Every finding on record at Affinis Hospice LLC

Based on record reviews, review of policy titled "Clinical Standard of Practice, On -Call Triage,” and staff interview, it was determined that the agency failed to effectively manage the patient's pain and symptoms related to the terminal illness in a timely manner. Specifically, the agency failed to provide on-site nursing services within one hour of notification where the terminally ill patient experienced a symptom-management crisis situation for one patient (P) (P#5) of fourteen sampled patients. --- Findings include: Review of the policy titled "Clinical Standard of Practice, On -Call Triage,” revised date of 4/2025 reveals the following:Overview Standard: Onsite nursing service must be made available within one hour of notification where the terminally ill patient and the patient with an advanced and progressing disease experiences a symptom -management crisis situation.On-call Nurse will triage the patient needs:Symptoms/Issues:If the patient is unstable then the nurse will make a visit offering recommendations of what the caregiver can do to alleviate the symptoms/issues until the nurse arrives. Review of record for P#5 revealed that patient was admitted to hospice on 4/4/25. P#5 resides in an Assisting Living Facility (ALF). Review of document titled “On-call Communication,” dated 6/1/25, revealed that Registered Nurse (RN) DD received a call from the on-call service at 11:07 p.m., from the facility regarding P#5. The On-call Communication note revealed that P#5 had a projectile vomiting that smelled strongly of iron, was red tinged and grainy but no food noted in emesis.  The document revealed that the patient was covered in feces and the facility staff were unable to move him because the patient turned gray and pulse went from 125 to 148 (normal resting pulse rate for adults is 60-100 beats per minute) and blood pressure 152/99 (normal blood pressure for adults 120/80). On-call Communication note further revealed that patient had another episode of vomiting, and the facility notified the hospice agency of patient’s change in condition. In the On-call Communication note, RN DD documents the following: “facility nurse was also going to notify the family member of the episode as it is a change in condition.  Nurse to call back if any other changes in condition occur or if patient has more vomiting episodes.  Informed her we would do a PRN visit on him tomorrow”. Review of On-call Communication dated 6/2/25 at 11:12 pm, revealed a call was made by the facility nurse to the agency regarding P#5. The On-call Communication note revealed that P#5 had an episode of unresponsiveness for approximately one minute.  In the On-call Communication note RN DD documents the following: “both the facility nurse and myself think the patient may have had a TIA or possible second stroke. RN DD further documents the following: She was notifying us as an FYI, and she will monitor him closely through the night and she will notify patient’s family of this change in condition.  Nurse knows to notify hospice of any further change in condition.” On 6/24/25, at approximately 2:30 p.m., an interview was conducted with the Clinical Supervisor (CS) who revealed that the agency did not provide an onsite nurse to assess P#5 who was in symptom-management crisis situation. CS also verbalized that the agency failed to follow the policy where the onsite nursing service were made available within one hour of notification when the terminally ill patient and the patient with an advanced and progressing disease experiences a symptom -management crisis situation.

Based on record reviews, review of policy titled "Clinical Standard of Practice, On -Call Triage,” and staff interview, it was determined that the agency failed to ensure that a governing body (or designated persons so functioning) assumes full legal authority and responsibility for the management of the hospice, the provision of all hospice services, and continuous quality assessment and performance improvement. The agency failed to ensure that the governing body is responsible for the day-to-day operation of the hospice for three patients (P) (P#5, P#6, and P#7). --- Findings include: 1. Review of document titled “On-call Communication” dated 6/1/25, revealed that Registered Nurse (RN) DD received a call from the on-call service at 11:07 pm from the facility regarding P#5.On 6/24/25, at approximately 2:30 p.m., an interview was conducted with the Clinical Supervisor (CS) who revealed that the agency did not provide an onsite nurse to assess P#5 who was in symptom-management crisis situation. 2.  On 6/24/2025, home visits were conducted with P#6, and P#7, at the SNF where they reside. The agency failed to include a hospice plan of care at the SNF.A plan of care was requested from the SNF for P#6 and P#7 but not received. Cross refer to L0512 relating to the rights of the patientCross refer to L0781 relating to coordination of services

