Every finding on record at Adventa Hospice, LLC

Upon patient record review, 1 of 23 (Patient #7) did not contain evidence of a current/comprehensive Medication Profile: Patient #7: In the 01/08/25 IDG Meeting notes, the Physician documents, "The patient is now on Oxygen 3 lpm continuous per NC." This reflects the Oxygen order obtained/documented on 05/24/24. However, the Medication Profile within the clinical record lists, "Oxygen 2 lpm p.r.n. per NC" which is incorrect.

Upon patient record review, 2 of 23 (Patients #4 and 11) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #4: The 12/13/24 SOC CTI reflected that the patient has had persistent bilateral heel wounds. On the 12/13/24 RN visit report she documented, "Wound #1 (stage II right heel) and a wound #2 (stage II left heel) were present. Wound care was not provided as awaiting orders." A verbal order was obtained on 12/14/24 for, "Facility Wound Team will provide all wound care for patient's R/L heel wounds." However, the Hospice's Plan of Care did not include the details of the wound treatment to be provided by such facility staff. Patient #11: The12/10/24 SOC Plan of Care included, "SN to perform insertion of _____. Instill into balloon and secure tubing with change Q every ____ or as needed." The same POC included, "Hospice nurse to perform/teach the patient/caregiver pressure ulcer care to _(area)_. Irrigate cleanse with _____. Apply _____. Fill _____. Apply skin barrier to peri-wound to prevent maceration and protect peri-wound. Cover with _____. Secure with _____. Change QD and p.r.n. for _____. This is not a complete wound order.

Upon patient record review, 5 of 23 (Patients #1, 2, 3, 5, and 6) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: Home visit on 01/07/2025, it was noted that the patient had the following: 1) Hospital Bed; and 2) Overbed table. These DME had not been included in the Hospice's POC. Patient #2: Home visit on 01/07/2025, it was noted that the patient had the following: 1) Hospital Bed; 2) Overbed table; 3) Reclining Chair; and 4) Floor Fall Pad. These DME/Supplies had not been included in the Hospice's POC. Patient #3: Home visit on 01/07/2025, it was noted that the patient had the following: 1) Hospital Bed; 2) Overbed table; and 3) Heel protector boots and guards. These DME/Supplies had not been included in the Hospice's POC. Patient #5: Home visit on 01/07/2025, it was noted that the patient had the following: 1) Hospital Bed; and 2) Overbed table. These DME had not been included in the Hospice's POC. Patient #6: Home visit on 01/07/2025, it was noted that the patient had the following: 1) Hospital Bed; and 2) Overbed table. These DME had not been included in the Hospice's POC.

Upon patient record review, 2 of 23 (Patients #5 and 12) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #5: A verbal order was obtained on 12/13/24 for, "Wound #1 stage I left heel pressure ulcer. Cleanse with Saline/Wound Cleanser, pat dry with 4x4s, apply Xeroform and barrier cream, cover with 4x4 or bordered foam dressing, and wrap lower ankle and foot with Coban. Hospice SN to provide wound care Q 48 hours, and caregiver may provide in SN absence." The Hospice nurse provided this physician-ordered wound care, as ordered. On the 12/16/24 Hospice nurse visit, the nurse documented, "Wound care not ordered this visit. Family has removed dressing prior to RN arrival, as instructed. Hospice RN applied barrier cream and sock to left foot. Family was advised to remove sock in the morning and leave open to air. Dressings have been ordered, and facility is aware that Hospice nurse will provide further wound care when supplies arrive. On the 12/18/24 Hospice nurse visit, the nurse documented, "Family do not have supplies for wound care. Will order." Wound care was not provided to the patient as per Physician order. Patient #12: A 10/16/24 order was obtained for SW visits effective 11/10/24 of "1x per month x2". There was no SW visit made in the month of November 2024.

Upon patient record review 2 of 23 (Patients #9 and 13) did not contain documented evidence that a Registered Nurse had 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 is meeting the patient's needs: Patient #9: The first Aide visit/services were provided on 12/10/24. An Aide Supervisory visit was made on 12/18/24, but then not again until 01/03/25, for an interim period of 16 days. Patient #13: An Aide Supervisory visit was made on 11/21/24, but then not again until 12/06/24, for an interim period of 15 days.

Upon observation, there was not evidence that the 2024 year-end annual report documented the use of Volunteers providing day to day administrative and/or direct patient care services, in an amount that at a minimum equaled 5 percent of the total patient care hours of all paid Hospice employees and contract personnel. The Hospice's rate of volunteer utilization for 2024 was 2.2%.

