Three Oaks Hospice

“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. Agency Policy #PC.35 “Implementing Care and Treatment” (revised 04/04/23) stated in part, “The HHA will be provided with written instructions for patient care prepared by an RN.” In 7 of 9 (78%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the written patient care instructions prepared by the RN provided the HA clear and specific instructions related to the assigned tasks. Clinical Record 1: The patient elected hospice care on 05/01/2024. The HA care plan, effective 05/01/2024, assigned the HA the relevant tasks: shower, complete bed bath, and partial bath every visit. The HA visit note dated 05/02/2024 documented that a complete bed bath, a partial bath, and a shower were completed. The HA did not receive specific instructions regarding the patient’s type of bath, leaving the HA to make decisions outside their scope of practice. Clinical Record 3: The patient elected hospice care on 04/26/2024. The HA care plan, effective 04/26/2024, assigned the HA the relevant tasks: shower and sponge bath as needed. The HA visit note dated 04/29/2024 documented that a shower and sponge bath were completed. The HA did not receive specific instructions regarding the patient’s type of bath, leaving the HA to make decisions outside their scope of practice. Clinical Record 4: The patient elected hospice care on 06/27/2023. The HA care plan, effective 06/27/2023, assigned the HA the relevant tasks: shower and sponge bath patient as tolerated and provide nail care as tolerated. The HA visit note dated 06/28/2024 documented that a sponge bath, nail care, and a shower were completed. The HA did not receive specific instructions regarding the patient’s type of bath and nail care, leaving the HA to make decisions outside their scope of practice. Clinical Record 5: The patient elected hospice care on 06/22/2023. The HA care plan, effective 06/22/2023, assigned the HA the relevant tasks: shower sponge bath, and nail care as tolerated. The HA visit note dated 06/22/2023 documented that a shower, sponge bath, and nail care were completed. The HA did not receive specific instructions regarding the patient’s type of bath and nail care, leaving the HA to make decisions outside their scope of practice. Clinical Record 6: The patient elected hospice care on 04/04/2023. The HA care plan, effective 04/04/2023, assigned the HA the relevant tasks: shower, bed bath (1) one time a week as needed. The HA visit note dated 04/08/2024 documented that a bed bath and a shower were completed. The HA did not receive specific instructions regarding the patient’s type of bath, leaving the HA to make decisions outside their scope of practice. Clinical Record 7: The patient elected hospice care on 05/29/2024. The HA care plan effective 05/29/2024 assigned the HA the relevant tasks: shower and sponge bath, and nail care as tolerated. The HA visit dated 05/30/2024 documented that a sponge bath, nail care, and a shower were completed. The HA did not receive specific instructions regarding the patient’s type of bath and nail care, leaving the HA to make decisions outside their scope of practice. Clinical Record 11: The patient elected hospice care on 03/05/2023. The HA care plan, effective 03/05/2024, assigned the HA the relevant tasks: complete bed bath and partial bed bath every visit. The HA visit note dated 03/06/2024 documented that a complete bed bath and a partial bath were completed. The HA did not receive specific instructions regarding the patient’s type of bath, leaving the HA to make decisions outside their scope of practice. During an interview and a joint review of clinical records on 06/25/2024, the Director of Nursing (DON) confirmed that the records identified did not provide specific instructions for the aide. No further information was provided.”

“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. Agency Policy #PC.35 “Implementing Care and Treatment.” (revised 04/04/23) stated in part, “Inform Registered Nurse as changes relate to the POC and QAPI activities....” In 7 of 9 (78%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA reported changes related to the plan of care and the patient’s care needs to the Registered Nurse (RN). Clinical Record 1: The patient elected hospice care on 05/01/2024. The HA care plan, effective 05/01/2024, assigned the HA the relevant tasks: shower, complete bed bath, and partial bath every visit. The HA visit note dated 05/02/2024 documented that a complete bed bath, a partial bath, and a shower were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath to meet the patient’s needs. Clinical Record 3: The patient elected hospice care on 04/26/2024. The HA care plan, effective 04/26/2024, assigned the HA the relevant tasks: shower and sponge bath as needed. The HA visit note dated 04/29/2024 documented that a shower and sponge bath were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath to meet the patient’s needs.. Clinical Record 4: The patient elected hospice care on 06/27/2023. The HA care plan, effective 06/27/2023, assigned the HA the relevant tasks: shower, sponge bath, and nail care as tolerated. The HA visit note dated 06/28/2024 documented that a sponge bath, nail care, and a shower were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath and nail care to meet the patient’s needs. Clinical Record 5: The patient elected hospice care on 06/22/2023. The HA care plan, effective 06/22/2023, assigned the HA the relevant tasks: shower, sponge bath, and nail care as tolerated. The HA visit note dated 06/22/2023 documented that a shower, sponge bath, and nail care were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath and nail care to meet the patient’s needs. Clinical Record 6: The patient elected hospice care on 04/04/2023. The HA care plan, effective 04/04/2023, assigned the HA the relevant tasks: shower and bed bath (1) one time a week as needed. The HA visit note dated 04/08/2024 documented that a bed bath and a shower were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath to meet the patient’s needs.. Clinical Record 7: The patient elected hospice care on 05/29/2024. The HA care plan effective 05/29/2024 assigned the HA the relevant tasks: shower and sponge bath, and nail care as tolerated. The HA visit dated 05/30/2024 documented that a sponge bath, nail care, and a shower were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath and nail care to meet the patient’s needs. Clinical Record 11: The patient elected hospice care on 03/05/2023. The HA care plan, effective 03/05/2024, assigned the HA the relevant tasks: complete bed bath and partial bed bath every visit. The HA visit note dated 03/06/2024 documented that a complete bed bath and a partial bath were completed. The HA did not notify the RN that the care plan required an update to specify the patient’s type of bath to meet the patient’s needs. During an interview and a joint review of clinical records on 06/25/2024, the Director of Nursing (DON) confirmed that there was no documented evidence that the HA notified the RN of any change. No further information was provided.”