Based on home visits, staff interviews, and review of the policy titled “Clinical Standard of Practice: Coordination of Care: Hospice and  Skilled Nursing,” it was determined the agency failed to provide to the Skilled Nursing Facility (SNF) where the patient resides, with the hospice plan of care for two patients (P) (P#6, P#7) of three patients sampled. --- Findings include: Review of policy titled “Clinical Standard of Practice: Coordination of Care: Hospice and Skilled Nursing,” dated 9/2024, revealed the following:Overview of Standard:Hospice and center associates collaborate on a plan that meet (sic) the patient’s and family’s needs when a patient chooses to elect hospice services. Together, the partnered associates provide support to keep the patient comfortable and address symptoms as they arise. Hospice provides benefits that specialize in care at the end of life which includes bringing a knowledgeable team to collaborate with the center in providing quality of life for the patient and support to the family.Hospice team provides the following for patients on hospice:•       Hospice Plan of Care  On 6/24/2025, at approximately 10:00 a.m., a home visit was conducted with P#6, and P#7, at the SNF where they reside. The home visit failed to reveal care plan coordination between the hospice agency and the SNF with a current plan of care for P#6 and P#7. On 6/24/2025, at approximately 11:00 a.m., following a home observation visit with P#6, an interview was conducted at the NF with Chaplain FF, who revealed that care plan coordination is verbally reported to SNF staff. He additionally revealed that there is no designated hospice chart at the facility with the hospice plan of care, and he is unaware of a system for sharing the plan of care. On 6/24/2025 at approximately 12:00 p.m., an interview was conducted at the NF with the Assistant Director of Nursing (ADON), who revealed that the NF’s electronic medical record (EMR) contains visit notes from the hospice. However, she was unable to locate hospice plans of care in the NF’s EMR for P#6 and P#7. On 6/24/2025 at approximately 2:00 p.m., an interview was conducted with the hospice Clinical Manager (CM), who revealed that hospice clinical visit notes are uploaded by hospice office staff into the NFs’ EMR. The CM explained that hospice discipline-specific care plans are embedded and updated in visit notes by hospice staff and that the hospice plan of care is not uploaded to the NF’s EMR but revealed the hospice plan of care for all facility patients will now be uploaded into the NF’s EMR.

Based on observation, record review, and staff interviews, it was determined that the agency failed to ensure that patient medication profiles were updated to reflect current medications at the time of the comprehensive assessment for two (2) of twelve (12) sampled patients (P#1 and #2). --- The Findings include: During a home visit observation conducted on 10/13/22 at approximately 1:00 p.m., with Registered Nurse (RN) AA, for (P#2), it was revealed that (P#2) was admitted on 10/5/22, with a diagnosis of pneumonia, emphysema, pulmonary fibrosis, and chronic kidney disease, stage 3. The surveyor compared P#2's current medication list at Rehabilitation facility to the hospice agency's medication profile. Discrepancies were found. Tramadol 50 milligrams (MG), take one tablet oral every four hours as needed for pain. Medications was missing from P#2's hospice medication profile and plan of care. On 10/12/22 at 1:40 p.m., an interview was conducted with (RN) AA, who confirmed that she was not aware that P#2 was taking Tramadol 50mg one tablet oral every four hours as needed for pain, and she did not update the medication profile and plan of care. A home visit was conducted at 1:10 p.m., on 10/12/22, of patient (P#1) with Registered Nurse (RN) BB was admitted to Hospice on 7/26/22, with the diagnosis of Congestive Heart Failure. The clinical record was reviewed for certification period of 6/29/22 to 8/27/22. During the facility visit the surveyor compared P#1 current medication list with the agencys medication profile. Discrepancies were found. 1 The hospice agency medication profile and plan of care revealed Acetaminophen 325 milligrams (mg) oral tablet, two tablets orally every 6 hours as needed for mild pain; The facility revealed no record of medication. 2 The hospice agency medication profile and plan of care revealed Meloxicam oral tablet; one tablet orally once a day as needed for mild pain; The facility revealed no record of medication. 3 The hospice agency medication profile and plan of care revealed Milk of Magnesia 400 milligram (mg)/5 milliliter(ml) oral suspension 400 mg/5ml liquid; administer 30 ml orally once a day as needed for constipation; may give up to 4 doses per month before calling Medical Doctor (MD). The facility revealed no record of medication. 4 The hospice agency medication profile and plan of care revealed Hydrocortisone, Topical 2.5% topical cream; Apply one application topical two times a day as needed for itching. The facility revealed no record of medication. 5 The hospice agency medication profile and plan of care revealed Ipratropium-albuterol 0.5 milligram (mg)-3 milligram (mg) (2.5 milligram base/3 milliliter (ml) nebulizer (neb) solution 0.5 mg liquid; inhale one application orally four times a day as needed for shortness of breath. The facility revealed medication was discontinued on 4/3/19. While reviewing medications in the home with RN, RN verbalized understanding of the requirement to reconcile all medications in the facility medical record (MR) with medications listed in the agency MR during each visit.