Every finding on record at Careline Health Group - Mi, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed and home visits observed, it was revealed that the agency did not ensure the documented comprehensive assessment includes a drug profile that contained the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. Home Visit 1: The patient elected the hospice benefit on 10/28/2024 for the diagnosis of hypertensive heart disease. The patient resided in a Skilled Nursing Facility (SNF). During the home visit with the Hospice Aide (Personnel Record 7) on 02/25/2035, the hospice medication list (printed 02/24/2025) was compared to the SNF medication listed (printed 02/25/2025). The SNF listed the following medications that were not included on the hospice list: Lactobacillus 100 mg give 1 tablet daily ordered on 02/19/2025. The hospice listed the following medications that were not included on the medication list at the SNF: Deep Sea nasal spray 0.65%, spray 2 sprays in each nostril as needed for dry nares ordered on 10/20/2024; and Dextromethorphan-Guaifenesin 20-400 mg tablet, take 1 tablet every four hours as needed for cough, ordered on 10/18/2024. A review of the clinical record was conducted on 02/25/2025 with the Administrator, Regional Quality and VP of Ops. After the review, they agreed that the medication lists had not been reconciled.

It is required that a hospice aide provides services consistent with aide training. This standard was not met as evidenced by clinical record review, personnel record review, document review, and interview. In 1 of 1 (100%) Home visits performed with a hospice aide revealed the agency did not ensure the aide provided services consistent with aide training. Agency Job Description titled, "Hospice Aide Job Description” (last revised 10/18/2021), stated in relevant parts, "1. Demonstrates competency in the following areas: measures temperature, pulse, respirations and blood pressure; assists or performs bed bath, tub, shower or sponge bath; performs shampoo in bed, tub, shower or sink; checks, clears and files nails; performs skin care; assists or performs oral hygiene; assists the patient with dressing; assists with toileting and elimination using toilet, bedside commode, bedpan, urinal or adult brief; safe transfer technique and ambulation, normal range of motion and positioning; adequate nutrition and fluid intake. 2. Provides personal care for each patient in accordance with the Hospice Aide Care Plan." Personnel Record 7: Hospice Aide Skills Competency, stated in relevant part, “the aide…measures temperature, pulse, respirations and blood pressure; assists or performs bed bath, tub, shower or sponge bath; performs shampoo in bed, tub, shower or sink; checks, clears and files nails; performs skin care; assists or performs oral hygiene; assists the patient with dressing; assists with toileting and elimination using toilet, bedside commode, bedpan, urinal or adult brief; safe transfer technique and ambulation, normal range of motion and positioning; adequate nutrition and fluid intake." Home Visit 1/Clinical Record 1: The patient elected the hospice benefit on 10/18/2024 for the diagnosis of hypertensive heart failure. The patient was a resident of a skilled nursing facility (SNF). The Hospice Aide Care Plans dated 10/18/2024, 10/19/2024 and 12/18/2024 all contained the following tasks: "bathing via shower, dressing, hair care-comb and style hair, nail care, oral care, peri care, shampoo hair, skin care-apply lotion after shower, transfer client, change linens, offer fluids, empty trash, fall, aspiration, oxygen and diabetic precautions every visit." A home visit was conducted with the Hospice Aide (Personnel Record 7) on 02/25/2025. The patient was eating breakfast upon our arrival for the site visit. The aide asked about taking her down for her shower and she agreed. The patient was seated in her wheelchair and the aide began pushing her towards the "shower room." Directly across from the shower room, the aide stopped, turned, and advised, "she can't make it through the entire shower unless I change out her tank (oxygen)." The aide then proceeded to an oxygen tank storage room, obtained a tank from the room and brought it towards the patient. She was then observed to remove the patient's tank from the wheelchair carrier, added a new tank and stated, "she's on 3 liters,” turned on the new tank and attached the tubing from the old tank. The aide then took the old tank to the storage room and took the patient into the shower room. Neither the Agency Policy, Competencies or Hospice Aide Care Plan detailed the aide removing the patient's oxygen or changing out any tanks. A review of the clinical record and personnel record was conducted on 02/25/2025 with the Administrator, Regional Quality and VP of Ops. After the review, it was determined the changing of the oxygen tanks were not on the hospice aide care plan, nor did her competencies show her being checked off on changing out oxygen tanks.

