Providence Hospice Care

“It is required that a hospice aide provide services that are ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 9 of 13 (69%) applicable clinical records reviewed, the agency did not ensure the aide provided care as ordered in the plan of care. CLINICAL RECORD 1: The patient elected the hospice benefit on 04/24/2025, with a terminal diagnosis of severe protein-calorie malnutrition. The aide plan of care assignment created by the Registered Nurse dated 07/23/2025 assigned the task of nail care to be provided every visit. The aide documented on aide visit notes dated 07/31/2025, 08/04/2025, 08/05/2025, 08/07/2025, 08/11/2025, 08/12/2025 and 08/13/2025 that nail care was not completed at each visit. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 3: The patient elected the hospice benefit on 07/25/2025, with a terminal diagnosis of malignant neoplasm of the colon. The aide plan of care assignment created by the Registered Nurse dated 07/25/2025 assigned the task of nail care and oral care to be provided every visit. The aide documented on aide visit notes dated 08/01/2025 and 08/05/2025 that nail care was not completed at each visit. The aide documented on aide visit notes dated 08/07/2025, 08/12/2025, and 08/14/2025 that oral care were not marked completed at each visit. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 6: The patient elected the hospice benefit on 02/26/2025, with a terminal diagnosis of neurocognitive disorder with Lewy bodies. The aide plan of care assignment created by the Registered Nurse dated 05/27/2025 assigned the task of change linen, empty trash in patient room, nail care, oral care, change brief, and shampoo to be provided every visit. The aide documented on aide visit note dated 06/05/2025 that shampoo, empty trash, change brief, oral care, and nail care was not completed at this visit. The aide documented on aide visit notes dated 07/24/2025, 08/07/2025, and 08/14/2025 that nail care, oral care, and shampoo were not completed at these visits. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 7: The patient elected the hospice benefit on 06/11/2025, with a terminal diagnosis of Alzheimer’s. The aide plan of care assignment created by the Registered Nurse dated 06/11/2025 assigned the task of change linen, empty trash in patient room, nail care, and shampoo to be provided every visit. The aide documented on aide visit notes dated 06/21/2025, 06/23/2025, 06/25/2025, 06/27/2025, 06/30/2025, and 07/01/2025 that change linen, empty trash, and shampoo were not completed at these visits. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 8: The patient elected the hospice benefit on 06/16/2025, with a terminal diagnosis of atherosclerotic heart disease. The aide plan of care assignment created by the Registered Nurse dated 06/16/2025 assigned the task of change linen and nail care to be provided every visit. The aide documented on aide visit notes dated 07/23/2025, 07/25/2025, 07/28/2025, 07/30/2025, 08/01/2025, and 08/13/2025 that change linen, and nail care were not completed at each visit. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 9: The patient elected the hospice benefit on 07/11/2025, with a terminal diagnosis of severe protein-calorie malnutrition. The aide plan of care assignment created by the Registered Nurse dated 07/11/2025 assigned the task of change linen and shampoo to be provided every visit. The aide documented on aide visit notes dated 08/07/2025 and 08/15/2025 that change linen and shampoo were not completed at each visit. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 11: The patient elected the hospice benefit on 03/08/2025, with a terminal diagnosis of late effects of CVA. The aide plan of care assignment created by the Registered Nurse dated 03/08/2025 assigned the task of change linen, nail care, and shave to be provided every visit. The aide documented on aide visit notes dated 05/06/2025 that nail care was not marked completed. The aide documented on aide visit note dated 05/09/2025 that change linen, nail care, and shave were not marked completed. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 12: The patient elected the hospice benefit on 01/18/2025, with a terminal diagnosis of heart failure. The aide plan of care assignment created by the Registered Nurse dated 04/18/2025 assigned the task of empty trash in patient room to be provided every visit. The aide documented on aide visit notes dated 06/06/2025, 06/10/2025, 06/12/2025, and 06/13/2025 that empty trash was not marked completed at each visit. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. CLINICAL RECORD 13: The patient elected the hospice benefit on 06/27/2025, with a terminal diagnosis of senile degeneration of the brain. The aide plan of care assignment created by the Registered Nurse dated 06/27/2025 assigned the task of shave to be provided every visit. The aide documented on aide visit notes dated 07/28/2025, 07/30/2025, and 08/01/2025 that shave was not completed at each visit. The aide did not follow the aide plan of care assignment or give a reason as to why she did not complete the task. This was shared with leadership on 08/21/2025, and in an interview on the same day with the Director of Nursing (Personnel Record 3), who stated, “ They need to do more education with the aides.””

