Every finding on record at C C Young Memorial Home

Based on record review and interview, the registered nurse failed to write patient specific care instructions for the hospice aide that indicated that the patients had wounds and did not include instructions or precautions for the wounds for 7 (#3, #8, #9, #13, #14, #15, and #16) of 8 patient records reviewed where the patient had a wound and received hospice aide services. The failure placed the patients at risk for wound complications and wound infection. --- Patient #3:Record review of Patient #3's clinical record revealed an Initial Plan of Care dated 5-8-2024 to 8-5-2024. The Plan of Care indicated that Patient #3 was admitted to the agency's services on 5/8/2024. The Plan of Care listed Cerebrovascular Disease (group of conditions that affect the blood vessels in the brain) as the terminal diagnosis. The Plan of Care contained an order for Patient #3 to receive aide services 1 to 5 times each week.  Registered Nurse D conducted a start of care comprehensive assessment on 5/8/2024. Registered Nurse D documented that Patient #3 had a pressure wound (damage to an area of the skin/tissue caused by pressure on the area for a long time) to the Left Trochanter (hip area). Registered Nurse D documented that the wound measured 2.5 x 2 centimeters, had serous drainage, necrotic (death of tissue) edging, with the center containing white eschar (dead tissue). Patient #3's clinical record contained an aide care plan dated 5/8/2024. The hospice aide care plan did not include written instructions that Patient #3 had a wound and did not include instructions or precautions for the wound. Patient #8:Record review of Patient #8's clinical record revealed an initial Plan of Care dated 10/7/2024 to 1/4/2025. The Plan of Care indicated that Patient #8 was admitted to the agency's services on 10/7/2024. The Plan of Care listed Chronic Lymphocytic Leukemia of B-Cell type (a type of blood cancer that occurs when the bone marrow produces too many lymphocytes, a type of white blood cell) as the terminal diagnosis. The Plan of Care contained an order that Patient #8 was to receive aide services two times each week. Registered Nurse E conducted a skilled nurse visit on 10/7/2024. Registered Nurse E documented that Patient #8 had an unstageable pressure wound (damage to an area of the skin/tissue caused by pressure on the area for a long time) to the sacrum (lower back) and a pressure wound to the left heel. Patient #8's clinical record contained an aide care plan dated 10/8/204. The hospice aide care plan did not include written instructions that Patient #8 had wounds and did not include instructions or precautions for the wounds. Patient #9:Record review of Patient #9's clinical record revealed an initial Plan of Care dated 11/26/2024 to 2/23/2025. The Plan of Care indicated that Patient #9 was admitted to the agency's services on 11/26/2024. The Plan of Care listed Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris (plaque build-up in the arteries of the heart) as the terminal diagnosis. The Plan of Care contained an order that Patient #9 would receive aide services two times each week.  Registered Nurse D conducted a start of care comprehensive assessment on 11/26/2024. Registered Nurse D documented that Patient #9 had 2 unstageable wounds on the buttocks and that the wounds had gray eschar.  Patient #9's clinical record contained an aide care plan dated 11/26/2024. The hospice aide care plan did not include written instructions that Patient #9 had wounds and did not include instructions or precautions for the wounds. Patient #13:Record review of Patient #13's clinical record revealed an initial Plan of Care dated 11-6-2024 to 2/3/2025. The Plan of Care indicated that Patient #13 admitted to the agency's services on 11/6/2024. The Plan of Care listed Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris (plaque build-up in the arteries of the heart) as the terminal diagnosis. The Plan of Care contained an order for Patient #13 to received aide services three times each week. Registered Nurse D conducted an initial comprehensive assessment on 11/6/2024. Registered Nurse D documented that Patient #13 had a wound to the right groin area that measured 17 centimeters, had moderate drainage, and a foul odor.  