Croi Health

“2. For Patient RR #2, the agency failed to follow the plan of care relative to skilled nursing visits. RR #2 was admitted to the Agency in May 2024 with a diagnosis of liver cell carcinoma. Review of the current physician orders for the certification period of 5/30/24-8/27/24, indicated orders for skilled nursing 2 times a week for 12 weeks. Review of the clinical record indicated the following services were not documented as being provided in accordance with the plan of care. *For the week of 6/16/24-6/22/24, only 1 skilled nursing visit was conducted instead of 2, as ordered. *For the week of 6/30/24-7/6/24, only 1 skilled nursing visit was conducted instead of 2, as ordered. During an interview on 7/25/24 at 9:30 A.M., the Quality Assurance Performance Improvement Compliance Manager said she contacted the nurse who said that RR #2 canceled the visits, but she failed to write a note. The Quality Assurance Performance Improvement Compliance Manager said the expectation is that if there is a change in the patient’s scheduled visit, the nurse should write a note in the clinical record. Based on record review and staff interviews, the Hospice Agency failed to follow the plan of care relative to the frequency of visits by Skilled Nursing, for 2 patients (RR#6, and RR#2), out of a total sample of 23 patients. Findings include: 1. For RR#6, the Agency failed to follow the plan of care relative to skilled nursing visits. RR#6 was admitted to the Agency in June 2024 with a diagnosis of Alzheimers disease with late onset. Review of the current physician orders for the certification period of 6/5/24 - 9/2/24, indicated orders for skilled nursing services 2 times a week. Review of the clinical record indicated that the following services were not documented as being provided in accordance with the plan of care: - For the week of 6/9/24 - 6/15/24, only 1 skilled nursing visit was conducted instead of the 2 that was ordered. - For the week of 6/16/24 - 6/22/24, only 1 skilled nursing visit was conducted instead of the 2 that was ordered. - For the week of 6/23/24 - 6/29/24, only 1 skilled nursing visit was conducted instead of the 2 that was ordered. - For the week of 6/30/24 - 7/6/24, only 1 skilled nursing visit was conducted instead of the 2 that was ordered. - For the week of 7/7/24 - 7/13/24, only 1 skilled nursing visit was conducted instead of the 2 that was ordered. - For the week of 7/14/24 - 7/20/24, only 1 skilled nursing visit was conducted instead of the 2 that was ordered. During an interview on 7/25/24 at 10:40 A.M., the Quality Assurance Performance Improvement Compliance Manager said that the nurse determined that the patient (RR #6) does not need 2 skilled visits a week but did not notify the Physician to update the physicians order nor write a note. She said that it was a missed visit since the nurse did not change the physicians order for skilled nursing from 2 times a week to 1 time a week.”

“Based on record review and interview, the Agency failed to ensure that a Nurse Aide Registry background check for 2 of 2 volunteers (Volunteer #1, and #2) was conducted prior to hire, as required. Findings include: Review of the 105 CMR 155.000: Patient and Resident Abuse Prevention, Reporting, Investigation, Penalties and RegistrySection: 105CMR 155.010 (E)(3) included the following: -All home health agencies, homemaker agencies, and hospice programs shall contact the Registry prior to hiring an individual who will provide direct care to patients or have access to patients or their property to ascertain if there is any sanction, finding or adjudicated finding of patient or resident abuse, neglect, mistreatment, or misappropriation of patient or resident property against the prospective employee. Review of Manual for MassHealth Providers, 130 CMR 437.000: Hospice Services: Hospice Providers Regulation indicated the following: Massachusetts Regulations 130 CMR 437.421: Administration and Staffing Requirements *Volunteer Services: The hospice provider must use volunteers in administrative or direct patient-care roles. The hospice provider must appropriately train volunteers and document its ongoing efforts to recruit and retain volunteer staff. The hospice provider must complete the same personnel screenings for volunteer staff that are required for paid employees of the hospice provider. Review of the facility policy titled “Hiring Policy”, with revised date of 5/2024 indicated the following: * The Agency makes all offers of employment contingent upon the completion and satisfactory results of the items listed below for all employees, regardless of their position and department. For all new hires, after an offer of employment is accepted by an applicant, the Agency will: *Certified Nurse Aide Registry (C.N.A. Registry): The Agency will conduct a search of Certified Nurse Aide (C.N.A.) registry on all applicants being considered for employment. Review of Volunteer #1s personnel record on 7/25/24 indicated that a background check was completed, and that Volunteer #1 joined the volunteer program on 5/31/24. Further review of the file failed to indicate a Nurse Aide registry check was conducted. Review of Volunteer #2s personnel record on 7/25/24 indicated that a background check was completed, and that Volunteer # 2 joined the volunteer program on 1/30/24. Further review of the file failed to indicate a Nurse Aide registry check was conducted. During an interview on 7/26/24 at 9:34 A.M. via telephone, the Quality Assurance Performance Improvement Compliance Manager said that she checked with the Human Resource (HR) Department and was told that HR does not conduct nurse aide registry check for volunteers.”