VNA & Hospice of Greater Milford

“Based on record review, policy review and interview, the agency failed to ensure care and services were provided in accordance with the plan of care (POC) for 8 Patients (#4, #5, #7, #1, #16, #6, #8 and #2), out of a total sample of 19 patients.Findings include: 8. For Patient #2, the Hospice agency failed to ensure Medical Social Worker (MSW) visits were provided as ordered.Patient #2 was admitted to Hospice services in June 2025 with diagnoses which included hepatic encephalopathy.Review of the Hospice POC with benefit dates 6/6/25 through 9/3/25, indicated for a MSW visit to evaluate patient and POC to be signed by physician.Review of the physician order, dated 6/8/25, indicated the following:-MSW visits-3 times a week for 1 week, 1 time a week for 1 week and 1 time every 2 weeks for 10 weeks.Review of the clinical record indicated MSW visits were provided on 7/10/25 and 7/29/25.During an interview on 8/20/25 at 3:19 P.M., the Director of Hospice and Palliative Services reviewed the clinical record and said the MSW visits were not provided as ordered by the physician. 6. For Patient #6, the Hospice agency failed to provide 5 Home Health Aide (HHA) visits, as care planned.Patient #6 was admitted to Hospice services in June 2025 with a diagnosis of senile degeneration and dementia.Review of Patient #6’s POC for certification period 6/27/25 through 9/24/25, indicated for HHA visit 2 times a week for 12 weeks. Review of the clinical record indicated no documentation that HHA visits occurred during the weeks of 6/29/25 through 7/5/25 and 7/20/25 through 7/26/25.Further review of the clinical record indicated that only 1 HHA visit was documented as being completed the week of 7/13/25 through 7/19/25, not the 2 visits as per the POC.During an interview on 8/19/25 at 3:54 P.M., the Director of Hospice and Palliative Services said that she could not find any documentation as to why the visits were missed.7. Patient #8 was admitted to the Hospice agency in February 2025 with a diagnosis of Parkinson’s Disease.Review of Patient #8’s POC for certification periods 5/6/25 through 8/3/25 and 8/4/25 through10/2/25, indicated for Skilled Nursing (SN) visits 2 times a week for 12 weeks and 3 as needed visits for change in condition and HHA visits 2 times a week for 12 weeks. (effective 4/21/25)Review of the clinical record indicated that for the week of 6/29/25 through 7/5/25 there was only 1 SN visit and not 2 as per the plan of care.Further review of the clinical record indicated no documentation that HHA visits occurred for the week of 7/20/25 through 7/26/25 and 8/10/25 through 8/16/25.During an interview on 8/20/25 at 10:40 A.M., the Director of Hospice and Palliative Services said she could not find any documentation as to why these visits were missed. 4. For Patient #1, the Hospice agency failed to ensure a Skilled Nurse (SN) visit was provided, as ordered.Patient #1 was admitted to the agency in May 2025 with a diagnosis of senile degeneration of the brain.Review of the Hospice POC with benefit dates 5/21/25 through 8/18/25 indicated the following:-SN: twice weekly for 12 weeks, 3 PRN (as needed)Review of the clinical record indicated a SN visit was not provided for the week of 7/6/25 through 7/12/25, as ordered.During an interview on 8/19/25 at 2:40 P.M., the Director of Hospice and Palliative Services reviewed the clinical record and said for Patient #1, the SN visit was not provided the week of 7/6/25 through 7/12/25, as ordered.5. For Patient #16, the Hospice agency failed to ensure SN, Home Health Aide (HHA), and Chaplain visits were provided, as ordered.Patient #16 was admitted to the agency in December 2024 with a diagnosis of Alzheimer’s disease.Review of the Hospice POC with benefit dates 6/11/25 through 8/9/25 indicated the following:-SN: 4 times weekly for 1 week, twice weekly for 8 weeks-HHA: twice weekly for 1 week, 4 times weekly for 8 weeks-Chaplain: twice weekly for 3 weeks (effective 7/20/25), twice a month for 8 weeks, 2 PRN (effective 7/26/25) Review of the clinical record indicated the following visits were not provided: -SN visit for the week of 7/6/25 through 7/12/25.-HHA visit for the weeks of 6/22/25 through 6/28/25, 6/29/25 through 7/5/25, 7/6/25 through 7/12/25, and 7/13/25 through 7/19/25.