Patient #13's clinical record contained an aide care plan dated 11/6/2024. The hospice aide care plan did not include written instructions that Patient #13 had a wound and did not include instructions or precautions for the wound. Patient #14:Record review of Patient #14's clinical record revealed an initial Plan of Care dated 12/13/20204 to 3/12/20205. The Plan of Care indicated that Patient #14 was admitted to the agency's services on 12/13/2024. The Plan of Care listed Other Pulmonary Embolism without Acute Cor Pulmonale (blockage in the lungs' arteries when a blood clot travels from another part of the body) as the terminal diagnosis. The Plan of Care contained an order for Patient #14 to receive aide services two times each week.  Registered Nurse D conducted an initial comprehensive assessment on 12/13/2024. Registered Nurse D documented that Patient #14 had a 1-centimeter superficial pressure wound to the left elbow. Registered Nurse D documented that a hydrocolloid dressing (wound dressing used in the treatment of mildly draining wounds, minor burns, or pressure wounds) was applied.  Patient #14's clinical record contained an aide care plan dated 12/13/2024.The hospice aide care plan did not include written instructions that Patient #14 had a wound and did not include instructions or precautions for the wound.  Patient #15:Review of Patient #15's clinical record revealed an initial Plan of Care dated 10/10/2024 to 1/7/2025. The Plan of Care indicated that Patient #15 was admitted to the agency's services on 10/10/2024. The Plan of Care listed Senile Degeneration of the Brain (decline in ability to think, learn, remember, use judgement, and make decisions that occurs with aging) the terminal diagnosis. The Plan of Care contained an order for Patient #15 to receive aide services three times each week. Registered Nurse F conducted an initial comprehensive assessment on 10/10/2024. Registered Nurse F documented that Patient #15 had a Stage III pressure wound to the left outer ankle that measured 4.5 x 1.5 x 0.3 centimeters.  Patient #15's clinical record contained an aide care plan dated 10/11/2024. The hospice aide care plan did not include written instructions that Patient #15 had a wound and did not include instructions or precautions for the wound.  Patient #16:Record review of Patient #16's clinical record revealed a Plan of Care dated 11/8/2024 to 1/6/2025. The Plan of Care listed Chronic Systolic (Congestive) Heart Failure (chronic condition where the heart doesn't pump enough blood to the body) as the terminal diagnosis. The clinical record indicated that Patient #16 was admitted to the agency's services on 11/14/2023. The Plan of Care contained an order for Patient #16 to have aide services three times each week. Registered Nurse E conducted a skilled nurse visit on 11/8/2024. Registered Nurse E documented that Patient #16 has an unstageable pressure wound to the left heel and a wound to the left calf.  Patient #16's clinical record contained an aide care plan dated 11/8/2024. The hospice aide care plan did not include written instructions that Patient #16 had wounds and did not include instructions or precautions for the wounds.  During an interview on 1/13/2025 at 1:46 p.m. with the Administrator/Supervising Nurse/Registered Nurse F and Social Worker C/Bereavement Coordinator, the patient records were reviewed. The surveyor discussed that the aide care plans did not include patient specific written care instructions for patients that had wounds and did not include instructions or precautions regarding the wounds. The surveyor asked who was responsible for the aide care plan. The Administrator/Supervising Nurse/Registered Nurse F stated that the admission registered nurse or registered nurse case manager was responsible for the aide care plans. The surveyor asked who was responsible for indicating that patients had wounds and any instructions or precautions to take regarding the wounds. The Administrator/Supervising Nurse/Registered Nurse F stated, "The registered nurse case