Every finding on record at Art of Hospice Care, Inc

Based on interview and record review, the agency failed to complete home visits per the plan of care for 3 of 11 sampled patients (6, 9, 10). As a result, the patients did not receive the number of visits ordered by the physician in order to address patient care needs. Findings: 1. Per the agency's Plan of Care for the certification period of 12/28/21 through 3/27/22, Patient 6 was admitted to the agency on 12/28/21 with diagnoses to include, malignant neoplasm of prostate (prostate cancer). Per the agency's History of Frequency of Visit, dated 1/13/22, there was an order on 12/28/21 for Patient 6 to have two Skilled Nurse (SN) visits per week. On 1/13/22 at 9:55 A.M., a concurrent interview and record review was conducted with the Clinical Supervisor. The Clinical Supervisor stated, Patient 6 should have had two SN visits on the week of 12/28/21, but only one visit was documented. On 1/13/22 at 3:35 P.M., a telephone interview was conducted with SN 11. SN 11 stated, he attempted to visit Patient 6 on 12/29/21, but the visit was refused and he forgot to document the missed visit. On 1/14/22 at 10:15 A.M., a telephone interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated, SN 11 should have documented the missed visit for Patient 6. 2. Per the agency's Plan of Care for the certification period of 9/27/21 through 12/25/21, Patient 9 was admitted to the agency on 6/29/21, with diagnoses to include protein calorie malnutrition. Per the agency's History of Frequency of Visit, dated 1/13/22, there was an order on 6/29/21 for Patient 9 to have two Certified Home Health Aide (CHHA) visits per week. On 1/13/22 at 9:55 A.M., a concurrent interview and record review was conducted with the Clinical Supervisor. The Clinical supervisor stated, Patient 9 should have had two CHHA visits on the week of 11/5/21, but only one visit was documented. On 1/14/22 at 8 A.M., a telephone interview was conducted with CHHA 12. CHHA 12 stated, she tried to visit Patient 9 on 11/5/21, but he wasn't home. CHHA 12 further stated, she did not remember why she did not document the attempted visit. On 1/14/22 at 10:15 A.M., a telephone interview was conducted with the DPCS. The DPCS stated, CHHA 12 should have documented the missed visit for Patient 9. 3. Per the agency's Plan of Care for the certification period of 8/25/21 through 11/22/21, Patient 10 was admitted to the agency on 8/25/21, with diagnoses to include, squamous cell skin carcinoma (skin cancer). Per the agency's History of Frequency of Visit, dated 1/13/22, there was an order on 8/25/21 for Patient 10 to have two CHHA visits per week. On 1/13/22 at 9:55 A.M., a concurrent interview and record review was conducted with the Clinical Supervisor. The Clinical supervisor stated, Patient 10 should have had two CHHA visits on the week of 8/25/21, but only one visit was documented. On 1/14/22 at 8 A.M., a telephone interview was conducted with CHHA 12. CHHA 12 stated, she only visited Patient 10 one time on the week of 8/27/21 because no one told her to visit him two times that week. On 1/14/22 at 10:15 A.M., a telephone interview was conducted with the DPCS. The DPCS stated, the agency should have directed CHHA 12 to visit Patient 10 two times on the week of 8/27/21, but there was a miscommunication. 4. Per the agency's Plan of Care for the certification period of 8/25/21 through 11/22/21, Patient 10 was admitted to the agency on 8/25/21, with diagnoses to include, squamous cell skin carcinoma (skin cancer). Per the agency's History of Frequency of Visit, dated 1/13/22, there was an order on 8/25/21 for Patient 10 to have 2 Social Worker (SW) visits per month. On 1/13/22 at 9:55 A.M., a concurrent interview and record review was conducted with the Clinical Supervisor. The Clinical supervisor stated, Patient 10 had an order for two SW visits per month, but the SW only made one visit that month. On 1/14/22 at 9:51 A.M., a telephone interview was conducted with the SW. The SW stated, she only visited Patient 10 one time in September 2021, and failed to complete her second visit that month. The SW further stated, she should have done a better job coordinating her visit frequency. On 1/14/22 at 10:15 A.M., a telephone interview was conducted with the DPCS. The DPCS stated, the SW should have updated her visit frequency on the plan of care to reflect that she was visiting one time per month. Per the facility's policy, titled Hospice Staff Visit Routines/Missed Visit, dated January 2022, " ...If it is not possible to meet the visit frequencies ... the Interdisciplinary Team will be notified as will the Attending Physician of the inability to follow the orders regarding visit frequencies ..."

Based on interview and record review the agency failed to ensure wound assessments were completed during a Skilled Nurse (SN) recertification visit for 1 of 11 patients (1). As a result, there was a potential that the progression or deterioration of the wound may not have been identified. Findings: Per the hospice certification and Plan of Care, dated 11/3/21 through 1/1/22, Patient 1 was admitted to the agency on 7/11/20 with diagnoses that included Alzheimer's disease (memory loss) per the agency's Patient Information sheet. Patient 1's Recertification assessment, dated 11/2/21, was reviewed. This document indicated Patient 1 had a pressure injury (wound from pressure) on the left ankle, however, there was no assessment made, no measurements taken, and no description documented related to this wound. On 1/13/22 at 3:50 P.M., a joint interview and record review with the skilled nurse (SN) 1 was conducted. SN 1 stated the agency used the standard of care related to wound care. SN 1 stated she would fill out the wound assessment area with the diagram that showed the wound location every week, however, with this visit, she missed it. On 1/14/22 at 10:10 A.M., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated it was her expectation that if a patient had wounds, a detailed assessment and documentation would have been completed to included a description of the wound, measurements and treatments rendered. The DPCS also stated it was important to document the current condition of the wound to monitor progress or deterioration and proper treatment. The agency's policy titled Wound Care, dated January 2014, indicated, "...5. The skilled nurse will observe the wound weekly and will document according to the individualized plan of care and the patient's specific goals including: a...description of drainage, wound surface and surrounding tissue, c. Interventions, instruction, patient's response..."