Every finding on record at A&Z Healthcare LLC

Upon patient record review, 1 of 5 (Patient #3) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 3: Fall precautions are not included in the CHHA instructions although per RN assessment 5/30/24 and current plan of care patient is a high fall risk with prior history of recurrent falls.

Upon patient record review 2 of 5 (Patient #1 & 5) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 1: Ambulation with assist marked as completed by the CHHA on 5/23/24 & 5/30/24. Task is not marked to be completed on the aide instructions. Patient 2: Range of Motion is marked completed by the CHHA on 5/14/24, 5/20/24, & 6/3/24. Tasks is not marked to be completed on the aide instructions.

Condition of Participation: Initial and Comprehensive Assessment of the Patient.

Upon patient record review 7 of 14 (Patient #3, #4, #7, #9, #11, #12, #13) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #3:The patient was admitted on 11-18-22 and the first contact and spiritual assessment by the chaplain was completed on 12-1-22. Patient #4: The patient was admitted on 11-16-22 and the first Chaplain contact and spiritual assessment was 12-1-22. Patient #7: The patient was admitted on 05-30-23 and the first MSW contact and psychosocial assessment was completed on 06-07-24. Patient #9:The patient was admitted 11-03-22 and the first contact and spiritual assessment by the SCC was 11-11-22. Patient #11:The patient was admitted on 11-16-22, the chaplain contact and spiritual assessment was 12-1-22. Patient #12:The patient was admitted on 10-19-22 and the first chaplain contact and spiritual assessment was 10-26-22. Patient #13:The patient was admitted on 06-30-23 and the first MSW contact and psychosocial assessment was completed on 07-06-23.

Upon patient record review, 4 of 14 (Patient #5, #6, #9, #14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #5: The narcotic count dated 2/1/24 - 2/129 indicated the patient was using Hydrocodone 5/325mg. Hydrocodone was not listed on the medication profile. Patient #6: The narcotic count dated 3/26/24 indicated the patient was using Hydrocodone 5/325mg. Hydrocodone was not listed on the medication profile. In addition, the patient had hydrocodone in the home and this was not on the medication profile. Patient #9: Trazadone 100mg and Tramadol 100mg were on the narcotic count in March 2024. There was no evidence of Tramadol and Trazadone on the medication Profile. Patient #14: On the narcotic count dated 3/28/24, Seroquel 50 mg and Tramadol 50 mg were listed. There was no evidence of either of these medications on the medication profile.

Upon patient record review, 13 of 14 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #14 ) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #1 - #9, #13: The plans of care dated from 01-2-24 through 4-9-24 indicate the RN frequency is "once per month for RN supervisory visit and twice per month for CNA supervisory visit". There is no evidence an assessment was completed by the RN except for recertification visits during these dates. Patient #14: POC from 01-02-24 to 03-28-24 indicate the RN frequency is "once per month for RN supervisory visit and twice per month for CNA supervisory visit". There was no evidence a reassessment was done by an RN during these dates. Patient #11, #12: POC from 01-02-24 to 01-28-24 and prior indicated the RN frequency is "once per month for RN supervisory visit and twice per month for CNA supervisory visit". There was no evidence a reassessment was done by an RN during these dates.

Upon patient record review, 4 of 14(Patient #5, #6, #9, #14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #5: Narcotic Count completed between 2/1/24 and 2/29/24 indicated the patient had Hydrocodone 5/325 mg q 5hours PRN. There was no evidence of an order for the hydrocodone. Patient #6: The narcotic count dated 3/26/24 indicated the patient was using Hydrocodone 5/325 mg q 6 hours PRN. There was no evidence of an order for this hydrocodone. Patient #9: The narcotic count for March 2024 indicated the patient had Trazadone 100 mg and Tramadol 50mg in their possession. There was no evidence of a physician order for Tramadol or Trazadone. Patient #14: The narcotic count for 3/28/24 indicated the patient was taking Seroquel 50 mg daily, and Tramadol 50 mg PRN. There was no evidence of these medications on the medication profile

Upon patient record review, 13 of 14 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #14) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #1-#9, and Patients #11 - #14: There was no evidence of an updated comprehensive assessment for these patients. The plan of care indicated and LVN visit was once weekly and there were no RN visits after the initial comprehensive assessment.

Condition of Participation: Hospice Aide and Homemaker Services. L607

Upon patient record review, 13 of 14 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #14) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patients #1-#9, #11-#14: There was no evidence of a care plan for the CNA.

Upon patient record review 13 of 14 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #14) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #1, #2, 3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #14: There is no evidence of a care plan for the aide specific duties. In all plans of care there is an open care plan for the hospice aide. The care plan indicates "bathing and ADLs" as interventions. There are no specific tasks assigned. For all patients, the aide completed the CNA documentation tool where all duties are open tasks and the aide documents the tasks that he/she completed. For example, the aide acknowledges all tasks 1)Ambulatory with assistance, 2) bedbound w/scheduled repositioning, 3)complete bed bath, 4) partial bed bath, and 5) shower. The aide then marks "completed" for some of the tasks.

Upon patient record review 13 of 14 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #14) did not have evidence documentation in the patient record that a Registered Nurse made 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 and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patients #1-#9, #11-#14: On all documented aide supervisory visits, there was no indication that the RN made a visit to the home. The only exception was admission and recertification visits.

Upon patient client record review, 8 of 14 (Patient #1, #2, #3, #5, #7, #8, #9, #13) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1: The frequency of the aide is stated on the scheduling tool is written as 1-3 x per week. Additionally, Per Chaplain assessment, dated 02-19-24 and RN Sup Visit dated 02-28-24, the aide's frequency is 6 x week. The IDG plan of care indicates 2 x week and is being followed by the IDG. Patient #2: The frequency of the aide is stated on the scheduling tool is written as 1-3 x per week. The IDG plan of care indicates 2 x week and is being followed by the IDG. Patient #3: The frequency of the aide is stated on the scheduling tool is written as 1-3 x per week. Additionally, per the RN supervisory visit dated 01-31-24, the hospice aide frequency is 6 x week. The IDG plan of care indicates 2 x week and is being followed by the IDG. Patient #5: On visit notes since the time of admission, Aide frequency is 4 x week, MD 1 x mo. The IDG POC indicates the aide 2 x week. There is no evidence of visit 1 x month by the MD and this is not indicated in the plan of care which is being followed by the IDG. Patient #7: On visit notes beginning on admission, 05-30-23, the aide frequency is 4 x month. The IDG plan of care indicates 2 x week and the plan of care is being followed. Patient #8: Chaplain notes dated 11-11-24 and 4-1-24 indicate the aide frequency is 4 x month. The IDG plan of care indicates 2 x week and the plan of care is being followed. Patient #9: The CNA schedule is written as 1-3 x per week. The IDG plan of care indicates 2 x week and the plan of care is being followed. Patient #13: The CNA schedule is written as 1-3 x per week. The IDG plan of care indicates 2 x week and the plan of care is being followed.