Every finding on record at Assured Hospice Care, LLC

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid-certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I and the patient's record, if requested. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) live discharged or revoked clinical records, the agency did not ensure that the hospice discharge summary or other requested forms were forwarded to the receiving facility. Clinical Record 14: The patient was elected the hospice benefit on 01/10/2024. The patient fell at home and sustained injuries. The family transported the patient to the hospital, where they revoked hospice services for aggressive treatment. The RN documented on 05/29/2024 in a note titled "RN HOSPICE DISCHARGE DATA COLLECTION ONLY - NO VISIT MADE" that the patient fell at home, fractured ribs, and was admitted to the hospital. The family signed the revocation form, but no documented evidence was found that the hospice agency forwarded the hospital a discharge summary or any patient report was communicated. A joint review of the clinical record with the compliance officer confirmed that no information was sent to the receiving facility. Clinical Record 13: The patient elected the hospice benefit on 03/06/2024. The RN documented on 04/17/2024 in a note titled "RN HOSPICE DISCHARGE DATA COLLECTION ONLY - NO VISIT MADE' that the social worker had made a visit to the patient, and while she was there "the patient had a psychiatric outburst, and she was endangering herself and all those in the household during the visit." The patient was sent to the hospital for a psychiatric evaluation and possible admission with treatment. Upon further review of the clinical record, there was no documented evidence that the agency forwarded the discharge summary to the hospice or any other form of report communication. A joint clinical record review and an interview with the compliance officer confirmed this.

Based on observation, record review, and staff interviews, it was determined that the agency failed to ensure that patient medication profiles was updated to reflect current medications at the time of the comprehensive assessment for one (1) of thirteen (13) sampled patients. (P#1). The findings include: A home visit observation was conducted on 5/11/22, at approximately 10:00 a.m. with Registered Nurse (RN) AA, for (P#1). The surveyor compared P#1's current medications at patient's home to the hospice agency's medication profile. Discrepancies were found. Patient #1 was admitted to the hospice on 10/29/21, diagnosed with heart disease and type 2 diabetes. According to hospice medication profile for P#1, physician's order dated 4/13/22, revealed Lasix 20 milligrams (MG), take one tablet by mouth as needed (PRN) for edema. The pharmacy label revealed Lasix 20mg take one tablet by mouth daily. The physician discontinued Lasix 20mg one tablet by mouth daily since 4/13/22. Clonazepam 0.5mg take one tablet by mouth every eight hours as needed (PRN) for anxiety. The medication was discontinued six months ago by P#1's physician, but the hospice medication profile and plan of care revealed that P#1 was currently taking Clonazepam 0.5mg tablet by mouth every eight hours as needed. On 5/11/22, at 11:00 a.m., an interview was conducted with RN AA. She stated, "I do not know how I missed the above medications."

Based on observation, record review, and staff interviews, it was determined that the agency failed to ensure that patient plan of care was updated to reflect current medications at the time of the comprehensive assessment for one (1) of thirteen (13) sampled patients. (P#1). The findings include: A home visit observation was conducted on 5/11/22, at approximately 10:00 a.m. with Registered Nurse (RN) AA, for (P#1). The surveyor compared P#1's current medications at patient's home to the hospice agency's medication profile. Discrepancies were found. Patient #1 was admitted to the hospice on 10/29/21, diagnosed with heart disease and type 2 diabetes. According to hospice medication profile for P#1, physician's order dated 4/13/22, revealed Lasix 20 milligrams (MG), take one tablet by mouth as needed (PRN) for edema. The pharmacy label revealed Lasix 20mg take one tablet by mouth daily. The physician discontinued Lasix 20mg one tablet by mouth daily since 4/13/22. Clonazepam 0.5mg take one tablet by mouth every eight hours as needed (PRN) for anxiety. The medication was discontinued six months ago by P#1's physician, but the hospice medication profile and plan of care revealed that P#1 was currently taking Clonazepam 0.5mg tablet by mouth every eight hours as needed. On 5/11/22, at 11:00 a.m., an interview was conducted with RN AA. She stated, "I do not know how I missed the above medications."

Based on home visit observations, and staff interviews it was determined that the hospice agency staff failed to follow standard precautions to prevent the transmission of infectious and communicable diseases during a shower bath for one (1) of thirteen (13) sampled patients. (P#2). The findings include: Patient #1 was admitted to hospice on 1/17/22, with a diagnosis of Alzheimer's disease, pulmonary hypertension, and heart failure. During a home visit with P#2 on 5/11/22, at 11:35 a.m., the surveyor observed Certified Nursing Aide (CNA) BB, perform bed bath care to P#1. During the entire bathing procedure, (CNA) BB did not change gloves; she used a washcloth to wash P#2's legs, and used the same washcloth to wash P#2's private area, washing it from front to back several times. (CNA) BB dropped the washcloth and towel on the floor, after completing the shower. On 5/11/22, at 12:10 p.m., an interview was conducted with (CNA) BB, she confirmed that she did not change gloves and used the same washcloth to wash P#2's private area. (CNA) BB said she was nervous during the bathing procedure. During an interview on 5/11/22, at 4:00 p.m., the Administrator acknowledged (CNA) BB did not follow acceptable standards for infection control, to prevent transmission of infectious and communicable diseases.

Based on clinical record review and staff interview, it was determined that the agency failed to obtain physician orders to provide Foley catheter care for one (1) of thirteen (13) sampled patients (P#1). The findings include: Review of the initial Skilled Nurse (SN) assessment and Plan of Care (POC) dated 10/29/21, revealed P#1 was admitted on 10/29/21, diagnosed with type 2 diabetes and heart disease. Patient #1 had a Foley Catheter due to urinary incontinent. Foley care was provided by caregiver. It was documented that a Skilled Nurse (SN) visited the patient once a week and as needed. Review of the clinical record revealed that there was no physician order for Foley care. On 5/11/22, at 10:40 a.m., an interview was conducted with Registered Nurse (RN) AA, who stated that she was not aware that the physician order for Foley care was not documented. During an interview on 5/11/22, at 3:40 p.m., the Administrator and the Clinical Manager (CM), confirmed that the agency did not have order for Foley care.

Based on record reviews, home visits, and staff interviews it was determined that the agency failed to provide clear written communication among the agency, the patient, and patient's caregiver or representative, that help ensure the patient and the caregiver understand what the purposes of the services are provided in one (1) of thirteen (13) sampled patients. (P#1) The finding include: Onsite visit was made to the home of P#1 at 10:10 am on 5/11/22, to observe clinician visit. Upon review of patient's home folder, there were no individualized instructions or education to the patient and caregiver regarding the purpose of each service being provided by the agency. On 5/11/22 at 11:00 a.m., an interview was conducted with Registered Nurse (RN) AA, who confirmed that the individualized instruction was missing; she also stated she did not know why the medication list and plan of care instruction were missing in the P#1 ' s home folder.