Vitas Healthcare Corporation of Illinois

“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. This standard was not met as evidenced by document review, interview, and observation. Agency policy “Hand Hygiene Policy and Procedure” (updated 06/18/2012) stated in part, “decontaminate the hands using an alcohol-based hand rub, or wash hands with an antimicrobial soap and water when hands are not visibly soiled and before having direct contact with patients... after all direct patient care contact.” In 1 of 4 (25%) home visits observed, the agency did not ensure that hand hygiene, using the correct technique, was performed when indicated per the agency’s policy. Home Visit 4/Clinical Record 4: The patient elected hospice care on 12/04/2021 and resided in a skilled nursing facility (SNF). During the home visit in a large community room at the SNF with the Social Worker (SW) [Personnel Record 3] on 07/23/2024, the SW did not wash their hands or apply hand sanitizer before the visit. The SW stated that they recently washed their hands. The SW met with the patient, touching the patient’s shoulder more than once. The SW left the patient and did not wash their hands or use hand sanitizer. The SW touched the visit logbook used by the hospice staff and other common area surfaces within the facility without washing their hands or applying hand sanitizer. The SW did not wash their hands or apply hand sanitizer before the visit or after direct contact with the patient.”

“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 who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 5 of 18 (28%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the HA care plan included all instructions required to meet the patient’s care needs. Clinical Record 8: The patient elected hospice care on 02/18/2023 with a diagnosis of unspecified cirrhosis of the liver. The patient resided in a skilled nursing facility (SNF). On 09/11/2023, the physician ordered the addition of airborne precautions for ten days. The HA care plan dated 08/13/2023 through 02/14/2024 was not updated to include the airborne precautions. The HA visit notes dated 09/11/2023, 09/12/2023, 09/13/2023, 09/14/2023, 09/18/2023, 09/19/2023, and 09/20/2023 did not include documentation or evidence of airborne precautions. The Regional Patient Care Director (RPCD) stated in an interview on 07/24/2024, “In the scheduling system, the aide can see an icon that indicates precautions.” The Regional Patient Care Director confirmed that the HA care plan was not updated to include precautions. Clinical Record 12: The patient elected hospice care on 02/27/2024 with a diagnosis of malignant neoplasm of the pharynx. The patient resided in a SNF. The skilled nursing (SN) assessment dated 02/27/2024 documented that the patient had a gastrostomy tube (G-tube). A clinical record review revealed that on 05/01/2024, a new wound was documented on the patient’s left hip that required dressing. The HA care plan dated 04/10/2024 through 06/05/2024 did not alert the HA to the presence of a G-tube or provide the HA with instructions related to the G-tube. The HA care plan was not updated with information or instructions regarding the new wound dressing on the left hip. The HA visit notes dated 05/02/2024, 05/07/2024, 05/09/2024, 05/14/2024, 05/16/2024, and 05/21/2024 did not reference the patient’s G-tube or a dressing on the left hip. Clinical Record 13: The patient elected hospice care on 07/14/2024 with a diagnosis of cerebral atherosclerosis. The patient resided in a SNF. The HA care plan dated 07/16/2024 assigned the HA the relevant tasks: shower with chair, sponge bath, and tub bath. The HA visit notes dated 07/16/2024 and 07/23/2024 documented: “shower with bath chair was not performed/not required this visit, sponge bath was not performed /not required this visit, and tub bath was not performed/required this visit.” The HA visit note dated 07/19/2024 documented: “shower with bath chair” was “performed,” and the “sponge bath and tub bath” were “not performed/required this visit.” The HA care plan did not specify the bath type the patient would receive. There was no documentation to indicate that the patient decided on the type of bath. Clinical Record 14: The patient elected hospice care on 07/11/2024 with the diagnoses: malignant neoplasm of the lung and chronic renal failure. The patient resided at home. The SN assessment dated 07/11/2024 documented that the patient had wounds on their elbows and buttocks that required dressings. The HA care plan dated 07/12/2024 assigned the HA the relevant task: sponge bath. The HA visit notes dated 07/17/2024 and 07/19/2024 did not document the elbow and buttock dressing management during the bath. The HA care plan provided the HA with no instructions for managing the dressing during the bath. Clinical Record 16: The patient elected hospice care on 01/16/2024 with a diagnosis of cerebral infarction. The patient resided at home. The HA care plan dated 01/17/2024 assigned the HA the relevant tasks: shower with bath chair, bath and inspect feet, and sponge bath. The HA care plan included comments “shower or sponge bath 1X week, wash hair 1X week.” The HA visit note dated 01/23/2024 documented that a “sponge bath” was “performed,” and the “shower with bath chair” was “not performed/declined.” The HA care plan did not specify when to provide a shower versus a sponge bath or clarify who would decide between a shower and a sponge bath. After a joint clinical record review and interview on 07/24/2024, the Regional Patient Care Director confirmed that the five (5) clinical records noted did not include required individualized care needs.”

