Vitas Healthcare Corporation of Ohio

“It is required that hospice aides are assigned to a specific patient by a registered nurse 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 24 (4%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA received all updates to written patient care instructions. Clinical Record 27: The patient elected hospice care on 07/06/2024. A Hospice Aide plan of care was initiated on 07/07/2023 and continued through 04/17/2024 with updates. The HA plan of care dated 07/07/2023 documented the directive for the HA that the left lower arm cast would be removed within a week or two. The cast was removed within two weeks of 07/07/2023, but the Hospice Aide plan of care was not updated with the change through 04/17/2024. During an interview on 04/22/2024, the General Manager and Regional Patient Care Manager stated that the aide plan should have been updated but it was missed.”

“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 and interview. In 7 of 24 (29%) clinical records reviewed of patients receiving Hospice Aide services, the agency did not ensure that the Hospice Aide (HA) provided services included in the plan of care. Clinical Record 3: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient was confused and at risk of elopement. A review of HA visit notes dated 11/08/2023 through 04/11/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for five (5) months. Clinical Record 5: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient was confused and at risk of elopement. A review of HA visit notes dated 12/08/2023 through 03/06/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for four (4) months. Clinical Record 8: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 12/20/2023 through 02/07/2024 revealed that a monthly weight was documented on 02/07/2024. After 02/07/2024, the HA visit notes dated through 04/11/2024 were reviewed and revealed no documented weights. No weights were documented initially for six (6) weeks then not for two (2) months. Clinical Record 12: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient had confusion and was at risk of elopement. A review of HA visit notes dated 01/18/2024 through 04/18/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for three (3) months. Clinical Record 13: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient had confusion and was at risk of elopement. A review of HA visit notes dated 11/20/2023 through 03/18/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for four (4) months. Clinical Record 15: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient had confusion and was at risk of elopement. A review of HA visit notes dated 10/06/2023 through 11/22/2023 revealed that monthly weights were documented as not performed/declined. No weights were documented for one (1) month. Clinical Record 23: The Hospice Aide Plan of Care assigned the HA the relevant tasks: inspecting/lotion applied to the skin, perineal care, showered with a bath chair each visit. For the HA visits dated 11/13/2023, 12/11/2023, 12/18/2023, 01/22/2024, and 01/29/2024 the HA documented that the assigned tasks were “Not performed/Not required for these visits.” The HA note documented that the facility aide was updated. For the HA visits dated 01/04/2024 and 01/08/2024, the HA documented the assigned task showered with a bath chair as “not performed/not required” and “spoke to facility aide.” During an interview, the General Manager and Regional Patient Care Manager confirmed the findings and stated that they would provide education.”

“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. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 7 of 24 (29%) clinical records reviewed of patients receiving Hospice Aide services, the agency did not ensure that the Hospice Aide (HA) reported changes in the patient’s needs related to the plan of care to the Registered Nurse (RN). Clinical Record 3: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 11/08/2023 through 04/11/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for five (5) months. The hospice patient was confused and at risk of elopement. The HA visit notes documented “not answered” on the line with a printed response “... notification/report to the nurse and directions received.” It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. Clinical Record 5: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 12/08/2023 through 03/06/2024 revealed that monthly weights were documented as not performed/declined. The hospice patient was confused and at risk of elopement. No weights were documented for four (4) months. The HA visit notes documented “not answered” on the line with a printed response “... notification/report to the nurse and directions received.” It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. Clinical Record 8: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 12/20/2023 through 02/07/2024 revealed that a monthly weight was documented on 02/07/2024. After 02/07/2024, the HA visit notes dated through 04/11/2024 were reviewed and revealed no documented weights. No weights were documented initially for six (6) weeks then not for two (2) months. The HA visit notes documented “not answered” on the line with a printed response “... notification/report to the nurse and directions received.” It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. Clinical Record 12: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 01/18/2024 through 04/18/2024 revealed that monthly weights were documented as not performed/declined. The hospice patient had confusion and was at risk of elopement. No weights were documented for three (3) months. The HA visit notes documented “not answered” on the line with a printed response “... notification/report to the nurse and directions received.” It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. Clinical Record 13: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 11/20/2023 through 03/18/2024 revealed that monthly weights were documented as not performed/declined. The hospice patient had confusion and was at risk of elopement. No weights were documented for four (4) months. The HA visit notes documented “not answered” on the line with a printed response “... notification/report to the nurse and directions received.” It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. Clinical Record 15: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 10/06/2023 through 11/22/2023 revealed that monthly weights were documented as not performed/declined. The hospice patient had confusion and was at risk of elopement. No weights were documented for one (1) month. The HA visit notes documented “not answered” on the line with a printed response “... notification/report to the nurse and directions received.” It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. Clinical Record 23: The Hospice Aide Plan of Care assigned the HA the relevant tasks: inspecting/lotion applied to the skin, perineal care, showered with a bath chair each visit. For the HA visits dated 11/13/2023, 12/11/2023, 12/18/2023, 01/22/2024, and 01/29/2024 the HA documented that the assigned tasks were “Not performed/Not required for these visits.” The HA note documented that the facility aide was updated. For the HA visits dated 01/04/2024 and 01/08/2024, the HA documented the assigned task showered with a bath chair as “not performed/not required” and “spoke to facility aide.” There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient’s needs and care plan. During an interview, the General Manager and Regional Patient Care Manager stated that they would provide education. Interviews with the HA revealed that the hospice case managers were called, and messages left, but documentation was not clear.”

“It is required that hospice inpatient facilities provide a sanitary environment by following current standards of practice, including nationally recognized infection control precautions, and avoiding sources and transmission of infections and communicable diseases. This standard was not met as evidenced by observation, document review, and interview. The hospice did not ensure that the inpatient facility provided a sanitary environment by avoiding sources and transmission of infections and communicable diseases. The tour of the inpatient unit on 04/23/2024 with the Inpatient Manager, Admission Director, and Facilities Maintenance Director revealed that a bathroom had been converted and labeled as a storage area. There were several commodes, approximately 5 fans, a wheelchair, and some IV (intravenous) poles in this room. Some of the commodes were tagged, but the majority of the equipment was not tagged. The equipment was intended for patient use, as verified through interview. One of the fan blades had a layer of dust that was visible. None of the fans were tagged. Cleaned equipment was not tagged to ensure that cleanliness was maintained. During an interview, the Housekeeping Director verified a log that documented the daily cleaning of equipment. LSC inpatient tour on 04/23/2024 with the inpatient manager, admission director, and facilities maintenance director revealed the following items which lacked proper sanitary processes and standard infection control processes to avoid sources of transmission of infections. The following items were confirmed through observation and interviews not to be stored in a manner to prevent infections. A bathroom had been converted and labeled as a storage area. There were several commodes, about 15 fans wheel chair and some IV poles in this room. A couple of commodes were bagged but the majority of equipment was not bagged. The equipment was intended for patient use, as verified through interview. One of the fan blades had a layer of dust that was visible. None of the fans were bagged. Interview with the housekeeping director verified a log that documented daily cleaning of equipment. Cleaned equipment was not bagged or tagged to ensure that cleanliness was maintained.”