-Chaplain visit for the week of 7/20/25 through 7/26/25. During an interview on 8/20/25 at 9:20 A.M., the Director of Hospice and Palliative Services reviewed the clinical record and said for Patient #16, the SN, HHA, and Chaplain visits for the reviewed weeks were not provided, as ordered. Review of the agency policy entitled, Interdisciplinary Team: Plan of Care (POC) and Coordination of Services, revised 7/2025, included the following:*The Interdisciplinary Team (IDT) maintains responsibility for directing, coordinating and supervising the care and services provided in accordance with the POC. Additionally, the IDT is responsible for assuring that care and services provided are based on the assessment of the needs of the patient and family.1. For Patient #4, the agency failed to ensure Medical Social Worker (MSW) visits were provided, as ordered.Patient #4 was admitted to the agency in July 2025 with a diagnosis of liver carcinoma (cancer).Review of the Hospice POC for certification period 7/20/25 through 10/17/25 indicated the following:-MSW to evaluate patient and develop a POC to be signed by physician.-Review of the clinical record indicated MSW visits were provided on 7/20/25, 7/30/25 and 8/11/25.During an interview on 8/20/25 at 3:00 P.M., the Director of Hospice and Palliative Services reviewed the clinical record and said 2 extra visits were provided and the POC was not followed, as required. 2. For Patient #5, the agency failed to ensure A. MSW visits, and. B. Home Health Aide (HHA) visits were provided, as ordered.Patient #5 was admitted to the agency in July 2025 with a diagnosis of gastrointestinal (GI) hemorrhage.A. Review of the physician order, dated 7/14/25, indicated for MSW to evaluate patient and develop POC to be signed by physician.Review of a physician order, dated 8/11/25, indicated to add one MSW visit.Review of the clinical record indicated additional MSW visits were provided on 7/21/25 and 8/4/25.B. Review of a physician order, dated 7/14/25, indicated for increasing HHA visits to 3 times a week.Review of the clinical record indicated HHA visits were not provided the week of 7/20/25 through 7/26/25. Further review of the medical record indicated 2 HHA visits were provided for the week of 7/27/25 through 8/2/25.During an interview on 8/20/25 at 11:45 A.M., the Director of Hospice and Palliative Services reviewed the clinical record and said the MSW and HHA visits were not provided per the POC, as required.3. For Patient #7, the agency failed to ensure A. MSW visit, and. B. Home Health Aide (HHA) visits were provided, as ordered.Patient #7 was admitted to the facility in August 2025 with a diagnosis of Myelodysplastic Syndrome (a group of cancers in which blood cells in the bone marrow do not mature, and as a result, do not develop into healthy blood cells).Review of the Hospice POC for certification period 8/6/25 through 11/3/25 indicated the following:-HHA visits 3 times a week for 12 weeks.-MSW to evaluate patient and develop POC to be signed by physician.Review of the clinical record indicated the following: A. An additional MSW visit was provided on 8/12/25.B. One HHA visit was provided the week of 8/10/25 through 8/16/25.During an interview on 8/20/25 at 12:00 P.M., Director of Hospice and Palliative services reviewed the clinical record and said the MSW and HHA visits were not provided per the POC, as required.”

“Based on record review, policy review and interview, the agency failed to ensure there was communication shared with the physician when services were not provided, as ordered, for 6 patients (#5, #1, #16, #6, #8, and #2), out of a total sample of 19 patients.Findings include: 6. Patient #2 was admitted to Hospice services in June 2025 with a diagnosis of hepatic encephalopathy.Review of the physician order, dated 6/8/25, indicated the following:-Master of Social Work (MSW) visit -3 times a week for 1 week, 1 time a week for 1 week and 1 time every 2 weeks for 10 weeks.Review of the clinical record indicated MSW visits were provided on 7/10/25 and 7/29/25 but not provided at any time during the weeks of 7/13/25 through 7/19/25 and 7/20/25 through 7/26/25.Further review of the clinical record failed to contain any documentation the physician had been notified of the missed MSW visits for the weeks of 7/13/25 through 7/19/25 and 7/20/25 through 7/26/25.During an interview on 8/20/25 at 3:19 P.M., the Director of Hospice and Palliative Services reviewed the clinical record and said the physician was not notified of the missed MSW visits as required. 4. For Patient #6, the Hospice agency staff failed to ensure the physician responsible for the POC was notified of HHA missed visits.Patient #6 was admitted to the Hospice agency in June 2025 with a diagnosis of senile degeneration and dementia.Review of Patient #6’s POC for certification period 6/27/25 through 9/24/25, indicated HHA visits 2 times per week for 12 weeks. Review of the clinical record indicated HHA visits were not provided for the weeks of 6/29/25 through 7/5/25, 7/13/25 through 7/19/25, and 7/20/25 through 7/26/25, as required.Further review of the clinical record indicated no documentation that the physician was notified of the missed HHA visits, as required.During an interview on 8/20/25 at 10:40 A.M., the Director of Hospice and Palliative Services