Amedisys Hospice of Greater Chesapeake

“Upon patient record review, 1 of 27 (Patient #4) did not contain evidence that a Registered Nurse had been designated to ensure the continuous assessment of the patient and family’s needs, and to coordinate activities with other members of the interdisciplinary group (IDG): Patient #4: The IDG POC dated 05/28/24 included an RN note, “Patient has a Stage I pressure sore on sacrum. Repositioning encouraged, and Barrier Cream to be applied as needed.” The next two subsequent nursing visits made on 05/29/24 and 06/04/24 did not evidence that the nurse had assessed the patient’s sacrum area. The 05/29/24 visit noted, “Patient spends most of the day in recliner. Sleeps 16-18 hours per day. Uses donut for pressure relief.””

“Upon patient record review, 1 of 27 (Patient #5) 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, including medications and treatments: Patient #5: Beginning 05/16/24, Hospice visit notes reflected the weekly nursing assessment of, and measurement of a left buttock/hip wound; with the following wound care being provided on M-W-F by the in-home caregiver, “Cleanse normal saline, apply skin barrier to peri-wound, cover with bordered foam, M-W-F by in-home caregivers. RN to assess and measure wound weekly”. A Hospice nurse completed such weekly assessment and measurement. However, there was no documented, Physician-ordered wound care procedure for this left buttock/hip wound, that was being provided by the in-home caregiver.”

“Upon patient record review, 1 of 27 (Patient #10) did not contain evidence that the Hospice Aide assignments and duties were: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #10: The current 06/06/24 Aide POC included, “Ground Diet. Aide to assist patient with with feeding if present at meal time”. A 05/21/24 SN visit had noted, “Per SNF staff, patient had an episode of coughing after eating his ground diet today. The SNF Dietitian has downgraded patient’s diet to pureed.” The Aide POC had not been updated to reflect this pertinent information.”

“Upon patient record review, 2 of 27 (Patients #2 and 10) did not contain evidence that a written Hospice Plan of Care was established and maintained in consultation with SNF/NF representatives. All Hospice care provided must be in accordance with the Hospice Plan of Care: Patient #2; Resided in a SNF. The POC dated 03/13-05/11/24 ordered SW visits at a frequency of, “1x1 month, which was made 03/21/24, and then 2x per month x1. Only one SW home visit was made in April, on 04/30/24. Patient #10: SNF Resident. A verbal order was obtained 05/21/24 for, “Cleanse penile fissure/erosion with Normal Saline, pat dry, apply Maxsorb, cover with ABD. Treatment to be provided QD by the SNF staff. Hospice RN to assess and measure wound area weekly.” There was no documented evidence that a Hospice nurse had assessed nor measured such wound area the week of 05/26-06/01/24.”

“Upon patient record review, 1 of 27 (Patient #2) did not contain evidence that the Hospice had provided the following information to the Resident’s SNF: Patient #2: Admitted 03/19/23. During the 06/04/24 Surveyor-attended home visit, the RN was not able to locate evidence of the following documents having been provided to the SNF: • The most recent Hospice Plan of Care. There were no Plans of Care located within the SNF file. • The Physician Certification and Re-certification of the Terminal Illness. There were no CTI’s located within the SNF file. • Hospice Medication information. The Hospice RN stated that the current Medication Listing had been left at her home. • The names for the Hospice personnel assigned in the care of Patient #2. The section intended for this information, entitled, “Hospice Team Members” had been left blank for Patient #2’s SW, Spiritual Counselor, and Aide.”