Accentcare Hospice & Palliative Care of King County

“It is required that a qualified hospice aide has successfully completed a competency evaluation program that evaluates the aide’s competency in the following subject areas by observation of the aide’s performance with a patient or a pseudo patient: communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff; reading and recording temperature, pulse, and respiration; and appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist: bed bath; sponge, tub, and shower bath; hair shampoo (sink, tub, and bed); nail and skin care; oral hygiene; toileting and elimination; safe transfer techniques and ambulation; and normal range of motion and positioning. And also evaluates the aide’s competency in the following subject areas by written exam, oral examination, or after observation of a hospice aide with a patient or a pseudo-patient during a simulation: observation, reporting, and documentation of patient status and the care or service provided; basic infection control procedures; basic elements of body functioning and changes in body function that must be reported to an aide’s supervisor; maintenance of a clean, safe, and healthy environment; recognizing emergencies and the knowledge of emergency procedures and their application; the physical, emotional, and developmental needs of—and ways to work with—the populations served by the hospice, including the need for respect for the patient, his or her privacy, and his or her property; adequate nutrition and fluid intake; and any remaining task(s) that the hospice chooses to have an aide perform. This standard was not met as evidenced by document review, interview, observation, and personnel record review. Agency policy, “Competency Evaluation 8049 Protocol,” stated in part, “Hospice aides will receive a competency evaluation prior to providing solo patient care and annually thereafter. The Hospice Aide (HA) will be evaluated by a registered nurse during direct patient care, prior to providing care independently. The validation of competency follows the Back to Bedside template and process will include minimally: observation of the HA” ‘s ability to communicate, including the ability to read, write, and verbally report clinical information to patients’ caregivers and other hospice staff, appropriate and safe techniques in performing personal hygiene and grooming tasks including items on the following basic checklist: bed bath, sponge, tub, and shower back, hair shampoo, nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques and ambulation, normal range of motion and positioning. The Hospice Aide may not provide solo patient care until all competency items have been demonstrated, met, and signed off by a credentialed evaluator. The Hospice Aide Evaluation in Back to Bedside and evidence of the joint visit must be documented in the EMR...” In 1 of 1 (100%) personnel record of a Hospice Aide, the agency did not ensure that the Hospice Aide had a competency evaluation prior to providing care to patients. Personnel Record 5: The Hospice Aide (HA) was hired on 05/28/2017 and transferred to another location in another state on 03/04/2024. The Hospice Aide job description signed by the employee on 03/05/2024 documented that the HA had the following required qualifications: certified by the state(s) as a nurse’s aide, listed on the state aide registry with a clear record, successful completion of the Back-to-Bedside Aide competency, meet the regulations and requirements of the State in which the program provides services. During the home visit with the HA [Personnel Record 5] on 03/18/2024, the HA was observed bathing the patient, shampooing their hair, applying lotion, and providing ambulation assistance. A personnel record review revealed no documented evidence of the competency evaluation, “Hospice Aide Evaluation in Back to Bedside,” and evidence of the joint visit documented in the electronic medical record (EMR) prior to the HA providing solo patient care per the agency’s policy. The Executive Director was interviewed on 03/20/2024 and agreed there was no documented evidence of a competency evaluation in 2024, 2023, or 2022. Additionally, during an interview on 03/20/2024, the Executive Director stated that a new bedside competency should have been completed when the aide transferred before providing care in the new state, but it’s not documented in the EMR or personnel record. The Executive Director confirmed 03/20/2024 that the Hospice Aide had been making visits from 03/05/2024 through 03/18/2024 and was pulled from the field on 03/18/2024 after the site visitor home visit.”