Ancora Hospice & Palliative Services, LLC

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs, supplements; herbal remedies and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review and interview. In 3 of 4 (75%) home visits revealed the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. Home Visit 1: During Home Visit 1 (Clinical Record 1) on 09/17/2024 to observe the Hospice Aide (Personnel Record 12), the hospice medication list dated 09/17/2024 was compared to the skilled nursing facility (SNF) medication list dated 09/17/2024. The SNF list included the following medication(s): Miralax 17 grams every 24 hours as needed and Miralax 17 grams daily scheduled. Only the as needed Miralax was on the hospice list and not the scheduled dosage. Home Visit 2: During Home Visit 2 (Clinical Record 2) on 09/18/2024 to observe the Registered Nurse (Personnel Record 4), the hospice medication list dated 09/18/2024 was compared to the skilled nursing facility (SNF) medication list dated 09/18/2024. The SNF list included the following medication(s) not listed on the hospice list: Haldol 5 mg and Vitamin D 1 tablet) Home Visit 3: During Home Visit 3 (Clinical Record 3) on 09/18/2024 to observe the Spiritual Counselor (Personnel Record 5), the hospice medication list dated 09/18/2024 was compared to the assisted living facility (ALF) medication list dated 09/18/2024. The ALF list included the following medication(s) not listed on the hospice list: Supplemental nutritional drink 2 times daily dated 07/31/2024. During an interview and joint record review with the Chief Operating Officer on 09/18/2024, the medication list differences were confirmed and she agreed the lists needed to be reconciled.”

“It is required that each patient’s individualized written plan of care includes measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 5 of 19 (26%) clinical records reviewed revealed the agency did not ensure the patient’s individualized written plan of care included measurable outcomes anticipated from implementing and coordinating the plans of care. Clinical Record 9: The patient elected the hospice benefit on 10/10/2023 for the diagnosis of respiratory failure. The plan of care dated 10/10/2023 included the respiratory goal of “Patient will receive optimal breathing patterns, airway patency and comfort.” It did not include measurable outcomes or define “optimal” breathing patterns or comfort. Clinical Record 12: The patient elected the hospice benefit on 06/19/2024 for the diagnosis of end-stage renal failure. The plan of care dated 06/19/2024 included the goal of “Physical mobility. Optimal patient safety” but did not clarify how this would be accomplished, measured or individualized for the patient. Clinical Record 11: The patient elected the hospice benefit on 09/10/2024 for the diagnosis of malignant neoplasm of the bronchus of lung. The initial plan of care developed on 09/10/2024 included the goal: “Bowels will function per disease process.” The “disease process” cannot be measured. Clinical Record 14: The patient elected the hospice benefit on 08/21/2023 for the diagnosis of malignant neoplasm of the bronchus of lung. The plan of care dated 08/21/2024 included the goal “Patient will have optimal pain control”. The plan of care did not include the patient’s stated, measurable, pain goal. The plan of care did not provide the pain scale to be used to accomplish this goal or describe the pain ratings. Clinical Record 17: The patient elected the hospice benefit on 01/19/2024 for the diagnosis of sepsis. The initial plan of care dated 01/19/2024 included the goal “Patient will have optimal pain control.” The plan of care did not include the patient’s stated, measurable, pain goal. The plan of care did not provide the pain scale to be used to accomplish this goal or describe the pain ratings. The Chief Operating Officer stated in an interview on 09/19/2024 during a joint clinical record review that the plan of care interventions and goals had not been developed with measurable outcomes or individualized.”

“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, interview and observation. In 4 of 17 (24%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure the registered nurse provided specific written instructions for the hospice aide. Clinical Record 1: The patient elected the hospice benefit on 09/06/2024 for the diagnosis of Parkinson’s disease. The hospice aide care plan written by the registered nurse dated 09/06/2024 included the following task “Barrier cream to ________ (this was blank)”. During Home Visit 1 on 09/17/2024 with Hospice Aide (Personnel Record 12)the skilled nursing facility aide and hospice aide utilized the Hoyer lift to move the patient from chair to bed. Specific instructions for the Hoyer lift were not noted on the aide care plan. Clinical Record 8: The patient elected the hospice benefit on 04/29/2024 for the diagnosis of chronic obstructive pulmonary disease. The aide care plan written by the registered nurse dated 04/29/2024 included the following tasks: “shower as directed, perineal care as directed, and bed bath as directed”. The aide care plan did not include specific instructions for the “as directed” portions for each of these tasks. Clinical Record 10: The patient elected the hospice benefit on 01/18/2023 for the diagnosis of senile degeneration of the brain. The aide care plan written by the registered nurse dated 01/18/2023 included the relevant task of “foot care.” A nursing visit dated 02/26/2023 noted “Wounds to right ankle covered with gauze.” The aide care plan was not updated to include specific instructions for the aide regarding notification of the wound or notification to the nurse if the dressing on the ankle became soiled, dislodged, or wet. Clinical Record 15: The patient elected the hospice benefit on 02/02/2024 for the diagnosis of senile degeneration of the brain. The hospice aide care plan dated 02/02/2024 included the tasks of “Barrier cream to ________(this was blank) “ but did not include specific instructions for the location of where to place the barrier cream. During an interview and joint record review with the Chief Operating Officer on 09/18/2024, it was confirmed the hospice aide care plans did not contain specific written instructions for the aide regarding the location of where to apply the barrier cream, the hoyer lift, the wound, or specific instructions for items listed “as directed”.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative and social needs to a registered nurse. This standard was not met as evidenced by clinical record review and interview. In 3 of 17 (18%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure the aide reported changes to a registered nurse. Clinical Record 7: The hospice aide care plan dated 06/26/2024 included the task of “file nails every visit”. Hospice aide visit notes dated 07/22/2024 and 8/12/2024 marked the task as “refused”. The record lacked documentation the aide had notified the registered nurse the patient had refused the task. Clinical Record 8: The hospice aide care plan dated 04/29/2024 included the tasks of “change linens and mouth care every visit.” The hospice aide visit note dated 06/04/2024 noted these tasks were “not needed.” The record lacked documentation the aide had notified the registered nurse the tasks had not been completed as ordered. Clinical Record 18: The hospice aide care plan dated 08/08/2024 included the tasks of clean nails and assist with bed pan every visit. The hospice aide visit note dated 09/11/2024 noted these tasks as “refused.” The record lacked documentation the aide had notified the registered nurse the patient had refused the tasks, During an interview and joint record review with the Chief Operating Officer on 09/18/2024, it was confirmed the hospice aide(s) did not document the reporting of changes in the plans of care,”