manager or admit nurse." The survey asked why the registered nurses didn't include written instructions regarding the wound on the aide care plans. The Administrator did not state why the registered nurses were not including that the patients had wounds and instructions or precautions regarding the wounds on the aide care plan. The Administrator/Supervising Nurse/Registered Nurse F informed the surveyor that regarding Patient #15, "I did that, I didn't put it (instructions that Patient #15 had a wound and instructions or precautions regarding the wound) on the aide care plan."During an interview on 1/14/2024 at 11:40 a.m., the surveyor asked what affect that this could have on the agency's patients. The Administrator/Supervising Nurse and Social Worker C informed the surveyor that, "Staff wouldn't know what was going on or what to do." During an interview on 1/15/2025 at 9:24 a.m. with Registered Nurse G, the surveyor discussed the aide care plans. The surveyor asked how the registered nurses generated the aide care plans for the patients. Registered Nurse G informed the surveyor that the aide care plan would have check boxes and the nurse would check what was appropriate for that patient. The surveyor asked what instructions would be included on the aide care plan regarding wounds. Registered Nurse G stated, "I would put to keep wounds dry. If the patient had a foot wound, I would have the aide cover the foot with a bag." During an interview on 1/16/2025 at 1:22 p.m. with Registered Nurse H (Registered Nurse H had worked for the hospice agency approximately 4 months), the surveyor discussed the aide care plans. The surveyor asked Registered Nurse H about the aide care plan regarding wounds. Registered Nurse H informed the surveyor that Registered Nurse H has created aide care plans. The surveyor asked what written instructions would be given to an aide if a patient had a wound. Registered Nurse H stated, "I would put to cover the dressing with a plastic bandage and/or a clean trash bag. The surveyor discussed Patient #9 and Patient #13, that the aide care plans did not contain written instructions that Patient #9 and Patient #13 had wounds, instructions, or precautions. Registered Nurse H stated, "I did not do their admissions, I don't know why it’s not on it." The surveyor asked how often the aide care plan was reviewed. Registered Nurse H stated, "The care plan would be assigned to be reviewed, or every certification period." During an interviewed with Registered Nurse E on 1/16/2025 1:52 p.m., the surveyor discussed that the aide care plan did not indicate that Patient #16 had a wound and no instructions or precautions regarding the wounds. Registered Nurse E informed the surveyor that Registered Nurse E became Patient #16's nurse approximately two months ago. Patient #16 wore a boot, and that the aide was not to take off the boot for bathing. The surveyor discussed that the instructions were not written for the aide on the aide care plan. Registered Nurse E informed the surveyor that the aide was "instructed verbally not to remove Patient #16's boot." Registered Nurse E could not state why instructions regarding Patient #16's wound was not on the aide care plan.   Registered Nurse D was on vacation and was not available for the interview.  Review of the agency's policy titled "Implementing Care and Treatment," labeled PC.35, last reviewed on 9/1/2024 read in part; "Purpose To ensure patient care and treatment are provided as identified in the care planning process...Procedure...III. The Hospice RN (Registered Nurse), who is a member of the IDG/IDT (Interdisciplinary Group/Interdisciplinary Team), will oversee the assignment of a Hospice Aide (HA) to a particular patient, initiating hospice aide services within time frame to meet identified patient's needs...IV. The HA will be provided with written instruction for patient care prepared by an RN…”

