Every finding on record at Apf Hospice, Inc

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 3 (67%) home visit observations, it was revealed that the agency did not ensure the drug profile contained the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. Home Visit 1: The patient elected the hospice benefit on 02/18/2025 for a diagnosis of atherosclerotic heart disease. During the home visit with the Hospice Aide (Personnel Record 7) on 03/26/2025, the hospice medication profile (printed on 03/25/2025) was compared to the Group Home medications. The hospice list included "Vitamin D 1000 units, take one tablet by mouth daily" dated 02/18/2025. The medication in the "bubble pack" from the pharmacy at the group home and their medication list included "Vitamin D 1000 units, take three tablets by mouth daily." Home Visit 2: The patient elected the hospice benefit on 10/18/2024 for a diagnosis of sequelae of cerebral infarction. During the home visit with the Registered Nurse (Personnel Record 4) on 03/26/2025, the hospice medication profile (printed on 03/25/2025) was compared to the Skilled Nursing Facility medication profile (printed on 03/26/2025) The hospice list documented the following medications that were not included on the Skilled Nursing medication profile: Docusate 100 mg soft gel 1 tab by mouth twice daily (dated 10/18/2024); Lorazepam 1 mg 1/2 tab by mouth every six hours as needed for anxiety, agitation or restlessness (dated 11/12/2024). The Skilled Nursing Facility medication list included the following medication not listed on the hospice profile: Fleet enema 1 dose rectally daily as needed for constipation (dated 10/18/2024). In a joint clinical record review and interview with the Director of Patient Care Services on 03/27/2025, the findings were confirmed, and she said the nurses hadn’t reconciled the medications appropriately.

It is required that 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, interview and observation. In 2 of 14 (14%) clinical records reviewed in which hospice aide services were accepted, it was revealed the agency did not ensure the registered nurse provided specific written instructions for the hospice aide. CLINICAL RECORD 1/Home Visit 1: The hospice aide care plan dated 02/18/2025 included visit frequency orders for twice weekly and the following relevant tasks: bed bath, shampoo, shave, brush teeth, apply lotion; visualize condition of skin and report to RN every visit, and change linens. During the home visit on 03/26/2025, with the Hospice Aide (Personnel Record 7) the aide was performing the task of bed bath, and a dialysis catheter with gauze dressing was observed on the patient's right chest. The aide stated, "I am careful not to get it wet." The aide care plan did not include specific instructions for the dialysis catheter or surrounding dressing during tasks. CLINICAL RECORD 8: The hospice aide care plans dated 10/03/2024 and 01/09/2025 included visit frequency orders of three times weekly and the following relevant tasks: bed bath, shampoo, assist to dress, oral care, apply lotion, visualize condition of skin and report to RN every visit, and change linens. The initial nursing assessment, dated 10/02/2024, noted the patient was on continuous oxygen at 4 liters per minute. The hospice aide care plan did not provide instruct if the aide could or could not remove the oxygen during cares. In a joint clinical record review and interview with the Director of Patient Care Services on 03/27/2025, she noted the aide should have been provided with instructions for protecting the dialysis catheter during tasks and if the aide was able to remove the oxygen briefly during tasks.

It is required that a hospice aide provide services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, in which aide services were accepted, it was revealed that the agency did not ensure services were provided as ordered in the plan of care. CLINICAL RECORD 4: The hospice aide care plan dated 08/14/2024 ordered an aide frequency of three visits per week. The week of 02/23/2025, only 2 visits were documented, one on 2/25/2025 and one on 02/28/2025. The week of 03/02/2025, only 1 visit was documented on 03/02/2025. The clinical record did not include documentation on why the visits were missed. CLINICAL RECORD 7: The hospice aide care plan dated 01/19/2025 ordered an aide frequency of two visits per week. From 01/19/2025 to 02/06/2025, there were no aide visits documented. For the week of 02/02/2025 one visit was documented on 02/07/2025 (1 visit missing), and for the week of 02/02/2025 one visit was documented on 02/14/2025 (1 visit missing). There were no aide visits documented after 03/13/2025 to the date of the review (03/26/2025). The clinical record did not include documentation on why the visits were missed. In a joint clinical record review and interview with the Director of Patient Care Services on 03/27/2025, she stated that there was a "message sent out about the missed visits on Clinical Record 4, but it should have been documented in the clinical record." She further went on to advise she "was not sure what had happened with the missed visits on Clinical Record 7 but did not see any messages about why they would be missed."

