Every finding on record at Badger Hospice, LLC

It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 18 (11%) clinical records reviewed for patients that elected aide services revealed the agency did not ensure the hospice aide provided services as ordered on the aide care plan. CLINICAL RECORD 3: The aide care plan dated 07/07/2025 ordered the task "Hair Care: Comb/brush" every visit. The aide was ordered to complete two (2) visits per week. The aide visit note dated 10/31/2025 lacked evidence that the aide completed the task "Hair Care: Comb/brush". The record lacked evidence of supportive documentation as to the reason "Hair Care: Comb/brush" was not completed by the aide, as ordered. CLINICAL RECORD 4: The aide care plan dated 10/28/2025 ordered the tasks for Bathing: "Bed bath" and "Assist to dress"; and for Oral Care: "Swab/clean mouth" and "Assist with brushing teeth" every visit. The aide was ordered to complete two (2) visits per week. The aide visit note dated 10/28/2025 lacked evidence that the aide completed the task "Assist with brushing teeth". The record lacked evidence of supportive documentation as to the reason "Assist with brushing teeth" was not completed by the aide, as ordered. The aide visit note dated 10/30/2025 lacked evidence that the aide completed the tasks "Bed bath", "Assist to dress", "Swab/clean mouth" and "Assist with brushing teeth". The record lacked evidence of supportive documentation as to the reason "Bed bath", "Assist to dress", "Swab/clean mouth" and "Assist with brushing teeth" was not completed by the aide, as ordered. The Clinical Manager and Alternate Clinical Manager stated in an interview on 11/12/2025, while completing joint clinical record review, that the aide did not complete tasks, as ordered, on the aide care plan.

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 6 (33%) clinical records reviewed for patients that elected hospice aide services revealed the agency did not ensure the aide reported changes in the patient's medical needs to the RN as the changes related to the aide care plan. CLINICAL RECORD 3: The aide care plan dated 07/07/2025 ordered the task "Hair Care: Comb/brush" every visit. The aide frequency was two (2) visits per week. The aide visit note dated 10/31/2025 lacked evidence that the aide completed the task "Hair Care: Comb/brush". The record lacked evidence of supportive documentation as to the reason "Hair Care: Comb/brush" was not completed by the aide, as ordered. Furthermore, the record lacked evidence that the aide notified the RN of the above changes in the patient's medical needs as related to the ordered task "Hair Care: Comb/brush". CLINICAL RECORD 4: The aide care plan dated 10/28/2025 ordered the tasks for Bathing: "Bed bath" and "Assist to dress"; and for Oral Care: "Swab/clean mouth" and "Assist with brushing teeth" every visit. The aide frequency was two (2) visits per week. The aide visit note dated 10/28/2025 lacked evidence that the aide completed the task "Assist with brushing teeth". The record lacked evidence of supportive documentation as to the reason "Assist with brushing teeth" was not completed by the aide, as ordered. Furthermore, the record lacked evidence that the aide notified the RN of the above changes in the patient's medical needs as related to the ordered task "Assist with brushing teeth". The aide visit note dated 10/30/2025 lacked evidence that the aide completed the tasks "Bed bath", "Assist to dress", "Swab/clean mouth" and "Assist with brushing teeth". The record lacked evidence of supportive documentation as to the reason "Bed bath", "Assist to dress", "Swab/clean mouth" and "Assist with brushing teeth" was not completed by the aide, as ordered. Furthermore, the record lacked evidence that the aide notified the RN of the above changes in the patient's medical needs as related to the ordered tasks "Bed bath", "Assist to dress", "Swab/clean mouth" and "Assist with brushing teeth". The Clinical Manager and Alternate Clinical Manager stated in an interview on 11/12/2025, while completing joint clinical record review, that the aide did not notify the RN of tasks not completed that were ordered on the aide care plan.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. This standard was not met as evidenced by a review of clinical records and interviews. In 4 of 11 (36%) clinical records reviewed revealed the agency did not ensure the written plan of care for each patient included the active problems identified by the skilled nurse in the comprehensive assessments. . Clinical Record 1 Patient elected hospice benefit on 12/2/22 and had a terminal diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The nursing comprehensive assessment dated 12/2/22 identified the patient was at risk for falls and documented "history of a fall within the last 6 months: 1 or 2 falls" with a fall risk assessment score of 24 and "10 or more points = high risk." The nurse also documented "she (patient) is incontinent of bowel and has a Foley catheter in place". A nursing visit note updating the comprehensive assessment on 12/5/22 documented the patient had a urinary tract infection and was to begin taking Cipro. There were no problems, goals, or interventions on the written plan of care related to the fall risk, the indwelling Foley catheter, or the urinary tract infection. Clinical Record 2 Patient elected hospice benefit on 8/18/22 and had a terminal diagnosis of Congestive Heart Failure. The nursing comprehensive assessment dated 8/19/22 indicated pain was an active problem for the patient and documented a verbal pain rating of 3 (out of 10), a rating of 10 (out of 10) at its worst, and described the pain as "occasional," and "cramping." The assessment also documented the patient had "1+ edema to lower extremities and sacral area"," "shortness of breath with minimal exertion such as talking," and "patient uses oxygen per nasal cannula, liters per minute: 4.5 continuous." A nursing visit note updating the comprehensive assessment on 1/4/23 documented "rash on breasts, nystatin powder applied." There were no problems, goals, or interventions related to pain, edema, dyspnea, or skin impairment on the written plan of care. Clinical Record 3 Patient elected hospice benefit on 12/9/22 and had a terminal diagnosis of neoplasm of the lung. The nursing comprehensive assessment dated 12/9/22 indicated pain was an active problem for the patient and documented pain as "intermittent, origin of pain: discomfort in his left shoulder, lower back and right thigh, pain character: aching, current treatments for pain: opioids, PRN opioids, Norco”. There were no problems, goals, or interventions related to pain on the written plan of care. Clinical Record 5 Patient elected hospice benefit on 12/14/22 and had a terminal diagnosis of Parkinson's Disease. The nursing comprehensive assessment dated 12/15/22 documented "verbal pain rating 1 (out of 10), 5 (out of 10) at worst, pain pattern: constant, character: aching, dull." The assessment also documented “patient coughs with food and fluid intake” and “the patient has had respiratory concerns and is at high risk for aspiration pneumonia." There were no problems, goals, or interventions related to pain or aspiration risk on the written plan of care. Staff 11 During an interview on 2/1/23, the clinical director confirmed the plans of care for the identified patients did not include problems, goals, or interventions for needs that were identified by the nurse in the comprehensive assessments.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: Drugs and treatment necessary to meet the needs of the patient, and medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records, interviews and observations. In 3 of 11 (27%) clinical records reviewed revealed the written plans of care were missing treatment orders or durable medical equipment (DME) in use by the patient. . Clinical Record 1 Patient elected hospice benefit on 12/2/22. The nursing comprehensive assessment dated 12/2/22 documented the patient had an indwelling urinary Foley catheter. In addition, a nursing visit note dated 12/10/22 documented "writer assessed patient's Foley. Foley was clogged with cream colored sediment. Writer flushed irrigated patient's Foley and removed multiple sediments until patient's Foley started to drain." The admission orders dated 12/2/22 included "May anchor Foley catheter and change/irrigate per hospice protocol" but there were no specific orders for the size and maintenance, including irrigation, of the indwelling urinary Foley catheter. In an interview on 2/1/23, the clinical director stated they did not have any protocols in place for an indwelling Foley catheter and that the nurse should have written a specific order as part of the written plan of care for the patient. Clinical Record 3 Patient elected hospice benefit on 12/9/22. During a home visit observation on 2/1/23, a hospital bed and wheelchair were in use by the patient. There were no orders included in the written plan of care for these equipment items. During an interview on 2/1/23, the Chief Executive Officer (CEO) stated they were not aware they needed orders for all of the equipment that was in use by the patient. Clinical Record 5 Patient elected hospice benefit on 12/14/22. A nursing visit note dated 12/19/22 documented "right chest pleurex intact, dressing changed, tegaderm applied." Another nursing visit note dated 12/21/22 documented "small open area to right buttocks had some blood drainage, writer cleansed area with normal saline, foam bordered dressing and barrier cream applied to buttocks". There were no written treatment orders on the plan of care for the pleurex site care or the right buttocks wound care provided by the skilled nurse. During an interview on 2/1/23, the clinical director confirmed they did not have orders in place.