“It is required that the hospice aides must report changes in the patient’s nursing, needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities. This standard was not met as evidenced by clinical record review and interview. In 9 of 13 (69%) applicable clinical records reviewed, the agency did not ensure the aide reported change in the patient’s needs to the registered nurse. CLINICAL RECORD 1: The patient elected the hospice benefit on 04/24/2025, with a terminal diagnosis of severe protein-calorie malnutrition. The aide plan of care assignment created by the Registered Nurse dated 07/23/2025 assigned the task of nail care to be provided every visit. The aide documented on aide visit notes dated 07/31/2025, 08/04/2025, 08/05/2025, 08/07/2025, 08/11/2025, 08/12/2025 and 08/13/2025 that nail care was not completed at each visit. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 3: The patient elected the hospice benefit on 07/25/2025, with a terminal diagnosis of malignant neoplasm of the colon. The aide plan of care assignment created by the Registered Nurse dated 07/25/2025 assigned the task of nail care and oral care to be provided every visit. The aide documented on aide visit notes dated 08/01/2025 and 08/05/2025 that nail care was not completed at each visit. The aide documented on aide visit notes dated 08/07/2025, 08/12/2025, and 08/14/2025 that oral care were not marked completed at each visit. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 6: The patient elected the hospice benefit on 02/26/2025, with a terminal diagnosis of neurocognitive disorder with Lewy bodies. The aide plan of care assignment created by the Registered Nurse dated 05/27/2025 assigned the task of change linen, empty trash in patient room, nail care, oral care, change brief, and shampoo to be provided every visit. The aide documented on aide visit note dated 06/05/2025 that shampoo, empty trash, change brief, oral care, and nail care was not completed at this visit. The aide documented on aide visit notes dated 07/24/2025, 08/07/2025, and 08/14/2025 that nail care, oral care, and shampoo were not completed at these visits. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 7: The patient elected the hospice benefit on 06/11/2025, with a terminal diagnosis of Alzheimer’s. The aide plan of care assignment created by the Registered Nurse dated 06/11/2025 assigned the task of change linen, empty trash in patient room, nail care, and shampoo to be provided every visit. The aide documented on aide visit notes dated 06/21/2025, 06/23/2025, 06/25/2025, 06/27/2025, 06/30/2025, and 07/01/2025 that change linen, empty trash, and shampoo were not completed at these visits. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 8: The patient elected the hospice benefit on 06/16/2025, with a terminal diagnosis of atherosclerotic heart disease. The aide plan of care assignment created by the Registered Nurse dated 06/16/2025 assigned the task of change linen and nail care to be provided every visit. The aide documented on aide visit notes dated 07/23/2025, 07/25/2025, 07/28/2025, 07/30/2025, 08/01/2025, and 08/13/2025 that change linen, and nail care were not completed at each visit. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 9: The patient elected the hospice benefit on 07/11/2025, with a terminal diagnosis of severe protein-calorie malnutrition. The aide plan of care assignment created by the Registered Nurse dated 07/11/2025 assigned the task of change linen and shampoo to be provided every visit. The aide documented on aide visit notes dated 08/07/2025 and 08/15/2025 that change linen and shampoo were not completed at each visit. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 11: The patient elected the hospice benefit on 03/08/2025, with a terminal diagnosis of late effects of CVA. The aide plan of care assignment created by the Registered Nurse dated 03/08/2025 assigned the task of change linen, nail care, and shave to be provided every visit. The aide documented on aide visit notes dated 05/06/2025 that nail care was not marked completed. The aide documented on aide visit note dated 05/09/2025 that change linen, nail care, and shave were not marked completed. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 12: The patient elected the hospice benefit on 01/18/2025, with a terminal diagnosis of heart failure. The aide plan of care assignment created by the Registered Nurse dated 04/18/2025 assigned the task of empty trash in patient room to be provided every visit. The aide documented on aide visit notes dated 06/06/2025, 06/10/2025, 06/12/2025, and 06/13/2025 that empty trash was not marked completed at each visit. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. CLINICAL RECORD 13: The patient elected the hospice benefit on 06/27/2025, with a terminal diagnosis of senile degeneration of the brain. The aide plan of care assignment created by the Registered Nurse dated 06/27/2025 assigned the task of shave to be provided every visit. The aide documented on aide visit notes dated 07/28/2025, 07/30/2025, and 08/01/2025 that shave was not completed at each visit. There was no documented evidence that the aide reported to the nurse changes in the patient’s needs. In an interview with the Director of Nursing (Personnel Record 3) on 08/21/2025, it was stated, “ They need to do more education with the aides.””

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The review of the Hospice Volunteer Requirement Report revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. Document 1: The review of the 2024 Hospice Volunteer Requirement Report revealed the volunteer percentage of hours worked for January 2024 through December 2024 was 2.4%. The Administrator stated in an interview on 08/21/2025, that the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. She stated, “They are getting more volunteer hours, and the percentage is up to 4.2% in 2025.” The review of the Hospice Volunteer Requirement Report revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.”