Every finding on record at A Path of Care Hospice I, LLC

Based on record review and interview, the hospice failed to:1. ensure completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for one (Patient #2) of 14 patients; and2. ensure completion of the initial social work assessment no later than 5 calendar days after the election of hospice care for one (Patient #9) of 14 patients. --- Findings:Patient #2A review of the clinical record showed an election of the hospice benefit on 04/22/25 with no completion of the initial spiritual assessment from 04/22/25 to 06/04/25 (43 days after the election of the hospice benefit).  Documentation showed no patient or caregiver refusal initial spiritual assessment.Patient #9A review of the clinical record showed an election of the hospice benefit on 04/02/25 with no completion of the initial social work assessment from 04/02/25 to 04/09/25 (7 days after the election of the hospice benefit), Documentation showed no patient or caregiver refusal of the initial social work assessment.On 06/04/25 at 2:39 pm., Staff C stated:1. the initial comprehensive assessment was to be completed within five days of the election of the hospice benefit;2. the initial spiritual assessment for Patient #2 was not completed within the first five days of the election of the hospice benefit; and3. the initial social work assessment for Patient #9 was not completed within the first five days of the election of the hospice benefit.

Based on record review and interview, the hospice failed to ensure hospice aide visits were provided in accordance with the plan of care for two (Patients #4 and 10) of 14 patients. --- Findings:Patient #4A review of the plan of care dated 01/27/25 showed a hospice aide frequency of two visits per week for thirteen weeks.  A review of the clinical record showed the following:A hospice aide visit dated 02/20/25 for the week of 02/16/25 to 02/22/25 (one of two completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule visits and no physician orders to change the ordered frequency.A hospice aide visit dated 03/04/25 and a hospice aide missed visit note dated 03/06/25 (due to the facility giving the patient a shower while the aide was assisting another hospice patient) for the week of 03/02/25 to 03/08/25 (one of two completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Patient #10A review of the plan of care dated 01/17/25 to 04/16/25 showed a hospice aide frequency of one visit per week for one week, five visits per week for 12 weeks and three visits per week for one week.  A physician order dated 02/05/25 showed a hospice aide frequency of three visits per week for nine weeks and two visits per week for one week.A hospice aide visit 02/10/25 and two hospice aide missed visits dated 02/12/25 (due to severe weather) and 02/13/25 (due to refused and weather) for the week of 02/09/25 to 02/15/25 one of three completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visits and no physician orders to change the ordered frequency.Hospice aide visits dated 02/20/25, 02/22/25 and one hospice aide missed visit dated 02/18/25 (due to weather) for the week of 02/16/25 to 02/22/25 (two of three completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 03/05/25, 03/06/25 and one hospice aide missed visit dated 03/07/25 (due to patient with Alzheimer's refusing) for the week of 03/02/25 to 03/08/25 (two of three completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 03/11/25, 03/13/25 and one hospice aide missed visit dated 03/14/25 (due to patient with Alzheimer's refusing) for the week of 03/09/25 to 03/15/25 (two of three completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.On 06/04/25 at 2:37 pm., Staff C stated the hospice aide frequency was not followed as ordered for Patients #4 and 10.

Based on record review and interview, the hospice failed to ensure supervisory aide visits were completed every 14 days for one (Patient #1) of 14 patients. --- Findings:Patient #1A review of the plan care dated 03/03/25 t0 05/01/25 showed a hospice aide frequency of two visits per week for nine weeks.  A review of the clinical record showed the following:Hospice aide visits were completed on 03/11/25 and 03/13/25 for the week of 03/09/25 to 03/15/25.A supervisory aide visit was completed on 03/11/25 for the week of 03/09/25 to 03/15/25.Hospice aide visits were completed on 03/18/25 and 03/20/25 for the week of 03/16/25 to 03/22/25.Hospice aide visits were completed on 03/25/25 and 03/27/25 for the week of 03/23/25 to 03/29/25.Hospice aide visits were completed on 04/01/25 and 04/04/25 for the week of 03/30/25 to 04/05/25.A supervisory aide visit was completed on 04/04/25 (23 days after the last supervisory aide visit) for the week of 03/30/25 to 04/05/25.Hospice aide visits were completed on 04/07/25 and 04/10/25 for the week of 04/06/25 to 04/12/25.Hospice aide visits were completed on 04/15/25 and 04/17/25 for the week of 04/13/25 to 04/19/25.Hospice aide visits were completed on 04/21/25 and 04/23/25 for the week of 04/20/25 to 04/26/25.Hospice aide visits were completed on 04/28/25 and 05/01/25 for the week of 04/27/25 to 05/01/25.A supervisory aide visit was completed on 04/29/25 (24 days after the last supervisory aide visit) for the week of 04/27/25 to 05/01/25.On 06/04/25 at 2:29 pm., Staff C stated the supervisory aide visits for Patient #1 were not completed every 14 days.