Upon patient record review, 2 of 23 (Patients #7 and 14) did not contain evidence that all entries were clear/consistent with the patient's status: Patient #7: In the 01/08/25 IDG Meeting notes, the Physician documented, "Patient coughs with each meal, and requires suctioning prn." There is no mention anywhere else in the clinical record that this patient is/or has been using suctioning. Additionally, in the same 01/08/25 IDG Meeting notes, the Physician notes that, "The patient is now on Oxygen 3 lpm continuous per NC." This reflects the Oxygen order obtained/documented on 05/24/24. However, the listing of medications integrated into the end of this same IDG Meeting Note lists, "Oxygen 2 lpm p.r.n. per NC." This is unclear. Patient #14: SOC was 12/05/24. The SW made the Evaluation visit on 12/06/24. On 12/06/24 a verbal order was obtained for, "Effective 12/05/24, SW visit frequency of 7m1, 9m1, 8m1, and then 1m1." A subsequent verbal order was obtained on 12/24/24 for, "Decrease SW visit frequency to monthly." An additional verbal order was then obtained on 12/31/24 for, " Effective 12/05/24 continue SW visit frequency of 6m1." This is unclear documentation.

Based on agency policy review, medical record review, and interview, the agency failed to furnish services indicated by the individualized written Hospice Certification and Plan of Care (POC) established by the hospice interdisciplinary team for 2 patients (#7 and #13) of 20 patients reviewed. The findings include: Review of the agency policy titled, "Plan of Care," dated 11/30/2021, showed "...All hospice care and services furnished to patients and their families must follow an individualized written plan of care...The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including the following...A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs..." Medical record review revealed Patient #7 was admitted to the agency on 12/3/2019 with diagnoses including Chronic Obstructive Pulmonary Disease and Anemia. Medical record review of Patient #7's POC for the certification period 1/21/2022-3/21/2022 showed the frequency for Skilled Nurse (SN) visits with an effective date of 1/23/2022 were 1 time per week for 8 weeks. Medical record review of Patient #7's SN visits for Resident #7 showed the week of 1/23/2022-1/29/2022 the SN did not complete a visit. The POC showed 1 visit was to be completed. Medical record review revealed Patient #13 was admitted to the agency on 3/18/2021 with diagnoses including Huntington's Disease, Anxiety, and Hypothyroidism. Medical record review of Patient #13's POC for the certification period 1/12/2022-3/12/2022 showed the frequency for SN visits were 1 time per week for 8 weeks. Medical record review of Patient #13's SN visits showed the week of 1/12/2022-1/15/2022 the SN did not complete a visit. The POC showed 1 visit was to be completed. During an interview on 2/9/2022 at 2:29 PM, the Director of Clinical Operations confirmed Patient #7 had a missed SN visit the week of 1/23/2022-1/29/2022. Further interview confirmed Patient #13 had a missed SN visit the week of 1/12/2022-1/15/2022.

Based on agency policy review, medical record review, and interview, the agency failed to provide volunteer services for 1 patient (Patient #9) of 20 patients reviewed. The findings include: Review of the agency policy titled, "Volunteers," dated 1/19/2022, showed "...A volunteer is an individual who provides support and assistance to the patient and the patient's family without compensation...A care plan is developed by the hospice team...Volunteers provide direct patient, indirect, and bereavement care to the hospice patient and their significant others under the supervision of a member of the hospice team...When a volunteer is requested...Volunteer activity will be included in the patient's hospice plan of care..." Medical record review showed Patient #9 was admitted to the agency on 12/30/2021 with diagnoses including Parkinson's Disease, Dementia, and Type 2 Diabetes Mellitus. Review of the Hospice Certification and Plan of Care (POC) for the certification period of 12/30/2021-3/29/2022, showed "...Volunteer services will be available to the patient/caregiver as needed...A volunteer plan will be established based on the needs of the patient/caregiver..." Review of a Visit Note Report dated 1/4/2022, showed "...DOES PATIENT ACCEPT VOLUNTEER SERVICES...YES...NO DIRECT VOLUNTEERS AVAILABLE IN PATIENT'S AREA AT THIS TIME..." During an interview on 2/9/2022 at 3:24 PM, the Director of Clinical Operations confirmed Patient #9 had desired to have volunteer services be provided. She further confirmed no volunteers had been available in the patient's area, but the branch office had not reached out to the parent office for the availability of volunteers.