Every finding on record at Agave Healthcare LLC

It is required that a qualified hospice aide has successfully completed a competency evaluation program that evaluates the aide’s competency in the following subject areas by observation of the aide’s performance with a patient or a pseudo patient: communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff; reading and recording temperature, pulse, and respiration; appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist: bed bath; sponge, tub, and shower bath; hair shampoo (sink, tub, and bed); nail and skin care; oral hygiene; toileting and elimination; safe transfer techniques and ambulation; and normal range of motion and positioning. This standard was not met as evidenced by interview and personnel record review. 1 of 1 (100%) applicable Hospice Aide personnel records reviewed revealed the hospice did not ensure the required initial Hospice Aide competency evaluation was completed. Record #75762 was reviewed and the Hospice Aide date of hire was 2/7/22. The "Initial Hospice Aide" competency evaluation form completed 2/7/22 through 2/24/22 did not contain the competency evaluation for the required skill of bed bath. During interview on 3/31/22, the Executive Director/RN Director stated the competency evaluation for the bed bath was not completed with a pseudo patient or direct observation of the Hospice Aide's performance with a patient. During home visit on 4/1/22, the Hospice Aide stated, "I have completed bed baths on patients since I started working at this hospice".

It is required that hospice aides 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. This standard was not met as evidenced by interview and clinical record review. 3 of 5 (60%) applicable records of patients receiving hospice aide visits revealed the hospice did not ensure hospice aides reported patient changes related to the plan of care. Record #16652 was reviewed and the aide plan of care included to shower patient every visit. The hospice aide visit dated 3/18/22 stated, "refused shower" and the narrative section included "shower room was full". There was no documented communication with the hospice RN as to why the assigned shower was not completed. During interview on 3/31/22, the Executive Director/RN Director confirmed the missing documented communication with the RN and stated, "I do remember that the hospice aide did call me about the refused shower". The documentation revealed the terminal diagnosis was Heart disease, the patient was forgetful and the patient lived in a group home with caregivers. Record #61001 was reviewed and the Hospice Aide plan of care included to shower, wash hair and apply lotion every visit. The hospice aide visit dated 3/29/22 stated, "refused shower, wash hair and lotion" and there was no documented communication with the hospice RN as to why the assigned tasks were not completed. During interview on 3/31/22, the Executive Director/RN Director confirmed the missing documented communication with the RN and stated, "I knew about the patient refusing these assigned tasks since the Hospice Aide did call me". The documentation revealed the terminal diagnosis was Heart disease, the patient was forgetful and the patient lived alone at home. Record #88179 was reviewed and the Hospice Aide plan of care included to wash hair every visit. The Hospice Aide visit dated 2/7/22 stated, "refused" for the assigned task of "wash hair" and there was no documented communication with the Hospice RN as to why the assigned hair wash was not completed. During interview on 3/31/22, the Executive Director/RN Director confirmed the missing documented communication with the RN and stated, "I knew about the patient refusing to get her hair washed since the Hospice Aide called me". The documentation revealed the terminal diagnosis was Gastric Cancer, the patient was minimally responsive, and the patient lived at home with husband.