“It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 18 (11%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the HA provided services that were included in the patient’s plan of care. Clinical Record 2: The patient elected hospice care on 06/12/2024 with the diagnoses: senile degeneration of the brain, lesion to scalp, malignant neoplasm on scalp. The patient resided in a skilled nursing facility (SNF). The HA care plan dated 06/13/2024 assigned the HA the relevant tasks: shower or sponge bath based on patient choice, oral hygiene, and dressing the patient. The HA visit notes dated 07/09/2024 and 07/16/2024 documented that the patient refused the shower or bed bath, oral hygiene, and dressing. In addition, the HA care plan assigned the HA the relevant task: “Update to caregiver or notification/report to the nurse.” The HA visit notes dated 07/09/2024 and 07/16/2024 documented the task as “not answered.” The HA did not perform the assigned tasks during the visits. Clinical Record 13: The patient elected hospice care on 07/14/2024 with a diagnosis of cerebral atherosclerosis. The patient resided in a SNF. The HA care plan dated 07/16/2024 assigned the HA the relevant tasks: shower with bath chair, sponge bath, perineal care, bath and inspect feet, tub bath, inspect and apply lotion to the skin, shave, apply protective cream. The HA visit notes dated 07/16/2024 and 07/23/2024 documented: perineal care, shower with bath chair, sponge bath, tub bath, lotion applied to skin, shave, apply protective cream were “Not performed/ not required this visit.” The HA visit note dated 07/19/2024 documented: “shower with bath chair” was “performed,” and the “sponge bath and tub bath” were “not performed/required this visit.” The HA did not perform the assigned tasks during the visits.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “VS Supervision Delegation and Coordination” (updated 07/15/2019) read in part, “Provides care only as designated on the POC...Contacts the RN with all changes in condition or inability to follow the care plan...Documents communication and direction received in the clinical note.” In 2 of 18 (11%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA reported changes in the patient’s condition or needs related to the plan of care to the Registered Nurse (RN). Clinical Record 2: The patient elected hospice care on 06/12/2024 with the diagnoses: senile degeneration of the brain, lesion to scalp, malignant neoplasm on scalp. The patient resided in a skilled nursing facility (SNF). The HA care plan dated 06/13/2024 assigned the HA the relevant tasks: shower or sponge bath based on patient choice, oral hygiene, and dressing the patient. The HA visit notes dated 07/09/2024 and 07/16/2024 documented that the patient refused the shower or bed bath, oral hygiene, and dressing. There was no documentation that the HA notified the RN of the change in the patient’s care needs and care plan. In addition, the HA care plan assigned the HA the relevant task: “Update to caregiver or notification/report to the nurse.” The HA visit notes dated 07/09/2024 and 07/16/2024 documented the task as “not answered.” A review of the clinical record revealed no documentation that the HA notified the RN that the patient refused care. Clinical Record 13: The patient elected hospice care on 07/14/2024 with a diagnosis of cerebral atherosclerosis. The patient resided in a SNF. The HA care plan dated 07/16/2024 assigned the HA the relevant tasks: shower with bath chair, sponge bath, perineal care, bath and inspect feet, tub bath, inspect and apply lotion to the skin, shave, apply protective cream. The plan of care did not indicate that the assigned tasks should be limited to less than every HA visit. The HA visit notes dated 07/16/2024 and 07/23/2024 documented that perineal care, shower with bath chair, sponge bath, tub bath, lotion applied to skin, shave, apply protective cream were “Not performed/not required this visit.” The HA visit note dated 07/19/2024 documented: “shower with bath chair” was “performed,” and the “sponge bath and tub bath” were “not performed/required this visit.” The HA care plan did not specify the bath type the patient would receive. There was no documentation to indicate that the HA sought clarification from the RN or that the RN was notified related to the care plan not being followed. During an interview and a joint record review on 07/24/2024, the Regional Director of Clinical Services confirmed that the aide did not document any notification to the RN related to the inability to follow the plan of care.”

“It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed in which the patient was transferred to another hospice, the agency did not ensure that a complete discharge summary was sent to the receiving facility. Clinical Record 15: The patient elected hospice on 02/22/2024 and requested a transfer to an alternate hospice on 03/08/2024. A review of the clinical record revealed no evidence that a discharge summary was sent to the receiving facility, the alternate hospice. In an interview on 07/24/2024,the Regional Patient Care Director confirmed that the branch had looked everywhere for a discharge summary and there was not one for this patient.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders, and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed of patients with a live discharge, the agency did not ensure that a discharge summary that contained all the required elements was completed. Clinical Record 15: The patient elected hospice on 02/22/2024 and requested a transfer to an alternate hospice on 03/08/2024. A review of the clinical record revealed no evidence of a documented discharge summary. There was no documented evidence of care coordination or communication with the alternate facility or physician related to the patient’s discharge. The Regional Patient Care Director stated in an interview on 07/24/2024, “We have looked everywhere and confirmed there is no documentation, and discharge summary does not exist for this patient.””