Based on record review and interview, the agency failed to include physician orders in the clinical record to change the indwelling urinary catheters (a flexible tube inserted into the bladder through the urethra to collect and drain urine) for 2 (#3, #8) of 3 patient records reviewed where the patient had an indwelling urinary catheter; and physician orders for wound care for 2 (#3, #15) of 8 patient records reviewed where the patient had wounds. The failure placed the patients at risk for infections and/or other complications which could result in a negative outcome. --- Indwelling urinary catheters Patient #3:Record review of Patient #3's clinical record revealed an initial Plan of Care dated 5/8/2024 to 8/5/2024. The Plan of Care indicated that Patient #3 started on the agency's services on 5/8/2024. The Plan of Care listed Cerebrovascular Disease (group of conditions that affect the blood vessels in the brain) as the terminal diagnosis. Registered Nurse D conducted an initial comprehensive assessment on 5/8/2024. Registered Nurse D documented that Patient #3 had a 16 French 10 cubic centimeter (size) indwelling urinary catheter. Registered Nurse D conducted a skilled nurse visit on 6/12/2024. Registered Nurse D documented that Registered Nurse D changed Patient #3's indwelling urinary catheter. Patient #3's clinical record did not include a physician's order to change the indwelling urinary catheter.  Patient #8:Record review of Patient #8's clinical record revealed an initial Plan of Care dated 10/7/2024 to 1/4/2025. The Plan of Care indicated that Patient #8 was admitted to the agency's services on 10/7/2024. The Plan of Care listed Chronic Lymphocytic Leukemia of B-Cell type (a type of blood cancer that occurs when the bone marrow produces too many lymphocytes, a type of white blood cell) as the terminal diagnosis.  Registered Nurse E conducted a skilled nurse visit on 10/7/2024. Registered Nurse E documented that Patient #8 had a 16 French 10 cubic centimeter (size) indwelling urinary catheter that was last changed on 9/11/2024 and was due to be changed. Registered Nurse D conducted an initial comprehensive assessment on 10/8/2024. Registered Nurse D documented that Client #8 had a 16 French 10 cubic centimeter (size) indwelling urinary catheter that was changed on 10/8/2024. Vocational Nurse I conducted a skilled nurse visit on 10/8/2024. Vocational Nurse I documented that Vocational Nurse I changed Patient #8's indwelling urinary catheter. Patient #8's clinical record did not include a physician order to change Patient #8's indwelling urinary catheter. Wound Care  Patient #3:Record review of Patient #3's clinical record revealed an Initial Plan of Care dated 5/8/2024 to 8/5/2024. The Plan of Care indicated that Patient #3 was admitted to the agency's services on 5/8/2024. The Plan of Care listed Cerebrovascular Disease (group of conditions that affect the blood vessels in the brain) as the terminal diagnosis.  Registered Nurse D conducted a start of care comprehensive assessment on 5/8/2024. Registered Nurse D documented that Patient #3 had a pressure wound (damage to an area of the skin/tissue caused by pressure on the area for a long time) to the Left Trochanter (hip area). Registered Nurse D documented that the wound measured 2.5 x 2 centimeters, had serous drainage, necrotic (death of tissue) edging, with the center containing white eschar (dead tissue). Registered Nurse D conducted a skilled nurse visit on 5/9/2024. Registered Nurse D documented wound care to the Left Trochanter and Right Heel- Medihoney (medical-grade honey dressing used to treat wounds and burns) then covered with a bandage. Registered Nurse D conducted a skilled nurse visit on 5/15/2024. Registered Nurse D documented wound care to the Left Trochanter and Right Heel- cleaned with Normal Saline, medihoney applied, and covered with a non-stick bandage.  Registered Nurse D conducted a skilled nurse visit on 5/22/2024. Registered Nurse D documented, "Left Trochanter wound care provided." Registered Nurse D conducted a skilled nurse visit on 5/29/2024. Registered Nurse D documented that the Left Trochanter was cleaned and reapplied medihoney and covered with a non-stick bandage.  Registered Nurse D conducted a skilled nurse visit on 6/12/2024. Registered Nurse D documented that a wound consultation was scheduled for 6/13/2024. No wound care was documented.  