Every finding on record at Adom Hospice Company, LLC

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care, ensure continuous assessment of each patient’s and family’s needs, and ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 5 (60%) clinical records reviewed revealed that the hospice did not ensure the patients were provided coordination of care, continuous assessments of each patient's and family's needs, and that the interdisciplinary plan of care was implemented. Agency Policy C:93, Effective Date: 09/2022, titled: Plan of Care/Interdisciplinary Group of Care, stated in part, the written plan of care will contain, but not limited to diagnosis, prognosis, identification of patient and family/caregiver needs, and frequencies of services. Care provided to the patient will be by the plan of care. Ensure all orders written by the physician are followed from admission, during illness, and after discharge/death to maintain continuity for the patient/family. Clinical Record 1: The plan of care (POC) dated 12/01/2023 included an order for skilled nursing (SN) visits at one time a week, social worker (MSW) visits at two times a month, chaplain (CH) visits at one time a month, hospice aide visits at two times a week, and volunteer visits at four times a month. During the clinical record review, a SN visit was documented on 12/13/2023. The next documented SN visit occurred on 01/10/2024. There were no documented SN visits for the weeks of 12/17/2023, 12/24/2023, or 12/31/2023. The MSW visited the patient on 12/02/2023, 12/23/2023, 01/11/2024, 01/30/2024, 02/20/2024, and 03/07/2024. The MSW made one visit in February. There was no documented evidence of the missed visit. The hospice aide visited one time a week for the weeks of 12/10/2023, 12/17/2023, 12/242023, 12/31/2023, 01/07/2024, 01/14/2024, 01/21/2024, and 01/28/2024. There was no documented evidence for the reason visits were missed. Clinical Record 2: The plan of care (POC) dated 12/06/2023 included an order for skilled nursing (SN) visits at one time a week, MSW visits at two times a month, CH visits at one time a month, hospice aide visits at two times a week, and volunteer visits at four times a month. During the clinical record review, the social worker documented visits on 12/06/2023, 12/28/2023, 01/06/2024, 01/28/2024, 02/25/2024, and 03/07/2024. There was no documented evidence explaining the MSW missed visit in February 2024. The hospice aide visited the patient on 12/06/2023, 12/10/2023, 12/23/2023, 12/31/2023, 01/07/2024, 01/14/2024, 01/21/2024, 01/28/2024, 02/04/2024, 02/11/2024, 02/18/2024, 02/25/2024, 03/03/2024, and 03/10/2024. There was no documented evidence of missed visits from December 2023 until March 2024. Clinical Record 3: The plan of care (POC) dated 12/01/2023 included an order for SN visits at one time a week, MSW visits at two times a month, CH visits at one time a month, hospice aide was declined, and volunteer visits at four times a month. During the clinical record review on 03/25/2024, the social worker visited on 12/05/2023, 12/21/2023, 01/30/2024, and 02/20/2024. A documented phone call was made on 03/05/2024 to schedule a visit for March 2024 (voicemail was left). There was no documented evidence of missed visits for January and February 2023 During an interview on 03/27/2024, the Administrator/Director of nursing agreed that the nurse, social worker, and hospice aide had not made visits based on the frequencies ordered on the plans of care for the patients. He further stated, it was his fault due to forgetting to write a physician's order to update the plans of care with update discipline frequencies.

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 and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s needs. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 3 (67%) clinical records reviewed revealed that the hospice agency did not ensure the registered nurse made on-site supervisory visits no less frequently than every 14 days. Agency Policy A:4; Effective Date: 09/2022, titled: Adequate and Appropriate Human Resources, stated in part, a registered nurse (R)N supervisory visit is made every 14 days to the patient's home when aide services are being provided to assess whether the aide is following the patient's plan of care for completion of tasks assigned, creating a successful interpersonal relationship with the patient and family, and demonstrating competency with assigned tasks. Clinical Record 1: The first hospice aide visit was dated 12/10/2023. The initial registered nurse supervisory visit was documented on 12/28/2023. This was four days past the required fourteen-day requirement. Clinical Record 2: The election of benefit was dated 12/06/2023. The first hospice aide visit was dated 12/06/2023. The last documented supervisory visit is on 03/02/2024. There was no documented evidence for not having a documented supervisory visit on 03/16/2024. During an interview on 03/27/2024, the Administrator/Director of Nursing agreed that the supervisory visits had not been completed every fourteen days as required.

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, the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes including the care and services provided. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed revealed that the hospice agency did not ensure that each patient’s record includes, at a minimum the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes including the care and services provided. Clinical Record 3/Home Visit 3: The patient’s election of hospice benefit was dated 12/01/2023 with a diagnosis of metastatic colorectal cancer. During the clinical record review, the last documented skilled nursing (SN) note was documented on 01/12/2024. There was no documented evidence for missed visits in the clinical record. During the home observation visit (Home Visit 3) with the Registered Nurse (Personnel Record 4) on 03/26/2024, the patient stated that she knew when the team members were coming to visit and that they came every week. During an interview with the Administrator/Director of Nursing (Personnel Record 4) on 03/27/2024, he stated he made the visits to the patient but fell behind with his documentation.