Breeze Hospice of Missouri

“It is required that hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any), the patient or patient representative if any of them so desire, and the primary caregiver in accordance with the patient’s needs if any of them so desire. This standard was not met as evidenced by clinical record review and interview. In 4 of 19 (21%) clinical records reviewed, the agency did not ensure hospice care and services were provided as ordered on the individualized plan of care. CLINICAL RECORD 1: The patient elected the hospice benefit on 07/19/2024. The Interdisciplinary Group Meeting notes and updates to the plan of care dated 04/08/2025 and 04/22/2025 documented “Medical Social Worker; 1 m 3 m 2 PRN Psychosocial needs, [once a month for three months and two as needed], Start Date: 3/16/2025 - End Date: 5/14/2025.” There was no documented evidence of a Medical Social Worker visit for April 2025 and no documentation of a missed visit for April. CLINICAL RECORD 12: The patient elected the hospice benefit on 01/15/2025. The Interdisciplinary Group Meeting notes and updates to the plan of care dated 03/11/2025 and 03/25/2025 included documentation “Chaplain; 1 m 3 m 4 PRN [once a month for three months and four as needed] visits for pt [patient] /family for spiritual distress, Start Date: 2/11/2025 - End Date: 4/14/2025.” There was no documented evidence of a Chaplain visit for March 2025 and no documentation of a missed visit for March. CLINICAL RECORD 16: The patient elected the hospice benefit on 02/01/2024. The Interdisciplinary Group Meeting notes and the updates to the plan of care dated 04/09/2024 and 04/23/2024 documented “Medical Social Worker; 1 m 3 m [once a month for three months], Start Date: 3/11/2024 - End Date: 5/31/2024.” There was no documented evidence of a Medical Social Worker visit for April 2025 and no documentation of a missed visit for April. CLINICAL RECORD 18: The patient elected the hospice benefit on 02/01/2024. The Interdisciplinary Group Meeting notes and updates to the plan of care dated 06/04/2024 and 06/18/2024 included documentation “Chaplain; 1 m 3 m 3 PRN [once a month for three months and three as needed], Start Date: 5/21/2024 - End Date: 7/29/2024.” There was no documented evidence of a Chaplain visit for June 2025 and no documentation of a missed visit for June. During a joint record review and interviews on 05/08/2025, the Vice President of Operations and the Senior Administrator/Registered Nurse confirmed there was no documentation in the clinical records to show the Chaplain, and the Social Worker had provided services as ordered on the plan of care.”

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene, use of gloves, mask, eye protection, or face shield depending on anticipated exposure, safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids, safe handling of soiled items in the patient’s care environment, and other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by document review, observation, and interview. In 2 of 4 (50%) home visit observations, the agency did not ensure staff performed hand hygiene as required by agency policy. Agency policy No. 7-009 Hand Hygiene, undated, required in part, “Hand decontamination using an alcohol-based hand rub should be performed: after removing gloves... Hand Washing with Soap and Water... Rinse with warm water and dry the hands with a disposable towel from the fingers toward the forearm. Use a dry disposable towel to turn off faucet.” HOME VISIT 1: During the home visit observation on 05/06/2025 with the Certified Nurse Aide (CNA) (Personnel Record 8), the CNA was observed to wash hands with soap and water, rinse the hands, turn off the water with the bare wet hands, and dry the hands with paper towels three separate times. The CNA did not use a disposable towel to turn off the faucet. HOME VISIT 2: During the home visit observation on 05/06/2025 with the Registered Nurse (RN) (Personnel Record 9), the RN was observed to provide wound care. During wound care, the RN applied gloves, removed the dressing to the left hip, removed the gloves, picked up the iPad to take a picture, placed the iPad on the barrier, and used alcohol rub to decontaminate the hands. The RN did not wash hands after glove removal. The nurse then applied a new pair of gloves, cleaned the wound, dried the wound area, retrieved a pen from the uniform pocket, wrote the date on the dressing, returned the pen to the pocket, applied the dressing to the wound, and removed the gloves. The RN did not remove gloves and wash hands before obtaining the pen for the uniform pocket. During a joint review and interviews on 05/06/2025, the Vice President of Operations and the Senior Administrator/Registered Nurse agreed that the staff did not follow the hand hygiene policy.”

“It is required that a hospice aide provide services ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Hospice Aide provided services as ordered in the plan of care. CLINICAL RECORD 2: The hospice aide plan of care dated 04/10/2025, and updated 04/22/2025, assigned the aide the following tasks, “assist patient with dressing every visit, skin care every visit, oral care every visit, shampoo every visit, shave every visit as needed, change patient linen weekly, incontinent care every visit, shower chair every visit, catheter care every visit, and assist with transfer every visit.” On the hospice aide visit note dated 04/24/2025, the Hospice Aide (HA) did not document that oral care and catheter care were provided. On the aide visit note dated 04/30/2025, the HA did not document that oral care was provided. On the HA visit note dated 05/07/2025, the HA did not document that oral care, dressing, and catheter care were provided. During a joint clinical record review and interview on 05/08/2025, the Vice President of Operations and the Senior Administrator/Registered Nurse agreed the record lacked evidence that the hospice aide provided services as ordered on the plan of care.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Hospice Aide notified the Registered Nurse of the changes in the patient’s nursing needs. CLINICAL RECORD 11: The hospice aide plan of care dated 05/03/2025 included an order for the aide to provide visits at a frequency of twice a week. The Hospice Aide documented on the aide visit note dated 05/06/2025 “patient refused” all assigned tasks and documented in the narrative, “Called patient multiple times. No answer.” The HA did not include documentation that the Registered Nurse was notified of the missed visit and change to the plan of care. During a joint clinical record review and interviews on 05/08/2025, the Vice President of Operations and the Senior Administrator/Registered Nurse confirmed that the hospice aide documentation lacked notification to the Registered Nurse of the missed visit.”