Admt Caring Hospice

“It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. 5 of 7 (71%) clinical records reviewed of patients who received aide services revealed the agency did not ensure that the aide services provided were consistent with the services ordered by the Interdisciplinary Group. Clinical Record 2: The patient elected hospice care on 12/12/2023. The aide care plan dated 12/12/2023 assigned the aide the tasks: oral care, nail care and shave three times a week. The aide documented on 12/19/2023 and 12/21/2023 no oral care was provided. There was no evidence that the assigned tasks had changed. Clinical Record 4: The patient elected hospice care on 06/22/2023. The aide care plan dated 12/19/2023 assigned the aide the tasks: shampoo once a week. The aide documented the week of 01/11/2024, no shampoo was provided. There was no evidence the assigned tasks had changed. Clinical Record 5: The patient elected hospice care on 08/15/2023. The aide care plan dated 08/15/2023 assigned the aide the tasks: shampoo weekly. The aide documented the week of 10/05/2023, no shampoo was provided. There was no evidence the assigned tasks had changed. Clinical Record 6: The patient elected hospice care on 12/02/2023. The aide care plan dated 12/02/2023 assigned the aide the tasks: oral care three times a week. The aide documented on 12/08/2023, no oral care was provided. There was no evidence the assigned tasks had changed. Clinical Record 13: The patient elected hospice care on 03/12/2022. The aide care plan dated 03/12/2022 assigned the aide the tasks: complete Shower three times a week. The aide documented on 03/14/2022, the completion of a partial bath instead of a complete shower. There was no evidence the assigned tasks had changed. During an interview and joint clinical record review on 11/20/2024, the DON confirmed the findings and stated the aide had not followed the plan of care.”

“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. (L628) The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. (L628) Hospice aide documentation complies with hospice policies and procedures. (L628) This standard was not met as evidenced by clinical record review and interview. 5 of 7 (71%) clinical records reviewed of patients receiving aides services, revealed the agency did not ensure that the aide reported changes relating to the plan of care and any quality assessment and improvement activities. Clinical Record 4: The patient elected hospice care on 06/22/2023. The aide care plan dated 12/19/2023 assigned the aide the tasks: shampoo once a week. The aide documented the week of 01/11/2024, no shampoo was provided. There was no evidence of communication with the registered nurse. Clinical Record 2: The patient elected hospice care on 12/12/2023. The aide care plan dated 12/12/2023 assigned the aide the tasks: oral care, nail care and shave three times a week. The aide documented on 12/19/2023 and 12/21/2023 no oral care was provided. There was no evidence of communication with the registered nurse. Clinical Record 6: The patient elected hospice care on 12/02/2023. The aide care plan dated 12/02/2023 assigned the aide the tasks: oral care three times a week. The aide documented on 12/08/2023, no oral care was provided. There was no evidence of communication with the registered nurse. Clinical Record 13: The patient elected hospice care on 03/12/2022. The aide care plan dated 03/12/2022 assigned the aide the tasks: complete Shower three times a week. The aide documented on 03/14/2022, the completion of a partial bath instead of a complete shower. There was no evidence of communication with the registered nurse. Clinical Record 5: The patient elected hospice care on 08/15/2023. The aide care plan dated 08/15/2023 assigned the aide the tasks: shampoo weekly. The aide documented the week of 10/05/2023, no shampoo was provided. There was no evidence of communication with the registered nurse. During an interview and joint clinical record review on 11/20/2024, the DON confirmed the findings and stated the aide did not inform the RN about changes or tasks not completed.”

“It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of: the hospice discharge summary described in HCDT 40.I; and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. 4 of 4 (100%) clinical records reviewed of patients who transferred to a facility revealed the agency did not ensure that the discharge summary was sent to the Medicare /Medicaid Certified facility for continuity of care. Clinical Record 3: The patient elected the hospice benefit on 09/15/2023. On 03/26/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Transfer to another hospice. The clinical record did not include documented evidence that the patient’s discharge summary or any of the patient’s clinical record was sent to the facility where the patient was transferred to for continuity of care. Clinical Record 2: The patient elected the hospice benefit on 12/12/2023. On 01/24/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Transfer to another hospice. The clinical record did not include documented evidence that the patient’s discharge summary or any of the patient’s clinical record was sent to the receiving facility where the patient was transferred to for continuity of care. Clinical Record 4: The patient elected the hospice benefit on 06/22/2023. On 02/13/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Transfer to another hospice. The clinical record did not include documented evidence that the patient’s discharge summary or any of the patient’s clinical record was sent to the receiving facility where the patient was transferred to for continuity of care. Clinical Record 5: The patient elected the hospice benefit on 08/15/2023. On 01/15/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Revoked transfer to another hospice.” The clinical record did not include documented evidence that the patient’s discharge summary or any of the patient’s clinical record was sent to the facility where the patient was transferred to for continuity of care. In an interview with the Director of Nursing, it was confirmed that the “Discharge - Live” visit document was the only Discharge Summary completed and there was no documentation in the clinical record that this form or any of the patient’s clinical record were sent to the facility where the patient was transferred for treatment. No further information was provided.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s HCDT.40.I/684community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; the patient’s latest physician orders; and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 11 of 11 (100%) clinical records reviewed in which live discharges from hospice occurred revealed the discharge summary did not include a summary of the patient’s hospice stay, medications or treatments, care plans, or physician orders. Clinical Record 2: The patient elected the hospice benefit on 12/12/2023. On 01/24/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Transfer to another hospice. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 3: The patient elected the hospice benefit on 09/15/2023. On 03/26/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Transfer to another hospice.” The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 4: The patient elected the hospice benefit on 06/22/2023. On 02/13/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Transfer to another hospice.” The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 5: The patient elected the hospice benefit on 08/15/2023. On 01/15/2024, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “Revoked transfer to another hospice.” The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 6: The patient elected the hospice benefit on 12/02/2023. On 12/26/2024 the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date 12/26/2024 for cause. Clinical Record 11: The patient elected the hospice benefit on 11/10/2022. On 01/26/2023, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “discharge to home or self-care”, reason for discharge: “discharged - patient no longer terminally ill. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 12: The patient elected the hospice benefit on 08/04/2022. On 11/01/2022, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “discharge to home or self-care”, reason for discharge: “discharged - patient no longer terminally ill. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 13: The patient elected the hospice benefit on 03/12/2022. On 10/11/2022, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “discharge to home or self-care”, reason for discharge: “discharged - patient no longer terminally ill. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 14: The patient elected the hospice benefit on 05/26/2022. On 03/14/2023, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “discharge to home or self-care”, reason for discharge: “discharged - patient no longer terminally ill. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 15: The patient elected the hospice benefit on 07/21/2022. On 08/12/2022, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “discharge to home or self-care”, reason for discharge: “discharged - patient no longer terminally ill. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. Clinical Record 16: The patient elected the hospice benefit on 08/11/2022. On 01/31/2023, the nurse completed the “Discharge - Live” document that included the staff member’s time in and time out, discharge order date (only signed by RN), patient status: “discharge to home or self-care”, reason for discharge: “discharged - patient no longer terminally ill. The “Discharge - Live” document did not include any summary of the patient’s care while on hospice and no medications, treatments/symptom management, or orders. During an interview with the DON ON 11/21/2024 regarding the discharge summary, She stated that their EMR does not have a discharge summary, only a discharge note and that all the requirements including: A summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders were not included in the discharge note. No further information was provided.”