Every finding on record at Absolute Home Health Care, Inc.

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 an 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 3 (33%) clinical records reviewed of patients that accepted hospice aide services, it was revealed that the agency did not ensure that the registered nurse prepared a plan of care for the aide that contained clear and specific instructions for the patient's required care. CLINICAL RECORD 2: The aide plan of care documented on 01/07/2025 and updated 01/15/2025, 01/27/2025, and 02/24/2025 ordered the task to apply barrier cream every visit as directed. There were no directions on any of the assignments for the hospice aide as to where to apply the barrier cream. The aide visited 3 times a week and applied barrier cream each visit, it was not documented where the barrier cream was applied. During an interview the Director of Hospice who reviewed the record, stated that the barrier cream instructions for the aide did not document the specific location to be applied.

It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group and Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 3 (33%) clinical records reviewed of patients that accepted the hospice aide for care, it was revealed that the agency did not ensure that the hospice aide followed all duties assigned in the hospice aide's plan of care. CLINICAL RECORD 2: The aide plan of care was dated 02/24/2025, and the assigned task was to complete a bed bath on Wednesday and a shower with a shower chair on Monday and Friday. The aide visit note dated 03/03/2025 (a Monday) documented the aide provided a complete bed bath and a shower A shower was assigned. On 03/05/2025 (Wednesday) a complete bed bath and a shower were documented as provided. A complete bed bath was assigned. On 03/07/2025 (Friday) a complete bed bath was provided but a shower was assigned. On 03/10/2025 a complete bed bath and a shower were provided but only a shower was assigned and on 03/14/2025 (Friday) a complete bed bath and a shower were provided but only a shower was assigned. During an interview with the Director of Hospice, it was stated that the specific baths ordered each day were not followed as required.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 1 of 3 (33%) clinical records reviewed, in which a hospice aide was accepted, it was revealed that the hospice agency did not ensure that the aide notified the case manager or supervisor when pain and skin changes were noted. CLINICAL RECORD 4: Aide assignment document noted 07/25/2024 assigned to evaluate pain and report if over 5. The Hospice Aide visit note dated 07/31/2024 with bath and personal care provided, documented the patient's pain level was 7, and noted redness underneath right breast and armpit but no documentation of case manager or supervisor notification. During an interview with the Director of Hospice, she stated that the pain level of 7 should have been documented as reported and that the pain medication orders had been changed.

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; safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids; safe handling of soiled items in the patient’s care environment; other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by observation, document review, and interview. In 1 of 4 (25%) observed home visits, it was revealed that the agency did not ensure that staff were compliant with hand hygiene, according to agency policy. Agency policy 7-009, Hand Hygiene (Revised November 2022), stated in part, "Hand decontamination using an alcohol-based hand rub should be performed: after removing gloves." Home Visit 2: The RN was observed performing wound care. The RN did the following: removed dirty gloves; and returned to the visit bag to obtain additional supplies. The RN did not perform hand hygiene after removing gloves, as required per policy. During an interview on 7/12/23, the Clinical Manager confirmed the finding.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: a copy of the hospice discharge summary; the patient's record, if requested. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed, it was revealed that the agency did not ensure that a discharge summary was sent to the patient's attending physician upon discharge. Agency policy 1-026, Discharge Summary (Revised November 2022), stated in part, " A copy of the discharge summary will be provided to the patient's attending physician." Clinical Record 2: The patient elected the hospice benefit on 5/4/23. The patient signed a revocation of hospice benefit on 5/8/23. There was no evidence that the agency sent the discharge summary to the physician. Clinical Record 5: The patient elected the hospice benefit on 7/27/22. The patient signed a transfer of hospice benefit on 1/4/23. There was no evidence that the agency sent the discharge summary to the physician. During an interview on 7/12/23, the Assistant Administrator confirmed the finding.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: The most recent hospice plan of care and Physician certification and recertification of the terminal illness; This standard was not met as evidenced by observation and interview. In 1 of 1 (100%) clinical records reviewed, it was revealed that the agency did not ensure the most recent hospice plan of care was provided to the SNF/NF. Home Visit 1: During the visit, the facility documentation was reviewed. The last plan of care provided to the facility was dated 3/1/23. There was no current plan of care, or recertification of terminal illness, available in the patient's record for facility staff. During an interview on 7/12/23, the Assistant Administrator confirmed the finding.