Every finding on record at A Vista Care Hospice Inc.

It is required that nursing care and services are provided by or under the supervision of a registered nurse and per the patient plan of care. Nursing services ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed, the agency did not ensure the nursing needs of the patient were identified in the comprehensive assessment. Clinical Record 2: The patient elected the hospice benefit on 10/29/2024 with diagnoses of coronary artery disease, colostomy, and a skin tear. The comprehensive assessment dated 10/29/2024, did not include documentation that the patient had a colostomy. During an interview on 11/13/2024, the Registered Nurse stated she was not sure why the colostomy was not included in the initial assessment.

It is required that Hospice Aides are assigned to a specific patient by a Registered Nurse (RN) 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, observation, and interview. In 1 of 5 (20%) clinical records reviewed with hospice aide services provided, the agency did not the Registered Nurse provided patient specific care instructions for the hospice aide. Clinical Record 2/Home Visit 1: The patient elected the hospice benefit on 10/29/2024. During the home visit observation on 11/12/2024 with the Hospice Aide (HA) (Personnel Record 6), the patient was observed to have a colostomy to the left upper quadrant of the abdomen. The aide plan of care assignment did not include notification and instructions to the aide related to the patient’s colostomy. The aide stated during an interview that she empties the bag when it is full and stated she had been an aide for over 10 years and knew what to do. During an interview on 11/13/2024, the Registered Nurse stated that she did not know why the colostomy care was not added to the aide plan of care but said she would update the plan of care to include colostomy instructions.

It is required that Hospice Aides are supervised by a Registered Nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to: Assess the quality of care and services provided by the hospice aide; Ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by document review, clinical record review, and interview. In 1 of 2 (50%) clinical records reviewed with Hospice Aide services provided, the agency did not ensure the Hospice Aide was supervised by a Registered Nurse no less frequently than every 14 days. Agency policy No. 2-041 Program/Service Operations, no date, required in part, "Aide supervisory visits are performed and documented every 14 days." Clinical Record 3: The patient elected the hospice benefit on 10/28/2024. The plan of care dated 10/28/2024 to 01/26/2025 included an order for home health aide services 2 times per week. The Hospice Aide provided the first aide visit on 10/29/2024. The first aide supervisory visit was completed on 11/13/2024, a total of 15 days after the first aide visit and one day outstanding. During an interview on 11/14/2024, the Registered Nurse stated that she did not realize it had been two weeks already but that she included it in yesterday’s visit and would monitor it more closely in the future.