Interim Healthcare of WI Madison

“It is required that each patient’s individualized written plan of care: reflects patient and family goals; [and] identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Interdisciplinary Group (IDG) Plan of Care” stated in part, “The IDG plan of care is developed, reviewed, and revised based on the findings of the initial comprehensive assessments, as well as updated comprehensive assessments conducted through the patient’s family’s care.” In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 14: The patient elected the hospice benefit on 01/ 21/2025. The updated nursing assessment dated 04/04/2025 documented that the patient had increased difficulty with constipation. Physician orders were written for Senna (laxative for constipation) and Dulcolax (laxative). The updated plans of care dated 04/11/2025, 04/25/2025, and 05/09/2025 did not include an intervention or goal for the patient’s identified problem with constipation. During an interview and a joint record review on 05/22/2025, the Vice President of Quality, who reviewed the records, stated that the plans of care had not been updated with the intervention and goal for the problem identified in the updated assessments.”

“It is required that the Interdisciplinary Group, in collaboration with the individual’s attending physician (if any), reviews, revises, and documents the individualized care plan: As frequently as the patient’s condition requires, but no less frequently than every 15 calendar days. A revised plan of care includes: information from the patient’s updated comprehensive assessment; [and] record of the patient’s progress toward the outcomes and goals specified in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed, the agency did not ensure that the patient’s updated plan of care included progress toward the outcomes and goals specified in the plan of care. Clinical Record 2: The patient elected hospice care on 05/16/2024. Occupational therapy was ordered. The Occupational Therapist (OT) evaluated the patient on 05/23/2024. OT visits were ordered one (1) time a week through 07/12/2024 for the right upper extremity range of motion, ADLS (activities of daily living), and adaptive equipment needs. On 06/03/2024, the physician ordered physical therapy (PT) for evaluation and treatment with weekly visits through 07/12/2024. The interdisciplinary team meetings dated 06/07/2024 and 07/05/2024 documented an update in the patient’s progress toward OT goals, but no documentation of progress in the PT goals. The interdisciplinary team (IDG) meeting dated 06/21/2024 did not document an update in the patient’s progress toward goals from PT or OT. The PT had goals for gait training and strengthening, as well as balance. The last PT visit was 07/01/2024. Clinical Record 11: The patient elected hospice care on 03/27/2025. On 04/02/2025, the physician ordered PT to evaluate and treat. PT services were ordered weekly for 4 weeks. A Physical Therapist Assistant (PTA) provided the visits with strengthening exercises, walking safety, and strengthening. The IDG meeting on 04/11/2025 documented the PT order. The IDGs dated 04/25/2025 and 05/09/2025 did not document an update in the patient’s progress toward goals for PT. The last PTA visit was dated 04/23/2025 and documented the education to the caregivers for: safety in transfer and walking, the need to continue exercises for strength and balance, and to engage their core for maintaining strength and balance. Home exercises were provided. None of the updates or progress toward PT goals were documented at the IDG meetings dated 04/25/2025 or 05/09/2025. Clinical Record 14: The patient elected hospice care on 01/21/2025. On 02/17/2025, the physician ordered PT services with the first PT visit note dated 02/21/2025. PT services were ordered weekly through 03/13/2025 for strengthening and safety, with a home exercise program provided. No progress toward the PT goals or updates were documented during the IDGs dated 02/28/2025 or 03/14/2025. During the interview on 05/21/2025, the Vice President of Quality stated that the goals and updates had not been documented on the IDG (interdisciplinary meeting) documents.”

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene; use of gloves, mask, eye protection, or face shield depending on anticipated exposure. This standard was not met as evidenced by document review, interview, and observation. Agency policy “Engineering Control and Work Practices” stated in part, “Employees who encounter patients or regulated biohazardous waste practice the following good hand-washing behaviors to reduce exposure and prevent the spread of bloodborne pathogens and other infections. Employees wash their hands immediately before gloves and other PPE and immediately after removing gloves and other PPE.” In 1 of 3 (33%) home visits observed, the agency did not ensure that hand hygiene was performed when indicated per the agency policy. Home Visit 3: During the home visit with the Registered Nurse (RN) [Personnel Record 5] on 05/21/2025, the RN set up their field to provide wound care on the patient’s left foot, performed hand hygiene and donned gloves, and the old dressing was removed and discarded. The RN doffed the gloves, sanitized their hands, and donned new gloves. The draining wound was cleaned and patted dry, gloves were doffed, and new gloves donned. The RN did not sanitize their hands between glove changes. The foot was re-dressed per the physician’s orders, and gloves were removed and hands sanitized. During the interview on 05/21/2025, the Vice President of Quality stated that hand sanitizing between glove changes was expected.”

“It is required that volunteers be used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. Volunteer services are: noted in the plan of care; [and] documented in the patient record, including the time spent. This standard was not met as evidenced by clinical record review and interview. In 2 of 9 (22%) clinical records reviewed of patients with an identified need for volunteer services, the agency did not ensure that the volunteer services were provided. Clinical Record 1: The patient elected the hospice benefit on 04/20/2025. The initial nursing comprehensive assessment, dated 04/29/2025, documented that the patient would enjoy having a volunteer. The initial psychosocial assessment dated 05/05/2025 documented that the patient and family were responsive to having a volunteer for socialization and card playing. The interdisciplinary team (IDG) dated 05/09/2025 did not document volunteer services or progress toward the identified patient need. A clinical record review on 05/21/2025 revealed no coordination related to the plan for the volunteer or documentation from the volunteer coordinator. Clinical Record 12: The patient elected the hospice benefit on 03/04/2024. The IDG meeting dated 03/29/2024 documented that a volunteer had been requested, and the placement of a volunteer was being worked on. The next IDG, dated 04/11/2024, did not document an update as to whether a volunteer had been found or that there was any follow-up with this request. A clinical record review revealed no documentation of what became of this volunteer request. As of this review on 05/20/2025, the patient has not had a volunteer. No volunteer was provided during the first benefit period dated 03/04/2024 through 06/01/2024. During an interview and a joint record review on 05/21/2025, the Vice President of Quality called the Volunteer Coordinator, who stated that the patient’s needs were more related to spiritual care needs, and that spiritual care visits were increased to meet the need. A late entry into the record to explain this was then completed. They agreed that the Chaplain had increased frequency, but the explanation had not related to the Volunteer not being needed.”

“It is required that a patient’s clinical record, containing past and current findings, is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the patient’s clinical record included physician orders for all care and services. Clinical Record 12: The patient elected the hospice benefit on 03/04/2024. On 03/22/2024, the physician ordered a Foley catheter, with directions for the catheter to be changed as needed. The skilled nurse (SN) visited and inserted the catheter. The updated SN assessments dated 05/28/2024 and 04/30/2025 documented that the Foley catheter was flushed - it was not documented what it was flushed with or how much solution. The plan of care did not document interventions for flushing the catheter, and there was no documented physician order to flush the catheter. There were no documented procedures presented that documented that catheter care would include a process to flush. During the interview and a joint record review on 05/21/2025, the Vice President of Quality stated that there was no physician order to flush the catheter and that an order should have been documented.”