical record review revealed the following: a. The POCs, dated 12/12/25 to 3/11/25 and 3/12/25 to 6/9/25, identified the patient had a diagnosis of congestive heart failure and included orders for skilled nurse, social worker,chaplain, massage therapy, music therapy and hospice aide. b. The chaplain visit notes, dated 3/8/25 and 4/27/25, completed by Staff C, Chaplain, included a signature and date but lacked a title of the clinician completing the visit notes. c. The massage therapist notes, dated 3/3/25 and 3/28/25, completed by Staff H, Massage Therapist, included a signature but lacked a title of the clinician completing the visit notes and date of signature. The hospice failed to ensure all completed documentation included appropriate authentication. 4. Patient #8 had a start of care date of 5/9/24 and received hospice services in a private home setting. Clinical record review revealed the following: a. The POCs, dated 1/4/25 to 3/4/25 and 3/5/25 to 5/3/25, identified the patient had a diagnosis of congestive heart failure and included orders for skilled nurse, social worker,chaplain, massage therapy, music therapy, volunteer and hospice aide. b. The chaplain visit notes, dated 3/24/25 and 4/8/25, completed by Staff C, Chaplain, included a signature and date but lacked a title of the clinician completing the visit notes. c. The massage therapist notes, dated 2/4, 2/20 and 2/25/25 and 3/17/25, completed by Staff H, Massage Therapist, included a signature but lacked a title of the clinician completing the visit notes and date of signature. The hospice failed to ensure all completed documentation included appropriate authentication.”

“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 3 sampled written agreements (Hospital A). 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 A, dated 1/28/25. 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.”

“Based on review of the written agreements between the hospice and inpatient facilities (hospitals), the hospice failed to ensure the written agreement identified the hospice’s responsibility to maintain a description of the training and documentation of the names of those giving the training for 3 of 3 sampled written agreements (Hospital A, B and C). Failure to ensure the written agreements with hospitals specified the hospice’s responsibility to ensure hospital staff caring for hospice patients received training and the hospice maintained appropriate documentation of the training placed hospice patients at risk for receiving inpatient care in conflict with the hospice philosophy. Findings include: 1.The hospice agency had a contractual agreement with Hospital A, dated 1/28/25. The contractual agreement failed to specify the agency responsibility to include a description of the training provided and documentation of the training facilitators. 2. The hospice agency had a contractual agreement with Hospital B, dated 1/29/25. The contractual agreement failed to specify the agency responsibility to include a description of the training provided and documentation of the training facilitators. 3. The hospice agency had a contractual agreement with Hospital C, dated 1/8/13. The contractual agreement failed to specify the agency responsibility to include a description of the training provided and documentation of the training facilitators. 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 2 of 6 sampled employees (Staff E & L) who began serving hospice patients since their last survey, dated 5/12/22. The hospice reported hiring 7 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 Background Check Procedures, last revised 11/20/23, criminal history, sex offender, dependent adult abuse, and child abuse histories are conducted through the Single Contact Repository Site (SING) for all applicants following an initial offer of employment. During an interview on 5/6/25 at 11:05 AM, the Administrator stated Staff E and Staff L had background checks completed when they previously worked at the hospital. Staff transferred to work for hospice. 1. Staff E, Medical Director, had a hire date of 12/21/23. A criminal background check was completed and dated 2/3/2020. 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 L, Hospice Aide, had a hire date of 2/11/25. A criminal background check was completed and dated 7/3/19. 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 reviewed with the Administrator and Clinical Manager.”