Registered Nurse H conducted a skilled nurse visit on 6/18/2024. Registered Nurse H documented that a wound consult was scheduled 6/13/2024 (sic). No wound care was documented. Patient #3's clinical record contained wound care orders, dated 6/27/2024, from a Nurse Practitioner as follows:Left Hip (wound measurement 3.5 x 3.5 centimeters) - cleanse wound with Anasept (topical, broad-spectrum antimicrobial cleanser/irrigation solution used for wound care), Chlorhexidine (an antiseptic and disinfectant that kills or prevents the growth of bacteria), or VASHE (saline-based wound cleanser that contains hypochlorous acid), pat dry. Insert medihoney covered packing strip into the undermining space (9:00 to 11:00) leaving 1–3-centimeter strip off wound bed for easy access and removal. Place calcium alginate (highly absorbent wound dressing made from seaweed) smeared with medihoney and place on wound bed. Cover with gauze. Apply skin prep on skin surrounding the wound bed and cover with foam dressing.Posterior Thoracic Region – upper and middle back, (wound measurement 9 x 5 centimeters) - Cleanse wound with Anasept, Chlorhexidine, or VASHE. Pat dry. Prepare calcium alginate, squeeze toothpaste size amount (did not indicate product) and smear it over the calcium alginate. Apply to the wound bed. Cover with gauze followed by foam dressing.  Patient #3's clinical record did not include physician orders for the wound care performed prior to 6/27/2024.     Patient #15:Review of Patient #15's clinical record revealed an initial Plan of Care dated 10/10/2024 to 1/7/2025. The Plan of Care indicated that Patient #15 was admitted to the agency's services on 10/10/2024. The Plan of Care listed Senile Degeneration of the Brain (decline in ability to think, learn, remember, use judgement, and make decisions that occurs with aging) the terminal diagnosis.  Registered Nurse F conducted an initial comprehensive assessment on 10/10/2024. Registered Nurse F documented that Patient #15 had a Stage III pressure wound to the left outer ankle that measured 4.5 x 1.5 x 0.3 centimeters.  Registered Nurse F conducted a skilled nurse visit on 10/11/2024. Registered Nurse F documented that wound care was provided as ordered.  Registered Nurse F conducted a skilled nurse visit on 10/14/2024. Registered Nurse F documented that the left outer ankle was cleaned with normal saline, dried, applied calcium alginate, covered with gauze and wrapped with kerlix (roll of gauze).  Registered Nurse F conducted skilled nurse visits on 10/18/2024, 10/23/20204, 11/2/2024, and 11/15/2024. Registered Nurse F documented at these visits that the wound was cleaned with soap and water, rinsed with normal saline, dried, applied calcium alginate to the wound bed, covered with a foam dressing, and wrapped with kerlix.  Registered Nurse J conducted skilled nurse visits on 10/16/2024, 10/21/2024, 10/25/2024, 10/28/2024, 10/30/2024, 11/4/2024, 11/6/2024, 11/11/2024, 11/13/2024, 11/18/2024, 11/20/2024, 11/22/2024, 11/25/2024, and 11/27/2024. Registered Nurse J documented at these visits that the wound was cleaned with soap and water, rinsed with normal saline, dried, applied calcium alginate to the wound bed, covered with a foam dressing, and wrapped with kerlix.  Patient #15's clinical record contained a physician order for wound care that was dated 11/29/2024. The order read to clean the left ankle wound with Normal Saline, dry, apply Hydrogel, cover with a foam dressing, cover with gauze, and secure with kerlix.  Patient #15's clinical record did not contain physician orders for the wound care that was performed prior to 11/29/2024. During an interview on 1/13/2025 at 1:46 p.m. with the Administrator/Supervising Nurse/Registered Nurse F and Social Worker C/Bereavement Coordinator, the surveyor discussed that the clinical record did not contain physician orders for wound care provided prior to 627/2024 and did not contain physician orders for indwelling urinary catheter changes. The surveyor asked how the nursing staff knew what wound care to provide and to change the indwelling urinary catheter. The Administrator/Supervising Nurse and Social Worker C reviewed the records. Social Worker C stated, "I don't see it (wound care) in