Every finding on record at Carewise Hospice Inc

Upon patient record review, 14 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients # 1 - 14) The comprehensive assessments did not contain evidence of the consideration related to the imminence of death.

Upon patient record review, 12 of 14 (Patients # 1, 2, 3, 4, 5, 6, 8, 9, 10, 12, 13, 14) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients # 1, 2, 3, 4, 5, 6, 8, 9, 10, 12, 13, 14) Orders for the MSW and Spiritual Care did not contain evidence of scope or frequency. The orders where written as MSW and Spiritual Care 1 visit within 5 days and then PRN.

Upon patient record review, 14 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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. Patients # 1 - 14) The plan of care did not contain evidence of supplies. Verified with hospice staff reviewing the log for patients supplies delivered to patients, all patients are or were using adult diapers and wipes.

Upon personnel record review, 1 of 11 (Personnel # 8) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel # 8) Employee file did not contain evidence of competency assessments for a) Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff, and b) Shampoo, sink, tub, and bed.

Upon patient record review, 4 of 14 (Patients # 3, 9, 13, 14) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient # 3) The aide plan of care dated 4/8/25 did not contain evidence of frequencies for the tasks of turn and reposition, record bowel movement, and feeding assistance. Patient # 9) The aide plan of care dated 7/8/25 did not contain evidence of frequencies for the task of turn and reposition. Patient # 13) The aide plan of care dated 12/1/24 did not contain evidence of frequencies for the tasks of turn and reposition, record bowel movement, encourage fluids if tolerated, clean nails, and change patient linens. Patient # 14) The aide plan of care dated 4/8/25 did not contain evidence of frequencies for the tasks of record bowel movement, encourage fluids if tolerated, and change linens.

Upon personnel record review, 1 of 11 (Personnel # 3) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel # 3) Personnel files did not contain evidence of orientation to hospice philosophy at the time of hire.

Observed in Record Review. In 1 of 8 patient records reviewed, for active patients, it was noted by the nurse surveyor that the RN did not visit the hospice patient every 15 days to conduct an assessment as required by regulation. For RR#6 the LVN conducted the assessment visits for periods of time that were greater than 15 days over the last two months. Finding was verified by the Director of Patient Care Services.

Observed in Record Review. In 8 of 8 patient records reviewed, of active records, it was noted by the nurse surveyor that for HV#1/RR#1, HV#2/RR#2, HV#3/RR#3, RR#4, RR#5, RR#6, RR#7, and RR#8, the goals were not measurable or individualized for the patients. For example, Constipation will be controlled with planned interventions throughout the episode of care and Patient will experience minimal cardiac/circulatory function symptoms as evidenced by blood pressure within expected limits throughout the episode of care. Additionally, most goals were set to be achieved by the end of the certification period. Findings were verified by the Director of Patient Care Services

Observed in Record Review. In 8 of 8 patient records reviewed, of active patients it was noted by the nurse surveyor that for HV#1/RR#1, HV#2/RR#2, HV#3/RR#3, RR#4, RR#5, RR#6, RR#7, and, RR#8 the visit frequency as established by the IDG (interdisciplinary group) included as needed visits by the physician; however, the as needed visits were not qualified with a reason for making them or quantified with a set number of visits as required by regulation. Additionally, for HV#2/RR#2, RR#6, and RR#8, skilled nursing did not have a defined visit frequency. Findings were verified by the Director of Patient Care Services.

Observed in Patient Home. In 2 of 3 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned. For example, during HV#1/RR#1 the hospice aide washed her hands with soap and water in the patient’s bathroom sink, turned the faucet off with a paper towel, and dried her hands with the same paper towel. She then touched the door and the doorknob on her way out of the bathroom, took gloves out of her bag, then put them on without hand sanitizing. She then set up the bathing supplies to include getting the water pans filled and disrobing and draping the patient all with the same pair of gloves on. During HV#2/RR#2 with a skilled nurse, proper hand technique was broken. The nurse washed her hands in the patient’s kitchen sink, she then donned gloves and went in and out of her nursing bag removing her blood pressure cuff, pulse oximeter, stethoscope, and thermometer, cleaning each piece of equipment separately as she removed it from the bag but doing so without changing her gloves or performing hand hygiene. The Director of Patient Care Services was present during the home visits and observed the breaks in technique per agency policy.