Heart to Heart Hospice of Greater Houston LLC

“It is required that the written Patient Bill of Rights includes the right to be involved in the development of his or her plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #PE.4, “Patient Discharge,” (revised 08/2022) stated in part, “The hospice will provide the Notice of Medicare Non-Coverage to the patient no later than two days before the effective date of the end of the coverage that their Medicare coverage will be ending... The hospice will keep the following in the patient’s file... A copy of the written notification provided.” In 1 of 1 (100%) clinical record review of a patient with a live discharge, the agency did not ensure the patient/representative was involved in the development of their plan of care. Clinical Record 15: The patient elected hospice care on 02/09/2024 and was discharged for an extended prognosis on 09/23/2024. A clinical record review revealed no evidence that the patient or representative was provided with the Notification of Medicare Non-Coverage Form before discharge per the agency’s policy. During an interview and a joint clinical record review on 12/05/2024, the Director of Nursing confirmed the form was not in the clinical record. There was an email that documented that it had been “mailed to the patient or legal representative, but there was no evidence it had been returned signed.””

“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. In 2 of 15 (13%) clinical records reviewed in which Hospice Aide (HHA) services were accepted, the agency did not ensure the Registered Nurse provided specific written instructions for the Hospice Aide. Clinical Record 8: The patient elected hospice care on 03/19/2024. The initial nursing assessment dated 03/19/2024 noted the patient to have a nephrostomy tube and a Stage II pressure ulcer to the buttock covered with a foam dressing. The nursing recertification visits dated 05/28/2024 and 09/03/2024 noted the nephrostomy tube and wound continued. The nursing recertification visit dated 10/17/2024 contained the nephrostomy tube, but the wound had healed. The HHA care plan dated 03/19/2024 assigned the HHA the relevant tasks of a bed bath, skin care, dressing, and RN notification of changes every visit with a frequency of twice weekly. No updates have been made to the HHA care plan since admission. The HHA care plan did not include notification to the HHA of the nephrostomy tube or the wound, nor specific instructions of the care of the dressings or tube during tasks should the dressings or nephrostomy tube become soiled, dislodged, or wet. Clinical Record 13: The patient elected hospice care on 10/21/2023. The initial nursing assessment dated 10/21/2023 noted the patient to have a colostomy. The HHA care plan dated 10/21/2023 assigned the HHA the relevant tasks of a bed bath, skincare, and colostomy precautions every visit with a frequency of twice weekly. It did not provide specific instructions for the HHA regarding the colostomy should the bag become wet, dislodged, or soiled during care. During an interview and a joint clinical record review on 12/04/2024, the Director of Nursing confirmed that the HHA care plans did not provide specific instructions for the nephrostomy and colostomy, including notifying the nurse if the surrounding dressing(s) became dislodged or soiled or wet.”

“It is required that a registered nurse makes an annual on-site visit to the location where a patient is receiving care in order to observe and assess each hospice aide while he or she is performing care per the hospice’s policies and procedures. This standard was not met as evidenced by document review, interview, and personnel record review. Agency policy #HR.11, “Employee Supervision” (revised 10/28/2023), stated in part, “A registered nurse must make an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while he or she is performing care.” In 1 of 1 (100%) personnel record reviewed of a Hospice Aide, the agency did not ensure the Registered Nurse (RN) made an annual on-site visit where a patient was receiving care to observe and assess if the Hospice Aide (HHA) was performing care per the hospice’s policies and procedures. Personnel Record 7: The Hospice Aide (HHA) was hired on 07/08/2024. A review of the HHA personnel record revealed no documentation of annual on-site supervisory visits for 2022 or 2023. During an interview and a joint record review on 12/04/2024, the Director of Nursing confirmed the HHA personnel record did not contain documentation of on-site supervisory visits by a Registered Nurse for 2022 or 2023.”