the clinical information from the referral source." The surveyor asked if the Administrator/Supervising Nurse or Social Worker C noted an order for wound care prior to 6/27/2024 or to change the indwelling urinary catheters. The Administrator/Supervising Nurse and Social Worker C stated, "No." The surveyor asked what the agency's procedure was for writing orders. The Administrator/Supervising Nurse informed the surveyor that the nurse entered the order into the clinical record and then presented to the physician at the interdisciplinary group meeting. The surveyor asked what the timeframe was for documenting an order into the clinical record. The Administrator/Supervising Nurse stated, "The same day or within 24 hours." The surveyor asked who was responsible for inputting wound care order in the clinical records when a patient was admitted with a wound. The Administrator/Supervising Nurse stated, "Admitting nurse or case manager." The surveyor asked why the orders for wound care and indwelling urinary catheters were not in the clinical records. The Administrator/Supervising Nurse informed the surveyor that the Administrator/Supervising Nurse did not know why the orders were not in the clinical records.  During an interview on 1/14/2025 at 11:40 a.m. with the Administrator/Supervising Nurse/Registered Nurse F and Social Worker C/Bereavement Coordinator, the surveyor discussed Patient #15, that there were no orders in the clinical record for wound care until 11/29/2024. The surveyor asked how the nursing staff knew what wound care to provide to Patient #15. Social Worker C reviewed the record and stated that wound care was listed in the history and physical that was provided to the agency from the referral source. The Administrator/Supervising Nurse/Registered Nurse F and Social Worker C were unable to find a physician order in the clinical record for the wound care provided prior to 11/29/2024. The surveyor asked what affect that this could have on the agency's patients. The Administrator/Supervising Nurse and Social Worker C informed the surveyor that, "Staff wouldn't know what was going on or what to do." During an interview on 1/15/2025 at 9:24 a.m. with Registered Nurse G, the surveyor asked what the agency’s policy regarding physician orders was. Registered Nurse G informed the surveyor that the physician would be contacted and would give an order. Registered Nurse G would enter the order into the clinical record and would write the order for the skilled nursing facility. Registered Nurse G informed the surveyor that the order would be put in the clinical record the same day or within 24 hours.  During an interview on 1/16/2025 at 1:22 p.m. with Registered Nurse H, the surveyor asked what the agency’s policy regarding physician orders was. Registered Nurse H informed the surveyor that orders go into the record as soon as possible. The surveyor asked what the agency’s policy regarding physician orders was. Registered Nurse H informed the surveyor that the orders were to be in the clinical record within 24 hours.  During an interview on 1/16/2025 at 1:52 with Registered Nurse E, the surveyor asked what the agency’s policy regarding physician orders was. Registered Nurse E informed the surveyor to that physician orders were to be written within 24 hours. Registered Nurse D was on vacation and not available for the interview.  Review of the agency's policy titled "Medical Record Content," labeled IM.30, and last reviewed on 9/1/2024 read in part; "Purpose To ensure each medical record contains complete, correct information which identified the patient, describes problems, and needs of the patient, justifies patient care, and accurately describes care provided, outcomes, significant events and continuity/coordination of care. Policy I. The Hospice will initiate and maintain an individual and accurate medical record containing past and current information for each patient accepted for care. The record will contain correct clinical information that is available to the patient's attending physician and hospice staff...Procedure I. The contents of the medical record will include, at a minimum...J. Physician orders..."