Based on record review and interview, the hospice failed to ensure volunteers provided services that equaled 5% of the total patient care hours of all paid hospice employees for 2024. --- Findings:A review of volunteer records and hours showed the hospice volunteers provided services that equaled 1.37% of the total patient care hours of all paid hospice employees for 2024.On 06/03/25 at 2:20 pm, Staff A stated the hospice volunteer services did not provide 5% of the total patient care hours of all paid hospice employees for 2024.

Based on record review and interview, the hospice failed to ensure: 1. Completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for three (Patient #1, 2 and 11) of 11 patients; 2. Completion of the initial bereavement assessment no later than 5 calendar days after the election of hospice care for three (Patient #1, 2 and 11) of 11 patients; and 3. Completion of the initial psychosocial assessment no later than 5 calendar days after the election of hospice care for three (Patient #1, 2 and 11) of 11 patients. Findings: Patient #1 A review of the clinical record showed an election of the hospice benefit on 03/31/22 with no completion of the initial spiritual assessment from 03/31/22 to 05/29/22 (90 days after election of the hospice benefit), no completion of the initial bereavement assessment from 03/31/22 to 05/29/22 (90 days after election of the hospice benefit) and no completion of the initial psychosocial assessment from 03/31/22 to 05/29/22 with no documentation of attempts to contact the patient made by the Chaplain or Medical Social Worker and no patient or caregiver refusal of Chaplain or Medical Social Worker visits. Patient #2 A review of the clinical record showed an election of the hospice benefit on 06/17/22 with no completion of the initial spiritual assessment from 06/17/22 to 07/22/22 (34 days after the election of the hospice benefit), no completions of the initial bereavement assessment from 06/17/22 to 07/22/22 (34 days after the election of the hospice benefit) and no completion of the initial psychosocial assessment from 06/17/22 to 07/22/22 (34 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain or the Medical Social Worker and no patient or caregiver refusal of Chaplain or Medical Social Worker visits. Patient #11 A review of the clinical record showed an election of the hospice benefit on 06/11/22 with no completion of the initial spiritual assessment from 06/11/22 to 07/22/22 (39 days after the election of the hospice benefit), no completions of the initial bereavement assessment from 06/11/22 to 07/22/22 (39 days after the election of the hospice benefit) and no completion of the initial psychosocial assessment from 06/11/22 to 07/22/22 (39 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain or the Medical Social Worker and no patient or caregiver refusal of Chaplain or Medical Social Worker visits. On 07/22/22 at 10:30 am, Staff C stated the initial spiritual assessments, the initial bereavement assessments and the initial psychosocial assessments were not completed within the first five days after the election of the hospice benefit for Patients #1, 2 and 11.

