Every finding on record at Amedisys Hospice, LLC

Upon patient record review, 3 of 19 (Patient #2, 3, and 8) did not contain evidence that a Registered Nurse had been designated to ensure the continuous assessment of the patient and family's needs, and to coordinate activities with other members of the Interdisciplinary Group (IDG). The IDG must work together, and is responsible for supervision of the care and service for each patient and family: Patient #2: The Physician 07/15/24 SOC CTI noted, "Pre-hospice, the patient has had a mid-back, Stage I pressure ulcer, which has healed." The RN SOC note reflected, "Patient has a Stage I pressure area to mid-back, no longer being treated". The next subsequent SN visit dated 07/17/24 did not document the assessment of this specific area of concern. Patient #3: The 07/24/24 Physician IDG note, and an RN note, reflected, "Patient has developed irritated red areas on the buttocks, hip, and spine." There was not nursing documentation at the next subsequent SN visit that these areas of concern had been assessed/followed up on. Patient #8: The 06/25/24 Physician SOC CTI, and the RN SOC Assessment reflected that, "The patient has no wound, but has mild RLE cellulitis; for which no current wound care has been ordered." The SN visits dated 07/01/24 and 07/08/2024 did not document an assessment to this specific area of noted concern.

Upon patient record review, 1 of 19 (Patient #1) 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: During Surveyor-attended home visit on 08/06/24 it was noted that the patient had the following DME: 1) Hospital Bed; and 2) Bedside Table. These DME were not included on the current POC.

Upon patient record review, 2 of 19 (Patients #1, and 6) did not contain evidence that the revised Plan of Care included information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the Plan of Care: Patient #1: The IDG POC dated 07/24/24 continued to include, "Hospice nurse to perform/instruct on wound #2 right distal foot pressure ulcer Stage II. Cleanse with wound cleanser, pat dry gauze, and cover with foam dressing. Change 3x per week or p.r.n. soiling/dislodgement. Caregiver may do in absence of Hospice nurse." A 07/09/24 SN visit note had documented, "Wound inactivated." This wound care was never removed from the subsequent IDG Plan(s) of Care. Patient #6: The 07/24/24 SN home visit reflected that the family was using "red light therapy" on the skin of her bottom; a previous compromised skin location. This therapy was not included on the Hospice IDG Plan of Care.

Upon patient record review, 2 of 19 (Patients #4, and 6) did not contain evidence that the IDG had ensured that care and services were provided only in accordance with the Plan of Care: Patient #4: Volunteer visits were ordered once weekly. There was no Volunteer visit made the week of 06/30/2024. Patient #6: The SN visit dated 05/07/24 documented that the nurse had, "Performed a fecal dis-impaction while the patient was sitting on the commode; with a moderate amount of clay-like stool being removed." however, there was not an order.

Upon observation, there was not documented evidence that the Hospice's use of Volunteers, providing day to day administrative and/or direct patient care services, is an amount that at a minimum equals 5 percent of the total patient care hours of all paid Hospice employees and contract personnel. The Administrator provided their 2023 calendar-year Volunteer report, which totaled 2.59%.

Upon patient record review, 1 of 19 (Patient #9) did not contain clear documentation: Patient #9: A verbal order was obtained on 05/13/24 for, "Stage II pressure ulcer left heel. Cleanse with soap/water, pat dry with gauze. Paint wound with Betadine. Leave open to air/dry, and float feet. BID and p.r.n. soiling/dislodgement." The Administrator confirmed that the patient had a right heel wound, rather than a left heel wound.