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. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, in which aide services were accepted, it was revealed that the agency did not ensure the hospice aides reported changes in the patient’s needs to the registered nurse (RN) as the changes related to the plan of care. CLINICAL RECORD 4: The hospice aide care plan dated 08/14/2024 ordered an aide frequency of three visits per week. The week of 02/23/2025, only 2 visits were documented, one on 2/25/2025 and one on 02/28/2025. The week of 03/02/2025, only 1 visit was documented on 03/02/2025. The clinical record did not include documentation that the hospice aide informed the RN that the aide visits were not completed as ordered. CLINICAL RECORD 7: The hospice aide care plan dated 01/19/2025 ordered an aide frequency of two visits per week. From 01/19/2025 to 02/06/2025, there were no aide visits documented. For the week of 02/02/2025 one visit was documented on 02/07/2025 (1 visit missing), and for the week of 02/02/2025 one visit was documented on 02/14/2025 (1 visit missing). There were no aide visits documented from 03/13/2025 to the date of the review (03/26/2025). The clinical record did not include documentation that the hospice aide informed the RN that the aide visits were not completed as ordered. In a joint clinical record review and interview with the Director of Patient Care Services (DPCS) on 03/27/2025, she stated that there was a message in the “chat” about a missed visit for clinical record 4, but nothing was documented in the clinical record. The DPCS further stated that she was unable to find any documentation related to the missed visits for clinical record 7.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed in which aides services were accepted revealed the agency did not ensure a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. CLINICAL RECORD 5: Hospice aide services were ordered for a frequency of twice weekly on 01/29/2025. The first aide visit was on 01/31/2025. The first supervisory visit was documented on 02/26/2025, making it 12 days outstanding. In a joint clinical record review and interview with the Director of Patient Care Services on 03/27/2025 the missed supervisory visit was confirmed.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. Document review of the volunteer program revealed the agency did not ensure hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The volunteer percentage for the past year (February 2024 to February 2025) in either an administrative or patient care role, was calculated at 2.5%. An interview was conducted with the Volunteer Coordinator on 03/26/2025 who reported that they had struggled with volunteer recruitment. Document review of the volunteer program revealed the agency did not ensure hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. An interview and document review was conducted with the Volunteer Coordinator on 03/26/2025 and the volunteer percentage for the past year (February 2024 to February 2025) in either an administrative or patient care role, was calculated at 2.5%.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene, and safe handling of soiled items in the patient’s care environment. This standard was not met as evidenced by observation and interview. One of 2 (50%) patients who received a home visit revealed the hospice did not ensure adherence to the agency's infection prevention and control policies and procedures. Patient #32027: During a home visit conducted on 6/8/22 at 1300, the LVN (#52931) observed during the handwashing procedure turned the faucet off with a bare hand. The LVN did not use a disposable towel to turn off the faucet. The LVN assessed the patient’s vital signs, then returned the stethoscope, blood pressure cuff, and thermometer back into the visit bag without cleaning the reusable equipment as per the agency’s policy. The agency policy #9-009.2 “Hand Hygiene” (revision 1/22) read in part, “Use a dry disposable towel to turn off faucet.” The agency policy #9-014.2 “Bag Technique” (revision 1/2022) read in part, “When the visit is completed, reusable equipment will be cleaned using antibacterial wipe and/or soap and water as appropriate….and equipment and supplies will be returned to the bag.” The Alternate DPCS was interviewed on 6/8/22 after the home visit and acknowledged that [Staff #52931] may have been nervous but should have used a dry towel to turn off the faucet and should have cleaned the equipment before putting the equipment back into the visit bag.