Every finding on record at Care Associates LLC

Upon observation, and interview with the Administrator, there was not evidence of a contract/agreement with other facilities/agencies/hospices to receive patients in the event that the Hospice cannot provide care to their patients during an emergency.

Upon patient record review, 14 of 14 (Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14) did not evidence that the Hospice had informed, and provided written information to, the patient concerning its policies on Advance Directives, including a description of any applicable Louisiana State law. Per interview with the Administrator, Louisiana has a POLST document, which the Hospice has not been providing/sharing with newly admitted patients.

Upon patient record review, 1 of 14 (Patients #3) did not contain evidence that the Hospice had developed an individualized written Plan of Care for each patient. The Plan of Care must reflect patient/family goals and interventions, based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The Plan of Care must include all services necessary for the palliation and management of the terminal illness and related conditions: Patient #3: The RN SOC assessment note described a patient choking incident during the admission process. The patient choked on food, resulting in coughing and dysphagia; taking 10 minutes to subside, and including x1 emesis. The RN documented that she confirmed with the family members that the patient would be provided pleasure foods, with aspiration precautions, food cut up into small bites, patient to be supervised while eating, while sitting up at a 90 degree angle. The 5/07/25 IDG POC Nutrition/Hydration section, only included, "Patient will have adequate food/fluids as tolerated. Regular diet of pleasure feedings." There were no problems/goals/interventions for dysphagia and aspiration precautions.

Upon patient record review, 2 of 14 (Patients #9, 10) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, specifically medications and treatments: Patient #9: Current IDG POC notes, "Patient has a wound/pressure ulcer area, Stage II sacrum. Patient on preventative skin care protocol. Sacral wound: Cleanse with NS, pat dry, apply zinc oxide 'daily', and p.r.n. soiling." This is not a compete wound order, as it does not indicate 'who' will be providing such daily wound care. Patient lives in ALF. Patient #10: An order was obtained on 05/01/25 for, "Insert Foley 16F to gravity. Change Q30 days." This is not a complete order as it does not identify who in the home would be providing the daily catheter/tubing care, who/frequency of emptying the drainage bag, and monitoring for signs of infection.

Upon patient record review, 2 of 14 (Patient #6, 8) did not contain documented evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #6: An order was obtained on 03/21/25 for, "Patient is refusing SW services at this time." However, 3 SW visits were made on April 3, 14, and 30, 2025. Patient #8: On the 04/18/25 RN SOC assessment, she documented the following, "Patient has multiple skin tears to bilateral forearms. Old bandages from 04/07/25 removed. I cleansed with saline, applied non-stick pads, then wrapped in Kerlix." There was no order on the POC for such dressing change.

Upon personnel record review, 1 of 11 (Personnel #9) did not contain evidence that an initial Aide Skills Competency Assessment had been conducted, as per CMS requirement. Personnel #9: DOH was 09/05/24, an Aide Skills Competency Assessment had been conducted on 09/05/24. However, the following skills were not evaluated for the Aide while performing the tasks with a patient or pseudo-patient: ·Normal Range of Motion. This section of the form had been left blank. · Shampoo, sink, tub, and bed. The entry on the tool used, only listed "Hair Care." · Sponge bath The other subject areas that may be evaluated through written examination, oral examination, or after observation of a Hospice Aide with a patient, were not evaluated for: The physical, emotional, and developmental needs of and ways to work with the populations served by the Hospice.

Upon patient record review 3 of 14 (Patients #6, 7, and 8) did not contain documented evidence that the Hospice Aide had provided services that are: • Ordered by the Interdisciplinary Group • Included in the Plan of Care Patient #6: The IDG POC ordered Aide services at a frequency of 3x per week. There was only (1) Aide home visit made the week of 04/13-04/19/2025. Patient #7: SOC 02/25/25. An Aide POC was first established 03/10/25, and assigned Aide visits at a frequency of 2x per week. A verbal order was obtained on 04/07/25 to change the Aide visit frequency to 3x per week. Only (1) Aide visit was made the week of 04/13-04/19/25. Patient #8: Effective 04/20/25 Aide visits were assigned at a frequency of 3x per week. Visits were made on 04/21, 04/23, and 04/25/25. Effective 04/21/25 Aide visits were changed to a frequency of 2x per week. However, Aide visits continued to be made 3x per week for the next two weeks.