It is required that a hospice aide provides services: As 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 interview. In 8 of 14 (57%) applicable clinical records reviewed with hospice aide services it was revealed that the hospice aide (HA) did not provide care according to assigned tasks on the plans of care. Record #38595: Hospice aide care plan included tasks of: oral care, transfer, perineal care, assist with feeding, dressing, and bed bath. For HA visit on 4/5/2022, there was no documented evidence that the assigned tasks of oral care or transfer were completed. For HA visit on 4/8/2022, there was no documented evidence the assigned tasks of oral care, transfer or assist with feeding were completed. For HA visit on 4/12/2022, there was no evidence the assigned tasks of transfer, bed bath, perineal care or dressing were completed. For HA visit on 4/22/2022, there was no evidence that the assigned tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #58402: Hospice aide care plan included tasks of: nail care, oral care, and dressing. For HA visit on 3/7/2022, there was no documented evidence that the assigned tasks of nail care or dressing were completed. For HA visit on 3/10/2022, there was no documented evidence that the assigned task of nail care was completed. For HA visit on 3/21/2022, there was no documented evidence the assigned tasks of oral care or nail care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #72372: Hospice aide care plan included tasks of: oral care and shampoo. For HA visit on 4/25/2022, there was no documented evidence that the assigned task of oral care was completed. For the HA visit on 4/28/2022, there was no documented evidence that the assigned tasks of shampoo or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #33300: Hospice aide care plan included tasks of: transfer, shower, shampoo, hair care, skin care, perineal care, oral care and dressing. For HA visit on 1/28/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, skin care, perineal care, oral care or dressing were completed. For HA visit on 2/1/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, oral care or dressing were completed. For the HA visit on 2/8/2022, there was no documented evidence that the assigned tasks of transfer, shampoo, oral care or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #13150: Hospice aide care plan included task of: oral care. For HA visit on 4/7/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/112022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/13/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/20/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 425/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/27/2022, there was no documented evidence that the assigned task of oral care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #62292: Hospice aide care plan included tasks of: assist with feeding, change linens, shampoo, transfer, and oral care. For HA visit on 3/16/2022, there was no documented evidence that the tasks of assist with feeding or change linens were completed. For HA visit on 3/17/2022, there was no documented evidence that the tasks of assist with feeding, change linens or shampoo were completed. For HA visit on 3/28/2022, there was no documented evidence that the tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #90164: Hospice aide care plan included tasks of: assist with feeding, nail care, shampoo, and hair care. For HA visit on 4/29/2022, there was no documented evidence that the tasks of assist with feeding, nail care or shampoo were completed. For HA visit on 4/20/2022, there was no documented evidence that the tasks of assist with feeding, hair care, shampoo or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #74294: Hospice aide care plan included tasks of: shower, shampoo, and shaving. For HA visit on 2/7/2022, there was no documented evidence that the tasks of shower or shampoo were completed. For HA visit on 2/14/2022, there was no documented evidence that the tasks of shower, shampoo or shaving were completed. There was no documented evidence the HA communicated any of these changes to the RN. The Administrator was interviewed on 5/4/2022 and stated there was no communication documentation between the hospice aide and a nurse within the clinical records identified nor was there any additional information to provide.

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. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by a review of clinical records and interview. In 8 of 14 (57%) applicable records with hospice aide services reviewed revealed that the hospice aide (HA) did not provide care according to assigned tasks on the plans of care or update nurse of these changes. Record #38595: Hospice aide care plan included tasks of: oral care, transfer, perineal care, assist with feeding, dressing, and bed bath. For HA visit on 4/5/2022, there was no documented evidence that the assigned tasks of oral care or transfer were completed. For HA visit on 4/8/2022, there was no documented evidence the assigned tasks of oral care, transfer or assist with feeding were completed. For HA visit on 4/12/2022, there was no evidence the assigned tasks of transfer, bed bath, perineal care or dressing were completed. For HA visit on 4/22/2022, there was no evidence that the assigned tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #58402: Hospice aide care plan included tasks of: nail care, oral care, and dressing. For HA visit on 3/7/2022, there was no documented evidence that the assigned tasks of nail care or dressing were completed. For HA visit on 3/10/2022, there was no documented evidence that the assigned task of nail care was completed. For HA visit on 3/21/2022, there was no documented evidence the assigned tasks of oral care or nail care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #72372: Hospice aide care plan included tasks of: oral care and shampoo. For HA visit on 4/25/2022, there was no documented evidence that the assigned task of oral care was completed. For the HA visit on 4/28/2022, there was no documented evidence that the assigned tasks of shampoo or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #33300: Hospice aide care plan included tasks of: transfer, shower, shampoo, hair care, skin care, perineal care, oral care and dressing. For HA visit on 1/28/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, skin care, perineal care, oral care or dressing were completed. For HA visit on 2/1/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, oral care or dressing were completed. For the HA visit on 2/8/2022, there was no documented evidence that the assigned tasks of transfer, shampoo, oral care or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #13150: Hospice aide care plan included task of: oral care. For HA visit on 4/7/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/112022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/13/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/20/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 425/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/27/2022, there was no documented evidence that the assigned task of oral care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #62292: Hospice aide care plan included tasks of: assist with feeding, change linens, shampoo, transfer, and oral care. For HA visit on 3/16/2022, there was no documented evidence that the tasks of assist with feeding or change linens were completed. For HA visit on 3/17/2022, there was no documented evidence that the tasks of assist with feeding, change linens or shampoo were completed. For HA visit on 3/28/2022, there was no documented evidence that the tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #90164: Hospice aide care plan included tasks of: assist with feeding, nail care, shampoo, and hair care. For HA visit on 4/29/2022, there was no documented evidence that the tasks of assist with feeding, nail care or shampoo were completed. For HA visit on 4/20/2022, there was no documented evidence that the tasks of assist with feeding, hair care, shampoo or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #74294: Hospice aide care plan included tasks of: shower, shampoo, and shaving. For HA visit on 2/7/2022, there was no documented evidence that the tasks of shower or shampoo were completed. For HA visit on 2/14/2022, there was no documented evidence that the tasks of shower, shampoo or shaving were completed. There was no documented evidence the HA communicated any of these changes to the RN. The Administrator was interviewed on 5/4/2022 and stated there were no communication documentation between the hospice aide and a nurse within the clinical records identified nor was there any additional information to provide.