Evertrue Hospice

“Based on the policy review, employee education record review, clinical record review, and interview, the hospice provider failed to ensure the hospice aide (Aide B) had successfully completed the basic skills test prior to the provision of patient care in one of one record reviewed (Record/Patient #12). This deficient practice has the potential to affect the provision of competent aide services for all of the provider’s patients. Findings included: Review of the providers undated policy titled, “;Competency Program,” showed in part, the providers competency program would:- Assess staff competency prior to assuming the duties for which they were hired, by a supervisor or peer that has also been assessed and meets the criteria for performing those skills;- Assure that each direct service staff member has demonstrated competency in any new task before being assigned to that task; and- Validation of skills competency is conducted annually thereafter. Review of the providers undated policy titled, “;Coordination of Services – Hospice Aide Training and Competency,” showed that, in part, an individual may furnish aide services on behalf of the provider when that individual has successfully completed a competency evaluation program that includes, but is not limited to:- Completion of a bed and sponge bath; and- Washing of the hair while the patient is in bed. Review of the providers employee education files showed that the provider failed to provide a complete aide basic skills test for Aide-B. The basic skills test failed to include documentation that Aide-B successfully completed;- A bed and sponge bath; and- Washing of the hair while the patient is in bed. RECORD/PATIENT #12: Review of the hospice aide visit note, dated 05/30/2024, showed that Aide-B provided a complete bed bath and shampoo of the patients hair during his/her visit. During an interview on 06/04/2024 at 2:18 PM, the hospice administrator stated:- The bed and sponge bath, and washing of the hair while the patient was in bed had not been documented as successful on Aide-Bs basic skills test; and- It was the providers practice to perform aide competency testing that include all of the elements on the aide basic skills test.”

“Based on policy review, record review, observation, and interview, the hospice provider failed to ensure the registered nurse (RN) prepared complete written care instructions for the hospice aide in two of four applicable records (Records/Patients #1 and #4). This deficient practice has the potential to affect all patients who receive aide services from the provider. Findings included: RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to hospice services on 09/29/2023 with a terminal diagnosis of other symptoms and signs involving cognitive functions following cerebral infarction (stroke). The patient had comorbidities including, but not limited to, a history of edema (swelling) in the feet. The patient resided in a skilled nursing facility. Review of the plan of care dated 05/24/2024 showed, in part, the following:- ACE wraps to BLE (bilateral lower extremities) on in AM, off at HS (hour of sleep); and- Surgical shoe to left foot. The aide assignment sheet dated 05/28/2024 failed to contain: - Directions for the management of the ACE wraps to the BLE during the bathing process; and- The use of the surgical shoe to the left foot. During an interview on 06/05/2024 at 10.21 AM, the administrator stated that they would expect the aide assignment sheet to contain directions for the aide management of the ACE wraps during the bathing process and the use of the surgical shoe. Review of the Hospice providers policy titled, “Coordination of Services- “;Named Hospice” Aide,” copyright date of 2016, showed in part, the following: - All aide services will be provided by qualified personnel in accordance with the states occupational certification regulations, where applicable, federal regulations and the organizations policies/job descriptions; - All aide services will be provided under the direction of a registered nurse with sufficient education and experience in the scope of services offered; - Written patient care instructions must be prepared by a registered nurse who is responsible for the supervision of a “;named Hospice” aide; - A named Hospice aide provides services that are ordered by the interdisciplinary group, included in the plan of care, permitted to be performed under state law, and consistent with the “;named Hospice” aide training. RECORD/PATIENT #1: Review of the clinical record showed that the patient was admitted to Hospice services on 02/06/2024 with an admitting terminal diagnosis of Huntington’s disease (a progressive, genetic condition that affects the cells in your brain that regulate voluntary movement and memory). The patient resided in a long-term care facility. Review of the Hospice aide assignment, dated 02/06/2024, showed under the skin care section: apply barrier cream as directed was check marked with a frequency of every visit. It failed to include the location and the indication for application of the barrier cream. Observation on 06/04/ 2024, beginning at 8:10 AM, during the patients home visit, showed during the patients shower the dressing on the coccyx (tailbone) fell off. Hospice aide A, dried the patient off, applied barrier cream to the open abrased area to the coccyx, and stated he/she would tell the nurse it fell off. Per interview conducted during the patients home visit Hospice aide-A stated that he/she believed that applying barrier cream to the open wound on the coccyx was listed on the aide assignment sheet. During an interview on 06/05/2024 at 10:35 AM the administrator acknowledged the location and indication for barrier cream application was missing from the aide assignment sheet.”

“Based on policy review record review, observation, and interview the hospice provider failed to ensure the hospice aide followed the aide assignment/aide plan of care (POC) in 1 of 4 applicable records reviewed (Record/Patient #1). This deficient practice has the potential to affect all patients receiving aide services. Findings included: Review of the hospice providers policy titled, “Coordination of Services- “;Named Hospice” Aide”, copyright date of 2016, showed in part, “;Named Hospice” aide provides services that are ordered by the interdisciplinary group and included in the plan of care. RECORD/PATIENT #1: Review of the clinical record showed that the patient was admitted to hospice on 02/06/2024 with a terminal diagnosis of Huntington’s disease (a progressive, genetic condition that affects the cells in your brain that regulate voluntary movement and memory). The patient resided in a long-term care facility. Review of the hospice aide assignment (aide POC), dated 02/06/2024, showed under the skin care section: apply barrier cream as directed was check marked with a frequency of every visit. It failed to show that the aide was to provide wound care to the open coccyx (tailbone) wound. Observation on 06/04/2024, beginning at 8:10 AM, during the patients home visit, showed during the patients shower the dressing on the coccyx (tailbone) fell off. Hospice aide A, dried the patient off, applied barrier cream to the open abraded (also known as an abrasion, a superficial break in the skin’s layers; caused by scraping, pressure, or impact) area to the coccyx, and stated he/she would tell the nurse it fell off. Per interview conducted during the patients home visit hospice aide-A stated that he/she believed that applying barrier cream to the open wound on the coccyx was listed on the aide assignment sheet. During an interview on 06/05/2024 at 10:35 AM the administrator stated that: - The licensed nurse should be doing the wound care, not the aide; and - If the wound was not open (no break in the skin) and the aide wanted to apply the protectant cream (barrier cream) then yes, they could.”

“Based on policy review, employee education file review, and interview, the hospice provider failed to complete an initial and annual skills competency for the chaplain and the social worker disciplines in two of four employee files reviewed (Chaplain-A and Social Worker-A). This deficient practice has the potential to affect the provision of competent services for all of the provider’s patients. Findings included: Review of the providers undated policy titled, “;Competency Program,” showed in part, the providers competency program would:- Assess staff competency prior to assuming the duties for which they were hired, by a supervisor or peer that has also been assessed and meets the criteria for performing those skills;- Assure that each direct service staff member has demonstrated competency in any new task before being assigned to that task; and- Validation of skills competency is conducted annually thereafter. Review of the providers employee education files showed that the provider failed to provide initial and annual competency evaluation(s) for Chaplain A and Social Worker A. During an interview on 06/04/2024 at 2:18 PM, the hospice administrator stated that they had not performed competency evaluations on chaplains or social workers in the past and would initiate the process in the future.”