said the physician should be notified of missed visits and it should be documented in the clinical record. She said she could not find documentation to indicate the physician was notified.5. For Patient #8, the Hospice agency staff failed to ensure the physician responsible for the POC was notified of HHA and SN missed visits.Patient #8 was admitted to the Hospice agency in February 2025 with a diagnosis of Parkinson’s disease.Review of Patient #8’s POC for certification periods 5/6/25 through 8/3/25 and 8/4/25 through 10/2/25, indicated SN 2 times a week for 12 weeks and 3 PRN visits for change in condition, and HHA 2 times a week for 12 weeks. Review of the clinical record indicated a SN visit was missed the week of 6/29/25 through 7/5/25, and HHA visits were missed the weeks of 7/20/25 through 7/26/25 and 8/10/25 through 8/16/25, as required.Further review of the clinical record indicated no documentation that the physician was notified of the missed HHA and SN visits, as required.During an interview on 8/20/25 at 10:40 A.M., the Director of Hospice and Palliative Services said the physician should be notified of missed visits and it should be documented in the clinical record. She said she could not find documentation to indicate the physician was notified. 2. For Patient #1, agency staff failed to ensure the physician responsible for the POC was notified of a missed Skilled Nursing (SN) Visit.Patient #1 was admitted to the agency in May 2025 with a diagnosis of senile degeneration of the brain.Review of the Hospice POC with benefit dates 5/21/25 through 8/18/25 indicated the following:-SN: twice weekly for 12 weeks, 3 PRN (as needed).Review of the clinical record indicated a SN Visit was not provided for the week of 7/6/25 through 7/12/25, as ordered.Further review of the clinical record indicated the physician was not notified of the missed SN visit, as required. During an interview on 8/20/25 at 10:15 A.M., the Director of Hospice and Palliative Services reviewed the clinical record and said there was no documentation of the missed visits or physician notification for Patient #1 in the clinical record, but there should have been. 3. For Patient #16, agency staff failed to ensure the physician responsible for the POC was notified of missed SN, Home Health Aide (HHA), and Chaplain visits, as required.Patient #16 was admitted to the agency in December 2024 with a diagnosis of Alzheimer’s disease.Review of the Hospice POC with benefit dates 6/11/25 through 8/9/25 indicated the following:-SN: 4 times weekly for 1 week, twice weekly for 8 weeks.-HHA: twice weekly for 1 week, 4 times weekly for 8 weeks.-Chaplain: twice weekly for 3 weeks (effective 7/20/25), twice a month for 8 weeks, 2 PRN (effective 7/26/25). Review of the clinical record indicated the following visits were not provided: -SN visit for the week of 7/6/25 through 7/12/25.-HHA visit for the weeks of 6/22/25 through 6/28/25, 6/29/25 through 7/5/25, 7/6/25 through 7/12/25, and 7/13/25 through 7/19/25.-Chaplain visit for the week of 7/20/25 through 7/26/25. Further review of the clinical record indicated the physician was not notified of the missed SN, HHA, and Chaplain visits, as required.During an interview on 8/20/25 at 10:15 A.M., the Director of Hospice and Palliative Services reviewed the clinical record and said there was no documentation of the missed visits or physician notification for Patient #16 in the clinical record, but there should have been. Review of the agency policy entitled, Scheduling and Coordinating Patient Visits, revised 4/2025, included the following:*Care, treatment and/or services provided by Salmon Home Care staff shall be ordered by a physician, consistent with the findings of the assessment data, and delivered according to the plan of care.*Missed Home Care visits or services as required by the patient’s Plan of Care (POC), shall be communicated to the patient’s interdisciplinary team and the physician(s) responsible for the Plan of Care. 1. Patient #5 was admitted to the agency in July 2025 with a diagnosis of gastrointestinal (GI) hemorrhage.Review of the clinical record indicated a physician order, dated 7/14/25, to increase Home Health Aide visits (HHA) to 3 times a week. Review of Patient #5 Client Calendar Report indicated HHA visits were scheduled on 7/23/25, 7/24/25, and 7/25/25.Review of the clinical record indicated HHA services were not provided for the week of 7/20/25 through 7/26/25. The clinical record did not not contain any documentation that the physician had been notified of the missed HHA visits for the week of 7/20/25 through 7/26/25.During an interview on 8/20/25 at 3:45 P.M., the Director of Hospice and Palliative Services said after reviewing the clinical record the physician was not notified of the missed HHA visits, as required.”