Heartland Hospice

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed, it was revealed that the agency did not ensure that the hospice Interdisciplinary Group completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. CLINICAL RECORD 3: The patient elected the hospice benefit on 07/04/2024. The Social Worker completed the initial assessment on 07/10/2024, six days after admission. The record lacked documentation as to why the visit was not completed within the 5-day requirement. A clinical record review and interview was conducted with the Administrator and Alternative Administrator on 02/19/2025 in which the Administrator stated the Social Worker had been counseled on late documentation.”

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current: Prescription and over-the-counter (OTC) drugs; Supplements; Herbal remedies; Other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 7 (29%) clinical records reviewed, it was revealed that the agency did not ensure that the comprehensive assessment includes a drug profile that contains the patient’s current: Prescription and over-the-counter (OTC) drugs; Supplements; Herbal remedies; Other alternative treatments that could affect drug therapy. Home Visit 2/Clinical Record 2: The patient elected the hospice benefit on 01/07/2025 for a diagnosis of chronic obstructive pulmonary disease. The patient resided in a private home. During the home visit on 02/19/2025, with the Spiritual Counselor (Personnel Record 6), the patient was interviewed by surveyor about her medications. The patient advised she had “multiple allergies and was allergic to Albuterol.” The hospice medication list, printed on 02/18/2025, was reviewed with the patient; it included “Albuterol Sulfate 2.5 mg/3ml 1 unit every 6 hours as needed for shortness of breath.” The patient advised she did not take that as she was allergic. She advised she had “told the admission nurse she had a lot of allergies but thought they had gotten the list from her other hospice.” She further went on to state that “she had never taken the Albuterol and had told the nurses not to order it.” The hospice Spiritual Counselor contacted the nurse to update her regarding the allergies. Home Visit 3/Clinical Record 3: The patient elected the hospice benefit on 07/04/2024 for the diagnosis of senile degeneration of the brain. A home visit was conducted on 02/19/2025, with the Registered Nurse (Personnel Record 4). The hospice medication list (printed on 02/18/2025) was compared with the Group Home Medication List (printed on 02/19/2025). The lists had the following discrepancies: group home listed Modafinil 100mg take 1/2 tablet and hospice list instructed to take 1 tablet; and the group home had the following medications not listed on the hospice medication list: Potassium 10 mEq daily, scopolamine 1 patch behind ear every 3 days, Senna Plus 8.6 mg 2 tablets at bedtime, and Thick It add 1 scoop to drinks daily. A clinical record review and interview was conducted with the Administrator and Alternative Administrator on 02/20/2025 in which the Administrator advised the nurses should have updated the medication lists.”

“It is required that medical social services are provided by a qualified social worker per the plan of care according to the patient’s and family’s needs and acceptance of these services. This standard was not met as evidenced by clinical record review, observation, and interview. In 3 of 7 (43%) clinical records reviewed, in which social services were accepted, it was revealed that the agency did not ensure the services were provided according to the plan of care. CLINICAL RECORD 1/Home Visit 1: The initial psychosocial assessment was completed on 01/31/2025 by the Registered Nurse. The nurse documented a social worker (MSW) assessment was needed. The admission order (01/31/2025) listed the MSW visit frequency as 1 time monthly. An initial MSW assessment was not completed, and no monthly visits had been documented to date. During the home visit, conducted on 02/19/2025, the patient and his wife reported they need assistance with their living situation as their property has been sold. The wife stated she “didn’t know they had a hospice social worker available to help but would welcome the help.” The interdisciplinary group meeting notes dated 01/31/2025 and 02/10/2025 were not signed by MSW and did not have care plan updates documented. CLINICAL RECORD 3: The Social Work visit frequency determined upon initial assessment dated 07/2024 were for visits 1x month. There were no documented social work visits for September 2024, December 2024 or January 2025. CLINICAL RECORD 4: The initial Social Work visit frequency dated 07/2024 stated, “support 1x month.” No visits were documented in August 2024 or September 2024. The patient revoked in late September 2024. A clinical record review and interview was conducted with the Administrator and Alternative Administrator on 02/19/2025 in which the Administrator stated she “was having issues with documentation from the Social Worker and was in the process of hiring another Social Worker.””

