Chi Health at Home - Lincoln

“Based on record review, policy and procedure review, and staff interview, the agency failed to ensure the Hospice Aide (HA) plan of care included all patient-specific care information to assist the HA in the performance of personal care, hygiene, and activities of daily living (ADLs) for 2 of 16 patients reviewed who received HA services (Patient 7 and Patient 10). The total sample size was 19. The census was 50. Findings are: A. Review of the agency policy and procedure titled 33.37 Aide and Homemaker Plan of Care, last revised 8/10/22, revealed: 1. The Aide plan of care was to be reviewed with the patient and/or caregiver to develop a plan that will meet the patient’s needs. 2. The plan of care can be individualized by the initiation of special orders, requests, frequencies, and the amount of assistance that is needed to perform specific tasks. 3. The plan of care was to be updated as needed, with significant changes in patient conditions. B. Review of Patient 7’s clinical record revealed: 1.The Hospice Certification and Plan of Care for the certification period of 7/11/24 through 10/8/24 included orders for HA services 2 times a week for 12 weeks, then 1 time a week for one week to assist with personal care, hygiene, and ADLs. 2.The Hospice Recertification Plan of Care Update for the certification period of 9/18/24 through 12/16/24 included orders for HA services 1 time per week for 1 week, then 2 times per week for 12 weeks, then 1 time per week for 1 week, to assist with personal care, hygiene, and ADLs. 3.The Hospice Start of Care Visit Note Report (documentation of the nurses initial comprehensive assessment of the patient) dated 7/11/24, the Registered Nurse (RN) included findings of increased dementia behaviors including combativeness and hitting, needs assistance to be fed, unsteady on feet, recent increase in back pain, care coordination with long term care facility staff, pre-medication prior to bathing (type of premedication not indicated). 4.The HA Care Plan Report failed to include interventions or information of items listed in number B. 3. above, to assist the HA in the performance of personal care, hygiene, and ADLs for Patient 7. C. Review of Patient 10’s clinical record revealed: 1.The Hospice Certification and Plan of Care for the certification period of 6/20/24 through 9/17/24 included orders for HA services 2 times a week for 1 week, then 1 time a week for one week to assist with personal care, hygiene, and ADLs. 2.An order dated 7/14/24 for HA services 3 times per week for 9 weeks, then 1 time per week for 1 week. 3.The Hospice Recertification Plan of Care Update for the certification period of 9/18/24 through 12/16/24 included orders for HA services 2 times per week for 1 week, then 3 times per week for 12 weeks to assist with personal care, hygiene, and ADLs. 4.The Hospice Start of Care Visit Note Report (documentation of the nurses initial comprehensive assessment of the patient) dated 6/20/24, the RN included findings of severe cognitive dysfunction, non-verbal, 1/2 vision in both eyes, right sided paralysis, dysphagia (difficulty or inability to swallow), gastrostomy tube (a tube inserted through the abdomen into the stomach for the purpose of administering food, fluids, and medications), decreased muscle control below the neck, condom catheter (an external catheter used to drain urine into a collection bag), a strict wheelchair schedule, current cellulitis of left lower leg, is to take nothing by mouth, oral cares only, uses oxygen as needed. 5.The HA Care Plan Report failed to include interventions or information of items listed in number C. 4. above, to assist the HA in the performance of personal care, hygiene, and ADLs for Patient 10. D. During an interview on 11/12/24 at 3:30 PM, The Director of Clinical Services confirmed the agency failed to include patient-specific information on the HA plan of care for Patient 7 and Patient 10 to ensure the HA was able to effectively meet the patient’s needs.”

“Based on record review, policy and procedure review, and staff interview, the agency failed to ensure a Registered Nurse (RN) conducted an on-site visit at least every 14 days to the patient’s home, for 3 of 16 patients reviewed (Patient 3, 14 and 15), who received hospice aide (HA) services, to ensure the HA services meet the needs of the patient. The total sample size was 19. The census was 50. Findings are: A. Review of the agency policy and procedure titled 33.37 Aide and Homemaker Plan of Care, last revised 8/10/22, revealed the RN was to visit the patient’s residence to supervise the aides at least every 14 days when aide services are provided. The visit was to include an assessment of the aide services, with or without the aide present. B. Review of Patient 3’s clinical record revealed: 1.The Hospice Certification Plan of Care Update for the certification period of 8/17/24 through 10/15/24 included orders for HA services 2 times per week for 8 weeks, then 1 time a week for 1 week for assistance with personal care, hygiene, and activities of daily living (ADLs). 2. The Hospice Certification Plan of Care Update for the certification period of 10/16/24 through 12/14/24 included orders for HA services 3 times per week for 8 weeks for assistance with personal care, hygiene, and ADLs. 3. Review of skilled nurse (SN) visits from 8/1/24 through 11/4/24 revealed RN visits conducted on 9/4/24, 9/30/24, and 10/16/24, for an onsite visit to the patient’s home, for the purpose of a HA supervisory visit. There was no documentation an onsite HA supervisory visit by an RN was conducted every 14 days between 9/4/24 and 9/30/24, or between 9/30/24 and 10/16/24. C. Review of Patient 14’s clinical record revealed: 1.The Hospice Certification Plan of Care Update for the certification period of 7/31/24 through 9/28/24 included orders for HA services 1 times per week for 1 week, then 2 times a week for 8 weeks for assistance with personal care, hygiene, and ADLs. 2.The Hospice Certification Plan of Care Update for the certification period of 9/29/24 through 11/27/24 included orders for HA services 5 times per week for 8 weeks, then 3 times per week for 1 week, for assistance with personal care, hygiene, and ADLs. 3.Review of SN visits from 8/1/24 through 11/4/24 revealed RN visits conducted on 8/25/24, 9/17/24, and 10/6/24 for an onsite visit to the patient’s home for the purpose of a HA supervisory visit. There was no documentation an onsite HA supervisory visit by an RN was conducted every 14 days between 8/25/24 and 9/17/24, or between 9/17/24 and 10/6/24. D. Review of Patient 15’s clinical record revealed: 1.The Hospice Certification Plan of Care Update for the certification period of 7/24/23 through 10/21/23 included orders for HA services 2 times per week for 6 weeks, then 1 time a week for 1 week, then 2 times per week for 6 weeks, for assistance with personal care, hygiene, and ADLs. 2. Review of SN visits from 7/27/23 through 11/4/23 revealed RN visits conducted on 7/27/23 and 8/17/24 for an onsite visit to the patient’s home for the purpose of a HA supervisory visit. There was no documentation an onsite HA supervisory visit by an RN was conducted every 14 days between the 7/27/23 and 8/17/23. E. During an interview on 11/12/24 at 3:30 PM, the Director of Clinical Services confirmed the hospice failed to ensure RNs conducted onsite HA supervisory visits at least every 14 days for Patients 3, 14, and 15, who received HA services.”