Commonwealth Hospice, LLC

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group and 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 2 of 17 (11%) clinical records reviewed of patients receiving hospice aide services, the agency did not ensure the hospice aide care plan provided specific care instructions, thus leaving the aide to make decisions outside the scope of practice. Clinical Record 6: The patient elected hospice benefit was dated 10/27/2023. The initial comprehensive assessment dated 10/27/2023, the Registered Nurse, (RN) documented the patient was short of breath and required Oxygen at 4L/NC continuously. There was no documented evidence on the aide plan of care by the RN dated 10/27/2023 for specific oxygen precautions or specific instruction for the aide regarding the oxygen. Clinical Record 12: The patient elected hospice benefit was date 09/21/2023. The initial comprehensive assessment dated 9/21/23, the Registered Nurse (RN) documented that the patient had a 16F indwelling foley catheter. There was no documented evidence on the hospice aide plan of care by the RN dated 9/21/23 for specific instructions for the aide regarding the foley catheter. The catheter care and drainage bag section on the aide care plan were blank. During the interview on 11/16/2023, the administrator confirmed that the RN did not provide specific instructions to the aide. 2 of 17 (12%) of clinical records reviewed with a hospice aide involved in the care, the agency did not ensure that the aide care plan provided appropriate direction to the aide to meet the individual patient needs.”

“It is required that a hospice aide provides services 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 1 of 17 (6%) records reviewed of patients receiving hospice aide services revealed that the agency did not provide aide services when ordered by the Interdisciplinary Group. and only provided services included in the aide care plan. Clinical Record 6: The patient elected the hospice benefit on 10/27/2023. There was no documented evidence on the hospice aide care plan by the Registered Nurse (RN) dated 10/27/23, that any of the prefilled tasks were marked on the aide care plan. The hospice aide instructions were “Shave the patient when you see visible hair growth on the face as needed. Change linens when visibly soiled as needed. Weights are monthly. Report to RNCM/nurse/facility staff if the patient refuses care or has any reddened areas or change in condition. Assist with ambulation when the patient is weak and unable to walk. Notify RNCM nurse/facility staff if this occurs. Patient has skin tear to right shin. If the dressing is soiled or not intact, please notify the facility nurse and agency nurse.” The hospice aide documented in the aide notes dated 10/31/23 and 11/4/2023 the completion of chair bath, assisted with dressing, incontinence care, active ROM, passive ROM, clean dentures, comb hair, lotion, clean/file nails, oral care, and back rub which were not included on the hospice aide plan of care. There was no documented evidence that the aide notified the RN supervisor of changes in the task completed. In an interview on 11/15/2023, the administrator stated in part, “I am not sure how that was missed” and confirmed the finding. 1 of 17 (6%) clinical records reviewed with a hospice aide, the agency did not ensure that the aide followed the care plan and only provided services included in the aide care plan.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum, physician orders for all interventions. This standard was not met as evidenced by clinical record review and interview. 1 of 19 (5%) records reviewed revealed that the agency did not ensure physician orders for all interventions. Clinical Record 7: The patient elected the hospice benefit on 04/27/2023. The Registered Nurse (RN) comprehensive recertification assessment dated 10/9/2023 read in part, “He has increased and randomly occurring SOB at times without any precipitating factors. The RN documented the patient had oxygen. There was no documented evidence in the clinical record of a physician order for oxygen. In an interview on 11/16/2023, the administrator stated that he called the nurse to confirm if the patient actually had the oxygen in the home and confirmed that there was oxygen in the home and that there was no order in the clinical record for the oxygen. 1 of 19 (5%) of clinical records reviewed that the agency failed to obtain physician orders for all interventions.”