“It is required Hospice aides are assigned to a specific patient by a registered nurse (RN) who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed, in which hospice aide services were accepted, it was revealed that the agency did not ensure the registered nurse provided specific written instructions for the hospice aide. CLINICAL RECORD 2: The patient elected the hospice benefit on 01/07/2025 for the diagnosis of chronic obstructive pulmonary disease. The initial nursing assessment dated 01/07/2025 noted the patient to be on oxygen at 3 liters per minute continuously. The hospice aide care plan dated 01/07/2025 included the following relevant tasks: bathing via shower, dressing in pajamas or street clothes, shampoo hair, and blow dry hair every visit. The aide frequency was 3x week. The aide care plan did not include specific instructions for the oxygen during tasks. A clinical record review and interview was conducted with the Administrator and Alternative Administrator on 02/19/2025 in which the Administrator stated the “aide blow drying the patient’s hair with the oxygen probably wasn’t safe.””

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 7 (14%) clinical records reviewed in which hospice aide services were accepted, it was revealed that the agency did not ensure the aide provided services included in the plan of care as ordered. Home Visit 1/Clinical Record 1: During the home visit with the Hospice Aide (Personnel Record 7) on 02/19/2025, the aide performed the following tasks which were not included in the hospice aide care plan (dated 01/31/2025): trim nails. The aide did not perform the following tasks listed as every visit on the aide care plan: encourage fluids, comb hair, shampoo hair, shower patient, brush teeth, clean nails, peri care, ROM (range of motion) or change linens. A clinical record review and interview was conducted with the Administrator and Alternative Administrator on 02/19/2025 in which the Administrator stated the “aide should not be cutting nails and should have completed all tasks on the care plan.””

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide. Ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 3 of 7 (43%) clinical records reviewed, in which aide services were accepted, it was revealed that the agency did not ensure hospice aides were supervised by a registered nurse who made an on-site visit to the patient’s home at least every 14 days to assess the quality of care and services. CLINICAL RECORD 2: An Aide supervisory visit was documented on 01/21/2025 and next one 15 days later on 02/05/2025. CLINICAL RECORD 3: An Aide supervisory visit was documented on 10/25/2023 and next one 15 days later on 11/09/2023. CLINICAL RECORD 6: An Aide supervisory visit was documented on 11/02/2024 and the next one 28 days later on 11/30/2024. A clinical record review and interview was conducted with the Administrator and Alternative Administrator on 02/19/2025 in which the Administrator agreed the visits were late.”

“It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. The hospice has written policies and procedures describing the method(s) of assessing competency and maintains a written description of the in-service training provided during the previous 12 months. This standard was not met as evidenced by document review, interview and personnel record review. In 3 of 9 (33%) personnel records reviewed revealed the agency did not ensure that the hospice assessed the skills and competencies of all individuals providing care in accordance with agency policy. Agency Policy 4.28.1, Staff Competency Program (revised February 2021), stated in relevant part, “1. Patient care staff will be competency tested during orientation and at least every three years. 3. Qualified individuals will observe the employee during competency evaluations. 4. Examples of qualified individuals to perform competency assessments may include: Registered nurse (RN): Competency assessed by peer RN; Social Worker (SW): Competency assessed by peer SW; Chaplain: Competency assessed by another Chaplain or Clergy; Hospice aide: Competency assessed by RN.” Personnel Record 1: A Medical Director, hired in 2023, did not have initial competencies for 2023. Personnel Record 4: A Registered Nurse, hired in 2025, had initial competencies signed off by the Administrator, who is not a nurse. Personnel Record 5: A Social Worker, hired in 2024, had initial competencies signed off by the Administrator, who is not a social worker. A personnel record review and interview were conducted with the Administrator and Alternative Administrator on 02/18/2025 in which the Administrator agreed the policy stated, “like disciplines should have signed off the competencies.””