Hospice Associates of New Orleans, LLC

“Upon patient record review, 1 of 14 (Patients #3) 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 #3: The RN SOC assessment note described a patient choking incident during the admission process. The patient choked on food, resulting in coughing and dysphagia; taking 10 minutes to subside, and including x1 emesis. The RN documented that she confirmed with the family members that the patient would be provided pleasure foods, with aspiration precautions, food cut up into small bites, patient to be supervised while eating, while sitting up at a 90 degree angle. The 5/07/25 IDG POC Nutrition/Hydration section, only included, “Patient will have adequate food/fluids as tolerated. Regular diet of pleasure feedings.” There were no problems/goals/interventions for dysphagia and aspiration precautions.”

“Upon patient record review, 2 of 14 (Patients #9, 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, specifically medications and treatments: Patient #9: Current IDG POC notes, “Patient has a wound/pressure ulcer area, Stage II sacrum. Patient on preventative skin care protocol. Sacral wound: Cleanse with NS, pat dry, apply zinc oxide ‘daily’, and p.r.n. soiling.” This is not a compete wound order, as it does not indicate ‘who’ will be providing such daily wound care. Patient lives in ALF. Patient #10: An order was obtained on 05/01/25 for, “Insert Foley 16F to gravity. Change Q30 days.” This is not a complete order as it does not identify who in the home would be providing the daily catheter/tubing care, who/frequency of emptying the drainage bag, and monitoring for signs of infection.”

“Upon patient record review, 2 of 14 (Patient #6, 8) did not contain documented evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #6: An order was obtained on 03/21/25 for, “Patient is refusing SW services at this time.” However, 3 SW visits were made on April 3, 14, and 30, 2025. Patient #8: On the 04/18/25 RN SOC assessment, she documented the following, “Patient has multiple skin tears to bilateral forearms. Old bandages from 04/07/25 removed. I cleansed with saline, applied non-stick pads, then wrapped in Kerlix.” There was no order on the POC for such dressing change.”

“Upon personnel record review, 1 of 11 (Personnel #9) did not contain evidence that an initial Aide Skills Competency Assessment had been conducted, as per CMS requirement. Personnel #9: DOH was 09/05/24, an Aide Skills Competency Assessment had been conducted on 09/05/24. However, the following skills were not evaluated for the Aide while performing the tasks with a patient or pseudo-patient: ·Normal Range of Motion. This section of the form had been left blank. · Shampoo, sink, tub, and bed. The entry on the tool used, only listed “Hair Care.” · Sponge bath The other subject areas that may be evaluated through written examination, oral examination, or after observation of a Hospice Aide with a patient, were not evaluated for: The physical, emotional, and developmental needs of and ways to work with the populations served by the Hospice.”

“Upon patient record review 3 of 14 (Patients #6, 7, and 8) did not contain documented evidence that the Hospice Aide had provided services that are: • Ordered by the Interdisciplinary Group • Included in the Plan of Care Patient #6: The IDG POC ordered Aide services at a frequency of 3x per week. There was only (1) Aide home visit made the week of 04/13-04/19/2025. Patient #7: SOC 02/25/25. An Aide POC was first established 03/10/25, and assigned Aide visits at a frequency of 2x per week. A verbal order was obtained on 04/07/25 to change the Aide visit frequency to 3x per week. Only (1) Aide visit was made the week of 04/13-04/19/25. Patient #8: Effective 04/20/25 Aide visits were assigned at a frequency of 3x per week. Visits were made on 04/21, 04/23, and 04/25/25. Effective 04/21/25 Aide visits were changed to a frequency of 2x per week. However, Aide visits continued to be made 3x per week for the next two weeks.”

“Upon patient record review, 3 of 14 (Patient #3,4,9) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient’s clinical information and provide written documentation that it is anticipated that the patient’s life expectancy is 6 months or less. Patient #3: For the upcoming certification period beginning 04/25/25, the Physician signature was dated for 04/29/25. There was no oral certification obtained. Patient #4: For the upcoming certification period(s) beginning 09/27/24, 12/26/24, and 03/26/25, the Physician signature(s) were dated for 10/08/24, 01/07/25, and 04/01/25 respectively. There were no oral certification(s) obtained. Patient #9: For the upcoming certification period(s) beginning 07/18/24, 10/16/24, and 02/13/25, the Physician signature(s) were dated for 07/23/24, 10/21/24, and 02/18/25 respectively. There were no oral certification(s) obtained.”

“Upon patient record review, 14 of 14 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14) did not contain documented evidence that each patient record contained: A signed Election of Hospice Benefit Statement in accordance with 418.24: Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14): These Medicare Hospice Benefit Election form(s) do not include: • The information provided to the patient on the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), was missing the ‘contact information’ for the nearest BFCC-QIO.”

“Upon patient record review, 1 of 14 (Patient #10) did not contain evidence that all entries were clear, complete: Patient #10: An order was obtained on 05/01/25 for, “Insert Foley 16F to gravity. Change Q30 days.” On the 05/01/25 SNV note, the RN documented, “Catheter placed with sterile technique.” There were no details documented, to include but not limited to, the size of Foley inserted. The POC included x4 wound orders that were all initiated on 03/06/25: 1) Coccyx: Cleanse wound cleanser, pat dry, apply Dakins soaked gauze to wound bed, cover ABD, and tape to secure, daily; 2) Left buttocks: Paint with Betadine, cover with Mepore dressing daily; 3) Right hip: Paint with Betadine, cover with Mepore dressing daily; and 4) Right shoulder: Paint with Betadine, cover with Mepore dressing daily. The 05/01/25 SNV documented wound care as follows, “Wound care completed per order”, without the details of the wound care having been provided.”

“Upon personnel record review, 3 of 11 (Personnel #2, 3, and 9) did not contain evidence of Criminal Background Checks having been obtained, in accordance with State requirements. In the absence of State requirements, Criminal Background Checks (CBC) are obtained within three months of the date of employment for all States that the individual has lived or worked in the past 3 years: Personnel #2: DOH 01/10/04. The Administrator reported that this personnel’s original criminal background check had been misplaced. It had not been re-ran and filed in the record. Personnel #3: DOH 09/06/16. The Administrator reported that this personnel’s original criminal background check had been misplaced. It had not been re-ran and filed in the record. Personnel #9: DOH 09/05/24. The Administrator reported that this personnel’s original criminal background check had been misplaced. It had not been re-ran and filed in the record.”