Advantage Home Health and Hospice

“Based on a review of agency policy/procedure, a review of clinical records, and an interview with the agency Administrator, agency failed to ensure volunteers were used in day-to-day direct patient care roles for nine (9) of fourteen (14) clinical records (CR) reviewed (CR#2, CR#4-CR#7, CR#9-CR#11, CR#13). Findings: Agency policy/procedure reviewed on May 30, 2024 at approximately 11:00 a.m. ‘Volunteer Services’ ‘Policy’ “Hospice uses volunteers in administrative or direct care roles ....”’Procedure’ (9) “Volunteer duties may include, but are not limited to: Patient care activities, .....Administrative support activities: ....” Patient CRs were reviewed on May 30, 2024 between approximately 10:30 a.m. and 2:00 p.m. Patients start of care (SOC) is listed below. CR#2, SOC 12/01/23: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#4, SOC 01/31/24: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#5, SOC 05/17/24: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#6, SOC 05/15/24: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#7, SOC 02/27/24: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#9, SOC 09/01/23: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#10, SOC 04/17/24: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR#11, SOC 02/17/23: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. CR13, SOC 07/12/23: No documentation provided of the agency offering volunteer services and/or the patient refusing volunteer services. An interview conducted with the agency Administrator on May 30, 2024, at approximately 2:15 p.m. confirmed the above findings.”

“Based on a review of agency policy/procedure, a review of agency volunteer use records, and an interview with the agency Administrator, agency failed to ensure volunteers provide day-to-day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours, for one (1) of one (1) volunteer cost savings documentation (VCSD) reviewed (VD#1). Findings: Agency policy/procedure reviewed on May 30, 2024 at approximately 11:00 a.m. ‘Volunteer Services’ ‘Policy’ “Hospice uses volunteers in administrative or direct care roles ....”’Procedure’ (2) Hospice will document the cost savings achieved through the use of volunteers and will include: “.....Hospice will document and maintain a volunteer staff sufficient to provide administrative and/or direct patient care in an amount that, at a minimum, equals 5% of the total patient care hours of all paid hospice employees and contract staff. Hospice will document a continuing level of volunteer activity. ....” VCSD was reviewed on May 29, 2024 at approximately 11:30 a.m. VD#1: Volunteer cost savings was requested for the past (12) months. The total cost savings equated to 3 percent. An interview conducted with the agency Administrator on May 30, 2024, at approximately 2:15 p.m. confirmed the above findings.”

“Based on a request of agency policy/procedure, a review of the hospice inpatient agreement with an outside facility, and an interview with the agency Administrator, agency failed to ensure an arrangement was established with a facility (in a written agreement), to provide for short-term inpatient care, for one (1) of one (1) facility inpatient written agreements (FA) reviewed (FA#1). Findings: Agency policy/procedure related to obtaining a written agreement from a facility to provide short term in-patient care was requested on May 30, 2024 at approximately 11:00 a.m. No specific policy provided. FA was reviewed on May 29, 2024 at approximately 1:00 p.m. FA#1: The ‘Agreement for Hospice Services’ between the hospice agency and the facility (hospital network in western and central Pennsylvania (Pa.) ) was dated 10/30/23 (effective date). ‘Exhibit A’ “The (facilities) included within this agreement shall be: “........... “ (Locations (inpatient settings) listed included the following: Hershey, Pa. 17033, Reading, Pa. 19605, Enola, Pa. 17025, Lancaster, Pa. 17601). The closest facility to the agency is approximately (32) miles, approximately (50) minutes west of the agency.(Note: The agreement was signed by a hospice agency representative. The agreement was not signed by the facility representative.) An interview conducted with the agency Administrator on May 30, 2024, at approximately 2:15 p.m. confirmed the above findings.”

“Based on a request of agency policy/procedure, skilled nursing facility contracts, a review of clinical records, and an interview with the agency Administrator, agency failed to provide to the facility with the following: The most recent hospice plan of care specific to each patient nor the physician certification and/or recertification of the terminal illness for one (1) of one (1) skilled nursing facilities (SNF) visited (SNF#1). Findings: Agency policy/procedure related to the hospice ensuring the most recent Hospice plan of care specific to each patient and the Physician certification and/or recertification of the terminal illness was requested on May 30, 2024 at approximately 11:00 a.m. No specific policy provided. SNF #1: Review of the agency/facility written agreement was conducted on May 30, 2024 at approximately 10:00 a.m. Documentation provided of ‘Nursing Facility Agreement’ dated November 3, 2023. Section 4.2.4 ‘Obtaining information from the Hospice:’ “a. The most recent Hospice Plan of Care for each Hospice patient. ...c. Physician certification and if applicable, recertification of the terminal illness for each Hospice patient. ...” (Note: The agreement was signed by SNF#1 (Administrator). The agreement was not signed by the agency.) During a home visit conducted at the facility on 05/29/24, the most recent hospice plan of care nor the physician certification and/or recertification of terminal illness was in the patients (CR#2) hospice chart. This was confirmed by the Hospice Vice-President of Compliance, who was present during the home visit. An interview conducted with the agency Administrator on May 30, 2024, at approximately 2:15 p.m. confirmed the above findings.”

“Based on a request of agency policy/procedure, a review of hospice services contracts, and an interview with the agency Administrator, agency failed to assure hospice philosophy orientation for skilled nursing facility staff for one (1) of one (1) skilled nursing facility contracts (SNFC) reviewed (SNFC#1). Findings: Agency policy/procedure related to the hospice assuring hospice philosophy orientation for skilled nursing facility staff was requested on May 30, 2024 at approximately 11:00 a.m. No policy provided. SNFC #1: Review was conducted on May 30, 2024 at approximately 10:00 a.m. of the agency/facility written agreement. Documentation provided of ‘Nursing Facility Agreement’ dated November 3, 2023. Section 5.8 ‘Education and In-Services’ “Hospice retains the responsibility for arranging Hospice training, upon execution of this agreement, of facility personnel who will be providing patient care, and a description of the training and instructor name will be documented by Hospice. ....” (Note: The agreement was signed by SNF#1 (Administrator). The agreement was not signed by the agency.) Documentation requested of the agency assuring hospice philosophy orientation for skilled nursing facility staff was requested on May 30, 2024 at approximately 10:30 a.m. No documentation provided. An interview conducted with the agency Administrator on May 30, 2024, at approximately 2:15 p.m. confirmed the above findings.”