Based on observation, record review, and interview, the agency failed to include in the written agreement with the skilled nursing facility, the delineation of the hospice's responsibilities that included, but not limited to: medical direction and management, nursing, counseling, social work, provision of medical supplies, durable medical equipment, drugs and all other services necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions for 3 (#8, #9, and #14) of 3 patients that resided in a skilled nursing facility where a home visit was conducted. The failure placed the patients at risk of omission of care or delayed care due to confusion of the hospice's responsibilities, which could result in poor symptom control. --- Patient #8:Record review of Patient #8's clinical record revealed an initial Plan of Care dated 10/7/2024 to 1/4/2025. The Plan of Care indicated that Patient #8 was admitted to the agency's services on 10/7/2024. The Plan of Care listed Chronic Lymphocytic Leukemia of B-Cell type (a type of blood cancer that occurs when the bone marrow produces too many lymphocytes, a type of white blood cell) as the terminal diagnosis.  Patient #8's clinical record did not contain a delineation of the hospice responsibilities.  Patient #8 lived at Facility X, a skilled nursing facility. A home visit was conducted on 1/14/2025 at 10:58 a.m. to visit Patient #8. The surveyor reviewed the hospice record at the facility. The hospice record at the facility did not contain a delineation of hospice responsibilities.  Patient #9:Record review of Patient #9's clinical record revealed an initial Plan of Care dated 11/26/2024 to 2/23/2025. The Plan of Care indicated that Patient #9 was admitted to the agency's services on 11/26/2024. The Plan of Care listed Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris (plaque build-up in the arteries of the heart) as the terminal diagnosis.  Patient #9's clinical record did not contain a delineation of the hospice responsibilities.  Patient #9 lived at Facility X, a skilled nursing facility. A home visit was conducted on 1/14/2024 at 10:22 a.m. to visit Patient #9. The surveyor reviewed the hospice record at the facility. The hospice record at the facility did not contain a delineation of hospice responsibilities. Patient #14:Record review of Patient #14's clinical record revealed an initial Plan of Care dated 12/13/20204 to 3/12/20205. The Plan of Care indicated that Patient #14 was admitted to the agency's services on 12/13/2024. The Plan of Care listed Other Pulmonary Embolism without Acute Cor Pulmonale (blockage in the lungs' arteries when a blood clot travels from another part of the body) as the terminal diagnosis.  Patient #14's clinical record did not contain a delineation of the hospice responsibilities.  Patient #14 lives at Facility X, a skilled nursing facility. A home visit was conducted on 1/14/2024 at 10:04 a.m. to visit Patient #14. The surveyor reviewed the hospice record at the facility. The hospice record at the facility did not contain a delineation of hospice responsibilities. An interview was conducted with Facility Nurse Y while the surveyor was onsite. The surveyor asked Facility Nurse Y to see the hospice delineation of responsibilities. Facility Nurse Y did not know what the delineation was and could not show the surveyor the delineation of responsibilities. Facility Nurse Y informed the surveyor that the facility communicated with the hospice on orders.  During an interview on 1/14/2025 at 11:40 a.m. with the Administrator/Supervising Nurse and Social Worker C, the surveyor discussed that there were no delineations of responsibilities in the hospice's clinical records and that the hospice records at Facility X did not contain the delineations of responsibilities. The surveyor asked about the delineations, who would have them, when were they completed. The Administrator/Supervising Nurse informed the surveyor that the floor nurse would have the delineations. We fill it out at admission. The surveyor asked if the hospice kept a copy of the delineations. The Administrator/Supervising Nurse stated, "No, we give them to the facility." The Administrator/Supervising Nurse informed the surveyor that the Administrator/Supervising Nurse did not know what Facility X did with them. The Administrator/Supervising Nurse informed they surveyor that Facility X had an admission nurse but if it's a long-term person that was new on hospice, the hospice give it to the charge nurse.  During an interview on 1/15/2025 at 9:24 a.m. with Registered Nurse G, the surveyor asked about the delineation of responsibilities. Registered Nurse G informed the surveyor that the hospice nurses fill out the delineation. The surveyor asked who would make sure the delineation was in the hospice record. Registered Nurse G informed the surveyor that the office would scan the delineation into the chart.  Review of the agency's policy titled "Hospice Care in a SNF/NF (Skilled Nursing Facility/Nursing Facility) or ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disability)," labeled PC.125, and last reviewed on 11/22/2024 read in part: "Purpose To describe the process for providing hospice care to residents of a Skilled Nursing Facility/Nursing Facility...Policy I. The Hospice and the facility will have a legally written binding contract/agreement in place defining the provision of services to Hospice patients in a SNF/NF...Procedure...II. The Hospice responsibilities will include, but not limited to, providing the following: A. Medical Direction and Management of the patient; B. Nursing; C. Counseling, including spiritual, dietary and bereavement; D. Social work (may also be provided by Mental Health Counselor and/or Marriage and Family Therapist; E. Medical supplies, durable medical equipment and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; F. Other hospice services that are necessary for the care of the resident's terminal illness and related conditions..."