Based on record review and interview, the hospice failed to ensure a timely review of medications for two (Patients #2 and 5) of 11 patients. Findings: Patient #2 A review of clinical records showed a physician's order dated 06/23/22 for the use of oxygen. Documentation showed no addition of oxygen to the medication profile. Patient #5 A review of clinical records showed a skilled nurse assessment dated 05/10/22 which documented the use and availability of oxygen. Documentation showed no addition of oxygen to the medication profile. On 07/22/22 at 11:05 am, Staff C stated oxygen was not added to the medication profile for Patient's #2 and 5.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for nine (Patients #1, 2, 3, 4, 5, 7, 8, 9 and 11) of 11 patients reviewed. Findings: Patient #1 A review of the plan of care dated 03/31/22 to 05/29/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #2 A review of the plan of care dated 06/17/22 to 09/14/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #3 A review of the plan of care dated 04/17/22 to 06/15/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #4 A review of the plan of care dated 06/02/22 to 07/31/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #5 A plan of care dated 05/08/22 to 07/06/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #7 A review of the plan of care dated 04/27/22 to 06/25/21 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #8 A review of the plan of care dated 05/02/22 to 06/30/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #9 A plan of care dated 02/23/22 to 05/23/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #11 A plan of care dated 06/11/22 to 08/09/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. On 07/22/22 at 10:50 am, Staff B and C stated the plans of care for Patients #1, 2, 3, 4, 5, 7, 8, 9 and 11 failed to include services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to ensure skilled nursing services met the needs of the patient for the management of wounds for one (Patient #4) of 11 patients. Findings: Patient #4 A plan of care dated 06/02/22 to 07/31/22 documented a skilled nurse frequency of one visit per week for one week and two visits per week for eight weeks. A review of the electronic medical record showed the following: Skilled nurse assessments dated 06/07/22 and 06/10/22 for the week of 06/05/22 to 06/11/22 documented the presence of 1) one stage III pressure ulcer to the third left toe, 2) the presence of one venous stasis ulcer to second right toe, 3) the presence of one venous stasis ulcer to the proximal left calf, 4) the presence of on venous stasis ulcer to the mid right calf and 5) the presence of one stage III pressure ulcer to the left heel. Wounds #1, 2, 3, 4 and 5 were documented to have the same wound care provided of cleanse the wound with wound cleanser, pat dry, cover with non stick dressing and secure with tape. No wound measurements were obtained. A skilled nurse assessment dated 06/17/22 for the week of 06/12/22 to 06/18/22 documented the presence of 1) one stage III pressure ulcer to the third left toe which measured of 1 cm long by 1 cm wide by 0.5 cm deep, 2) the presence of one venous stasis ulcer to second right toe which measured 1 cm long by 1 cm wide by 0.5 cm deep, 3) the presence of one venous stasis ulcer to the proximal left calf which measured 2.5 cm long by 1.5 cm wide by 0.5 cm deep, 4) the presence of on venous stasis ulcer to the mid right calf which measured 2 cm long by 2 cm wide by 0.5 cm deep and 5) the presence of one stage III pressure ulcer to the left heel which measured 1 cm long by 1.5 cm wide by 0.5 cm deep. Wounds #1, 2, 3, 4 and 5 were documented to have the same wound care provided of cleanse the wound with wound cleanser, pat dry, cover with non stick dressing and secure with tape. A skilled nurse assessment dated 06/21/22 for the week of 06/19/22 to 06/25/22 documented the presence of 1) one stage III pressure ulcer to the third left toe which measured of 1 cm long by 1 cm wide by 0.5 cm deep, 2) the presence of one venous stasis ulcer to second right toe which measured 1 cm long by 1 cm wide by 0.5 cm deep, 3) the presence of one venous stasis ulcer to the proximal left calf which measured 4 cm long by 5 cm wide by 0.5 cm deep, 4) the presence of on venous stasis ulcer to the mid right calf which measured 4 cm long by 3 cm wide by 0.5 cm deep and 5) the presence of one stage III pressure ulcer to the left heel which measured 1 cm long by 1.5 cm wide by 0.5 cm deep. A review of the clinical record showed no physician notification of deterioration of wounds 3 and 4 with no documented attempts to contact the physician for changes in wound care orders. A skilled nurse assessment dated 06/29/22 for the week of 06/26/22 to 07/02/22 documented the presence of 1) one stage III pressure ulcer to the third left toe which measured of 4 cm long by 4 cm wide by 0.2 cm deep, 2) the presence of one venous stasis ulcer to second right toe which measured 3 cm long by 4 cm wide by 0.2 cm deep, 3) the presence of one venous stasis ulcer to the proximal left calf which measured 5 cm long by 4 cm wide by 0.2 cm deep, 4) the presence of on venous stasis ulcer to the mid right calf which measured 5 cm long by 6 cm wide by 0.2 cm deep and 5) the presence of one stage III pressure ulcer to the left heel which measured 5 cm long by 0.5 cm wide by 0.2 cm deep. A review of the clinical record showed no physician notification of deterioration of wounds 1, 2, 3, 4 and 5 with no documented attempts to contact the physician for changes in wound care orders. Skilled nurse assessments dated 07/04/22, 07/06/22 and 07/08/22 for the week of 07/03/22 to 07/09/22 documented the presence of 1) one stage III pressure ulcer to the third left toe, 2) the presence of one venous stasis ulcer to second right toe, 3) the presence of one venous stasis ulcer to the proximal left calf, 4) the presence of on venous stasis ulcer to the mid right calf and 5) the presence of one stage III pressure ulcer to the left heel. No wound measurements were obtained. Skilled nurse assessments dated 07/11/22 and 07/13/22 for the week of 07/10/22 to 07/16/22 documented the presence of 1) one stage III pressure ulcer to the third left toe, 2) the presence of one venous stasis ulcer to second right toe, 3) the presence of one venous stasis ulcer to the proximal left calf, 4) the presence of on venous stasis ulcer to the mid right calf and 5) the presence of one stage III pressure ulcer to the left heel. No wound measurements were obtained. On 07/22/22 at 11:20 am, Staff C stated the skilled nurse should have notified the physician of the deterioration in Patient #4 wounds and notify the physician of the need to alter wound care orders.

Based on record review and interview, the hospice failed to ensure wound measurements were coordinated with the long term care facility for one (Patient #9) of 11 patients reviewed. Findings: Patient #1 A plan of care dated 02/23/22 to 05/23/22 showed a skilled nurse frequency of two visits per week for thirteen weeks and one visit per week for one week and documented diagnoses of pressure ulcers to the sacral region, right upper back and right heel (each unstageable) with wound care to be provided two days a week by the hospice and five days by the nursing home. A review of the electronic medical record showed the following: Skilled nurse visits dated 02/28/22 and 03/04/22 for the week of 02/27/22 to 03/05/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 03/07/22 and 03/11/22 for the week of 03/06/22 to 03/12/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 03/14/22 and 03/18/22 for the week of 03/13/22 to 03/19/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 03/21/22 and 03/25/22 for the week of 03/20/22 to 03/26/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 03/28/22 and 04/01/22 for the week of 03/27/22 to 04/02/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 04/04/22 and 04/08/22 for the week of 04/03/22 to 04/09/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 04/11/22 and 04/15/22 for the week of 04/10/22 to 04/16/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. Skilled nurse visits dated 04/18/22 and 04/22/22 for the week of 04/17/22 to 04/23/22 documented no wound measurements obtained by the hospice nurse or measurements obtained by the nursing home. On 07/22/22 at 11:05 am, Staff C stated the hospice failed to show coordination with the nursing home regarding wound measurements.