Upon patient record review, 3 of 14 (Patient #3,4,9) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient #3: For the upcoming certification period beginning 04/25/25, the Physician signature was dated for 04/29/25. There was no oral certification obtained. Patient #4: For the upcoming certification period(s) beginning 09/27/24, 12/26/24, and 03/26/25, the Physician signature(s) were dated for 10/08/24, 01/07/25, and 04/01/25 respectively. There were no oral certification(s) obtained. Patient #9: For the upcoming certification period(s) beginning 07/18/24, 10/16/24, and 02/13/25, the Physician signature(s) were dated for 07/23/24, 10/21/24, and 02/18/25 respectively. There were no oral certification(s) obtained.

Upon patient record review, 14 of 14 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14) did not contain documented evidence that each patient record contained: A signed Election of Hospice Benefit Statement in accordance with 418.24: Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14): These Medicare Hospice Benefit Election form(s) do not include: • The information provided to the patient on the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), was missing the 'contact information' for the nearest BFCC-QIO.

Upon patient record review, 1 of 14 (Patient #10) did not contain evidence that all entries were clear, complete: Patient #10: An order was obtained on 05/01/25 for, "Insert Foley 16F to gravity. Change Q30 days." On the 05/01/25 SNV note, the RN documented, "Catheter placed with sterile technique." There were no details documented, to include but not limited to, the size of Foley inserted. The POC included x4 wound orders that were all initiated on 03/06/25: 1) Coccyx: Cleanse wound cleanser, pat dry, apply Dakins soaked gauze to wound bed, cover ABD, and tape to secure, daily; 2) Left buttocks: Paint with Betadine, cover with Mepore dressing daily; 3) Right hip: Paint with Betadine, cover with Mepore dressing daily; and 4) Right shoulder: Paint with Betadine, cover with Mepore dressing daily. The 05/01/25 SNV documented wound care as follows, "Wound care completed per order", without the details of the wound care having been provided.

Upon patient record review, 1 of 14 (Patient #11) did not contain evidence that the 05/02/25 Discharge Summary included all CMS-required information, as follows: Patient #11: There was not documented evidence that the completed Discharge Summary included: • A summary of the patient's stay, including treatments, all symptom and pain management • The patient's current Plan of Care • The patient's latest Physician orders

Upon patient record review, 1 of 14 (Patient #2) did not contain evidence that the Interdisciplinary Group, as part of the review of the Plan of Care, had determined the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the Hospice must address this issue in the patient's Plan of Care: Patient #2: This section/question within the EMR had been left blank.

Upon personnel record review, 3 of 11 (Personnel #2, 3, and 9) did not contain evidence of Criminal Background Checks having been obtained, in accordance with State requirements. In the absence of State requirements, Criminal Background Checks (CBC) are obtained within three months of the date of employment for all States that the individual has lived or worked in the past 3 years: Personnel #2: DOH 01/10/04. The Administrator reported that this personnel's original criminal background check had been misplaced. It had not been re-ran and filed in the record. Personnel #3: DOH 09/06/16. The Administrator reported that this personnel's original criminal background check had been misplaced. It had not been re-ran and filed in the record. Personnel #9: DOH 09/05/24. The Administrator reported that this personnel's original criminal background check had been misplaced. It had not been re-ran and filed in the record.

Upon patient record review, 4 of 11 records (Patients #2,#4,#8,#9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient 2: The medication profile contained tramadol PRN with no indication specified for administration. Corrected on site. Patient 4: The medication profile contained illegible instructions for tramadol to take 1 tab "pre". Corrected on site. Patient 8: The medical record contained nursing documentation and listed oxygen equipment on the plan of care. There was no evidence of oxygen listed on the medication profile. Patient 9: The medication profile contained miralax powder by mouth with no instructions for a diluent.

Upon patient record review, 5 of 11 records (Patients #5,#6,#7,#8,#9) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 5: The initial bereavement assessment was completed 5-16-22. Patient admitted to hospice 4-14-22. Patient 6: The initial bereavement assessment was completed 5-16-22. Patient admitted to hospice 9-5-21. Patient 7: The medical record contained an initial bereavement assessment completed by the MSW 12-27-21. Patient admitted to hospice 12-16-21. Patient 8: The initial bereavement assessment was completed post-mortem dated 11-1-21. Patient admitted to hospice 10-9-21. Patient 9: The initial bereavement assessment was completed post-mortem dated 10-25-21. Patient admitted to hospice 9-3-21.

