Every finding on record at Alliance Hospice

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview 3 of 10 (30%) clinical records reviewed revealed the hospice did not ensure the initial spiritual assesments were completed within 5 calendar days after the election of hospice benefit. Record # 11017 was reviewed and identified the patient elected hospice care on 01/29/2020. There was no documented evidence of an initial spiritual assessment or any reason why the initial spiritual assessment was not completed during my review period 01/29/2020 through 02/29/2020. Record # 43446 was reviewed and identified the patient elected hospice care on09/25/2020. There was no documented evidence of an initial spiritual assessment or any reason why the assessment was not completed during my review period 09/25/2020 through 10/24/2020. Record # 30154 was reviewed and identified the patient elected hospice care on 02/05/2022. There was no documented evidence of an initial spiritual assessment or any reason why the assessment was not completed during my review period 02/5/2022 through 03/05/2022. The Director was interviewed on 04/21/2022. She agreed that the initial spiritual assessments were not completed within 5 days of the patient(s) election of hospice benefits. She had no additional information to provide.

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 a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by review of clinical records and interview. 5 of 10 (50%) records in which a hospice aide was accepted revealed a lack of clear and updated specific instructions for the aide assignment, thus leaving the hospice aide to make decisions outside of the aide's scope of practice. Record # 12060 was reviewed and identified the patient elected hospice care on 06/08/2021 with a diagnosis of senile degeneration of the brain. The aide assignment initiated by the RN assigned the aide to "shower patient 3 times a week." "Complete bed bath if unable to shower." No documented evidence to confirm that described the criteria to be used to determine as type of bath. There was no documented evidence that described criteria that was to be used by the hospice aide to determine the type of bath the patient was to receive. Record # 63866 was reviewed and identified the patient elected hospice care on 09/01/2020. The aide assignment initiated by the RN assigned the aide to " apply lotion, skin barrier, and foot care per patient's request." Per ongoing skilled nursing assessments and POC updates, the patient was unable to make their needs known due to being oriented to self only. Record # 57039 was reviewed and identified the patient elected hospice care on 01/08/2022. The aide assignment initiated by the RN assigned the aide to provide "foot care and apply lotion every visit and per patient's request." Record # 62152 was reviewed and identified the patient elected hospice care on 1/28/2022. The aide assignment initiated by the RN assigned the aide to "shower per patient's request." "Bed bath if patient prefers'" Per ongoing skilled nursing assessment and POC updates, the patient was unable to make her needs known due to weakness and due to be oriented to self only. Record # 77015 was reviewed and identified the patient elected hospice care on 11/21/2021. The aide POC assigned the aide to provide "peri care, comb/brush hair, assist with bed side commode and ambulation as needed." No documented evidence to confirm that described the criteria to be used to determine as needed tasks. The Director was interviewed on 04/19/2022 and she agreed that the aide POC lacked specific instructions for care. She had no additional information to provide.

It is required that a hospice aide provides services: ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation. This standard was not met as evidenced by clinical record review and interview. 3 of 10 (30%) applicable records of patients receiving Hospice aide services revealed that the aide services provided were inconsistent with the Interdisciplinary Group and the plan of care. The visit frequency of the aide visits provided did not match the care plan. Record # 12060 was reviewed and identified the patient elected hospice care on 06/08/2021. The Hospice aide plan of care assigned by the RN assigned the aide to "shower patient 3 times a week." "Complete bed bath if unable to shower," effective 06/10/2021. The aide documented on 06/15/2021 and 06/17/2021 that both types of baths were completed. There was no documnetation eplaining the documentation error that recorded both types of bath were completed. . Record # 77015 was reviewed and identified the patient elected hospice care on 11/21/2021. The orders for the aide visit frequency were written to be provided 2 times a week. There was 1 missed aide visit on 12/25/2021 and 12/12/2021. There was no documentation in the clinical record that described why the hospice aide visit was missed. Record # 63866 was reviewed and identified the patient elected hospice care on 09/01/2020. The orders for the aide visit frequency were written to be provided 3 times a week. There were 2 missed aide visit on 09/01/2020 and 1 missed visit the week of 09/06/2020. There was no documentation in the clinical record that described why the hospice aide visit was missed. The Director was interviewed on 04/19/2022 and she agreed that the aide did not follow the POC as ordered by the interdisciplinary group. She had no additional information to provide.

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. 3 of 10 (30%) 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 # 77015 was reviewed and identified the patient elected hospice care on 11/21/2021. The orders for the aide visit frequency was 2 times a week. There was 1 missed aide visit on 12/25/2021 and 1 missed visit the week of 12/12/2021. There was no documented evidence that the RN was notified of a change missed visit. Record # 63866 was reviewed and identified the patient elected hospice care on 09/01/2020. The orders for the aide visit frequency was 3 times a week. There were 2 missed aide visits on 09/012020 and 1 missed visit the week of 09/06/2020. There was no documented evidence that the RN was notified of the missed visits. Record # 11017 was reviewed and identified the patient elected hospice care on 01/29/2020. The Hospice aide assignment initiated by the RN assigned the aide to shower patient every visit. The aide documented on 01/31/2020 that the patient declined shower. There was no documented evidence that the RN was notified of a change in the plan of care. The Director was interviewed on 04/19/2022 and she agreed that the aide did not inform the RN about changes in the plan of care. She had no additional information to provide.