Jefferson Health at Home By Bayada

“Based on review of hospice policies, clinical records (CR), and interview with hospice staff, the hospice failed to provide services as ordered for four (4) of nineteen (19) CR reviewed. (CR #2, 7, 10, and 17) Findings include: Review of hospice policy #0-6277 “;Missed Visits/Hours” on July 16, 2024, at approximately 4:00 P.M. stated, “;Our Procedure: 1.0 Communicating Missed Visits/Hours. 1.1 Physician Ordered Services. The physician must be notified when the plan of care is altered due to fewer visits or hours of service being provided as ordered. Notification of the missed visit/hours is timely, and as directed on a schedule determined in collaboration with the physician. 1.1.1 Documentation – Home Health and Hospice Offices. 1.1.1.1 A missed visit note to capture the reason that the visit was missed as well as evidence that the physician was informed verbally or by fax (unless otherwise required by State regulation) of this variation from the plan of care must be entered in the electronic record...” A review of clinical records was conducted on July 15, 2024, from approximately 11:00 A.M. to 3:30 P.M., and July 16, 2024, from approximately 1:00 P.M. to 4:00 P.M., revealed the following: CR #2, start of care and hospice benefit election date June 2, 2024. Certification period reviewed – June 2, 2024, through August 30, 2024. Hospice aide (HHA) services were ordered three (3) times per week for thirteen (13) weeks, beginning June 2, 2024. There was documentation of two (2) HHA visits the week of June 9, 2024, through June 15, 2024, June 16, 2024, through June 22, 2024, and July 7, 2024, through July 13, 2024. There was no documentation that the visit frequency had been amended or that the physician was notified that visits were not provided as ordered. CR #7, start of care and hospice benefit election date February 19, 2024. Certification period reviewed May 19, 2024, through August 16, 2024. HHA services were ordered two (2) times per week for thirteen (13) weeks. There was documentation of one (1) HHA visit the week of May 19, 2024, through May 25, 2024, June 23, 2024, through June 29, 2024, June 30, 2024, through July 6, 2024, and July 7, 2024, through July 13, 2024. There was no documentation that the visit frequency had been amended or that the physician was notified that visits were not provided as ordered. CR #10, start of care and hospice benefit election date June 1, 2024. Certification period reviewed, June 1, 2024, through August 29, 2024. Skilled nursing visits were ordered one (1) per week for one (1) week, three (3) per week for one (1) week, and two (2) per week for eleven (11) weeks (beginning June 9, 2024). There was documentation of one (1) skilled nursing visit the week of June 23, 2024, through June 29, 2024, and July 7, 2024, through July 13, 2024. No skilled nursing visits were documented the week of June 30, 2024, through July 6, 2024. There was no documentation that the visit frequency had been amended or that the physician was notified that visits were not provided as ordered. CR #17, start of care and hospice benefit election date May 20, 2023. Certification period reviewed May 14, 2024, through July 12, 2024. Home hospice aide (HHA) services were ordered three (3) times per week for nine (9) weeks. There was documentation of two (2) HHA visits the week of May 26, 2024, through June 1, 2024, and one (1) HHA visit the week of June 23, 2024, through June 29, 2024. There was no documentation that the visit frequency had been amended or that the physician was notified that visits were not provided as ordered. An interview with the hospice Administrator and the Clinical Manager on July 16, 2024, at approximately 5:15 P.M confirmed the above findings.”

“Based on a review of hospice policy, clinical records (CRs), and staff interviews, the hospice failed to ensure that a registered nurse documented an on-site visit to the patient’s home no less frequently than every 14 days (two weeks) to assess the quality of care and services provided by the home hospice aide (HHA) for two (2) of nineteen (19) CR reviewed. (CR #2 and 7) Findings include: Review of hospice policy #0-4849 “;Frequency Of Staff Supervision – Hospice” on July 16, 2024, at approximately 3:45 P.M. stated, “;Our Procedure: ... 4.0 Home Health Aide Supervision. For clients receiving Home Health Aide (HHA) Services, an RN must make an on-site visit to the clients home: 4.1 No less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the clients needs. The hospice aide does not have to be present during this visit...” A review of clinical records was conducted on July 15, 2024, from approximately 11:00 A.M. to 3:30 P.M., and July 16, 2024, from approximately 1:00 P.M. to 4:00 P.M., revealed the following: CR #2, start of care and hospice benefit election date June 2, 2024. Certification period reviewed – June 2, 2024, through August 30, 2024. HHA services were ordered three (3) times per week for thirteen (13) weeks, beginning June 2, 2024. The registered nurse conducted skilled nursing visits twice weekly from June 2, 2024, through June 8, 2024, then weekly from June 9, 2024, through July 15, 2024. There was no documentation of HHA supervisions conducted every fourteen (14) days. CR #7, start of care and hospice benefit election date February 19, 2024. Certification period reviewed May 19, 2024, through August 16, 2024. HHA services were ordered two (2) times per week for thirteen (13) weeks. The registered nurse conducted weekly skilled nursing visits from May23, 2024, through July 12, 2024. There was no documentation of HHA supervisions conducted every fourteen (14) days. An interview with the hospice Administrator and the Clinical Manager on July 16, 2024, at approximately 5:15 P.M confirmed the above findings.”