It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by a review of clinical records and interviews. In 3 of 10 (30%) clinical records reviewed in which hospice aide services were provided revealed the agency did not ensure the hospice aide provided services as ordered on the aide plan of care. . Clinical Record 1 Patient with election of hospice benefit on 12/2/22. The hospice aide plan of care effective 12/3/22 to current included the following tasks to be completed with a frequency of every visit: comb/brush, shampoo/style, clean nails fingers and toes, inspect mouth, assist with brushing teeth. and empty foley bag. The hospice aide visit note dated 1/27/23 did not document these tasks as performed or a reason why they were not performed. Clinical Record 2 Patient with election of hospice benefit on 8/18/22. A hospice aide visit note dated 1/13/23 documented "has sore on top of butt, applied BC (barrier cream)." The hospice aide plan of care effective 8/19/22 to current did not include an ordered task to apply barrier cream. During an interview on 1/31/23, the clinical director stated "the barrier cream is not anywhere on the patient's plan of care." Clinical Record 5 Patient with election of hospice benefit on 12/14/22. The hospice aide plan of care effective 12/14/22 to current included the following tasks to be completed with a frequency of every visit: clean nails fingers and toes, inspect mouth, clean patient's room/area. The hospice aide visit notes on 1/4/23, 1/6/23, 1/9/23, 1/11/23, and 1/25/23 did not document these tasks as performed or a reason why they were not performed. Staff 11 In an interview on 2/1/23, the clinical director agreed the hospice aide did not follow the plan of care and stated the hospice aide did not document correctly if the tasks were not performed.

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. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 2 (50%) clinical records reviewed in which the care of the patient was transferred to a facility, the agency did not provide a copy of the discharge summary to the receiving facility. . Clinical Record 11 Patient elected hospice benefit on 4/28/22. A nursing progress note dated 11/20/22 documented the patient had a fall with injury and the patient's power of attorney requested transfer to a hospital for evaluation. The note documented “Patient was transferred to (Facility Name) Hospital at 2100". The discharge summary dated 11/20/22 indicated the "reason for D/C (discharge): patient revoked hospice benefit." There was no evidence the discharge summary was sent to the receiving hospital. Staff 13 During an interview on 2/1/23, the clinical office assistant confirmed the discharge summary was not sent to the hospital.