Upon patient record review, 1 of 11 records (Patient #1) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 1: The medical chart contained nursing documentation since admission identifying patient had wound that was receiving wound care from facility wound nurse. There was no evidence of wound care assessments completed by hospice nurse. Wound care guidelines per agency indicate wound assessments to be completed weekly.

Upon patient record review, 3 of 11 records (Patients #4,#5,#7) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 4: The medical record contained an ordered frequency for spiritual care visits twice every four weeks which were completed as ordered. There was no evidence of problems, goals, and interventions related to spiritual care. The medical record also contained nursing documentation upon admission identifying patient had PEG-tube and indwelling catheter requiring cares. There was no evidence of problems, goals, and interventions related to PEG- tube and catheter. Corrected on site. Patient 5: The medical record identified patient was on hospice services for heart failure. There was no evidence of problems, goals, and interventions related to cardiac dysfunction and assessments included on the plan of care. Corrected on site. Patient 7: The medical record contained a ordered frequencies for spiritual care visits and social work visits twice every four weeks. There was no evidence of problems, goals, and interventions related to spiritual care or social work. Corrected on site.

Upon patient record review, 4 of 11 records (Patients #2,#4,#8,#9) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 2: The medical record contained a medication order for tramadol PRN with no indication specified. Corrected on site. Patient 4: The medical record contained medication orders with illegible instructions for tramadol to take 1 tab "pre". Corrected on site. The medical record also contained nursing documentation upon admission identifying patient had PEG-tube and indwelling catheter requiring cares. There was no evidence of treatment orders for PEG-tube feedings and maintenance, or indwelling catheter type, size, and maintenance. Corrected on site. Patient 8: The plan of care included oxygen supplied listed as DME and the medical record contained nursing documentation identifying oxygen education completed. There was no evidence of an order for oxygen. Patient 9: The medical record contained medication order for miralax powder by mouth with no instructions for a diluent.

Upon patient record review, 3 of 11 records (Patients #1,#4,#7) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 1: During home visit, it was observed patient utilized wheelchair for mobility. There was no evidence of the wheelchair included on the plan of care. Corrected on site. Patient 4: The medical record contained attached documentation by RN identifying a hospital bed, APP mattress, over the bed table and suction machine were ordered from the DME supplier. There was no evidence of the bed, mattress, table, and suction included on the plan of care. Corrected on site. Patient 7: The medical record contained attached documentation by RN identifying a hospital bed 12-20-21, and wheelchair, over the bed table, and suction machine 12-16-21 were ordered from the DME supplier. There was no evidence of the bed, wheelchair, table, and suction included on the plan of care. Corrected on site.

Upon patient record review 10 of 10 applicable records (Patients #1,#2,#3,#4,#5,#7,#8,#9,#10,#11) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Consistent with the hospice aide training Patient 1, 2, 3, 4, 5, 7, 8, 9, 10, 11: The medical record contained vitals signs obtained during every aide visit. There was no evidence of a task assigned for completion of vitals on the aide care plan. Patient 4: The medical record contained evidence of aide visits completed once the week of 3-3-22 and then twice weekly to current. There was no evidence of an order for aide frequency included on the plan of care. Corrected on site.

Upon patient client record review, 3 of 11 records (Patients #6,#7,#9) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 6: The medical record contained signed election of benefit forms showing patient representative initialed and dated both choices to elect or decline receiving the patient notification of hospice non-covered items, services and drugs. This was error due to signatures received via docusign, not allowing to bypass space for data entry. There was no evidence the form was received. Patient 7: The medical record contained signed election of benefit forms showing patient representative initialed and dated both choices to elect or decline receiving the patient notification of hospice non-covered items, services and drugs. There was no evidence the form was received. Patient 9: The medical record contained signed election of benefit forms showing patient representative initialed and dated both choices to elect or decline receiving the patient notification of hospice non-covered items, services and drugs. There was no evidence the form was received.