Every finding on record at Alpowa Healthcare, Inc.

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 clinical record review and interview. In 3 of 5 (60%) clinical records reviewed revealed that the agency did not ensure that the aide plan of care provided necessary information. Clinical Record 5: Initial SN assessment on 05/21/2024 and plan of care dated 05/21/2024 revealed that the patient had a football-shaped bandage on the whole foot, was on continuous oxygen, and had a foley catheter. The aide care plan dated 05/21/2024 did not include direction to the aide related to how to address the foley catheter, oxygen, or wound dressing. Clinical Record 6: SN initial assessment and plan of care dated 05/09/2024 revealed that the patient had a pressure ulcer on the right hip with orders to apply a dressing two times per week. The aide plan of care developed by RN on 05/09/2024 did not include any direction to the aide related how to manage bathing with a hip dressing. Clinical Record 7: SN initial assessment and election of benefit 05/24/2024. A new order was received on 06/06/2024 which read, "SN to cleanse left side of coccyx with wound cleanser, apply Silvasorb to wound bed. Cover with Mepilex dressing to be changed 2 x week and PRN. Plan of care update on 06/20/2024 read in part, "wound care, cleanse bilateral lower legs with wound cleanser, ABD pad to weeping areas. Apply 2-step wrap toes to just below knee using clean technique. The aide plan of care was created by the RN on 05/29/2024. There were no updates to the aide's plan of care and no instructions to the aide related to wound care dressing sites. After review of clinical record and education on 07/15/2024, Director of Clinical Services confirmed there was lack of instruction to the aide on the care plan and stated in part, "Oh, that makes a lot of sense."