Every finding on record at A-1 Healthcare Management

It is required that all hospice aide services must be provided by an individual who has successfully completed a training and competency evaluation program. The competency evaluation addresses each of the following subject areas. It is evaluated by observation of an aide’s performance with a patient or pseudo-patient, including 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; appropriate and safe techniques in performing personal hygiene and grooming tasks, including 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, normal range of motion and positioning. This standard was not met as evidenced by document review, interview and personnel record review. In 1 of 1 (100%) personnel record reviews of a hospice aide revealed the agency did not ensure that all personal hygiene and grooming tasks were observed as competent by a Registered Nurse. DOCUMENT 1: The agency's policy "Competency Assessment (Policy No. 1-008.1)" dated October 2010, read in part that "...Competency Assessments will be completed at least one (1) time per year...Using a Competency Skills Performance Checklist, the Supervisor will evaluate the competence in performing and rendering care..." PERSONNEL RECORD 4: The Hospice Aide was hired on 05/03/2021. The hospice aide was out of work in 2023 and returned to work on 07/30/2024. There was no evidence that a Hospice Aide Competency Skills Assessment Checklist was completed upon her return to work or prior to providing patient care. It was confirmed during a joint personnel record review and interview with the Administrator (Personnel Record 1) and the Director of Patient Care Services (Personnel Record 2) on 03/26/2025 that a Hospice Aide Competency Checklist was not completed upon the hospice aide's return to work on 07/30/2024.

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 1 of 8 (12%) clinical records in which hospice aide services were accepted revealed the agency did not ensure that the Registered Nurse provided complete instructions to the hospice aide. CLINICAL RECORD 1: The patient elected hospice care on 02/24/2025. A bilateral buttocks pressure ulcer was noted during the admitting nurse visit on 02/24/2025. A physician's order of the same date included cleaning the area with normal saline and pat dry. Apply MediHoney to the wound bed, followed by Calcium Alginate, and cover with a silicone foam dressing. Secure the dressing border with MedFix and change the dressing three times a week and as needed if it becomes soiled or loose. The plan of care for the benefit period 02/24/2025 to 06/24/2025 included orders for the hospice aide to visit the patient at home twice a week. The Hospice Aide Plan of Care dated 02/24/2025 included the following tasks to be performed every visit by the aide: bed bath or shower (as the patient tolerates/patient was alert and oriented), pericare, skincare, and check pressure areas. No instruction was included for what the aide should do if the dressing became loose or soiled. PERSONNEL RECORD 2: During an interview with the Director of Clinical Services on 03/26/2025, she confirmed that the aide care plan did not include instructions to the aide regarding the patient's wound.

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 record review and interview. Review of 6 of 11 (55%) records revealed that duties assigned on the aide assignment did not include clear and specific written instructions for all of the assigned duties. for the aide assignment, is not present in the documentation as directed by the Interdisciplinary Team Members. This placed the aide in a position to make decisions outside of the aide's scope of practice. Record #31849: The aide assignment dated 3/18/22 included the task for the aide to complete "foot care" without specific instructions of what activities the assigned foot care included. Record #46864: The aide assignment dated 7/30/21 and 10/28/21 included the tasks of "shave" and "foot care" without specific instructions of what activities the assigned shave and foot care included. The assignment did not specify if the aide was to shave this diabetic patient using a safety razor or an electric shaver, or specifically what foot care was to be provided. Record #75257: The aide assignments dated 2/11/22 and 5/12/22 included the tasks of "foot care” and “nail care" without specific instructions of what care was specifically were to be provided as foot care and nail care. Record #28258: The aide care assignment dated 5/20/22 included the task "foot care", and there were no specific instructions present that described the foot care that was to be performed. Record #67622: The aide care assignment dated 5/15/21 included task "foot care", and there were no specific instructions present that described the foot care that was to be performed. Record #52263: The aide care assignment dated 5/4/22 included task "shave" without specific instructions of what type of instrument was to be used to shave the patient, such as either an electric razor or standard safety razor with shave crème. In an interview with the Administrator and Director of Nurses on 6/10/2022, they confirmed the finding and stated that the aide care assignments will be corrected with specific instructions to ensure patient safety and compliance.

It is required that a patient 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: Signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by record review and interview. Review of 9 of 11 (81%) records revealed they were missing evidence that the hospice election statement signed by the patients included the required verbiage that described the content, “Patient Notification of Hospice Non-Covered Items, Services, and Drugs”, as required in accordance with 42 CFR 418.24 [Records: #52263, #69916, #75257, #28258, #30468, #67622, #90783, #46864, #25251]. In an interview with the Administrator and Director of Nurses on 6/10/2022, it was stated that they will provide the information to the patients regarding non-covered items, services, and drugs.

It is required that the hospice obtains a criminal background check on all hospice employees who have direct patient contact, or access to patient records. Hospice contracts require that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. This standard was not met as evidenced by review of contracts and interview with the Administrator, which revealed that the long term care facility (LTCF) and rehab staffing (OT, PT, ST) contracts did not include verbiage that described the requirement for the completion of criminal background checks for all staff who will have direct patient contact. An interview was conducted on 6/8/2022 and 6/10/2022 with the Administrator, who stated that an addendum directing the contracted entities to conduct criminal background checks would be developed to ensure compliance with regulatory requirements. The documentation of the completed background checks will be verified according to agency policy.