Every finding on record at Chi Health Connect at Home - Fargo

Based on record review, policy review, and staff interview, the Hospice failed to ensure a registered nurse (RN) completed an on-site supervisory visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide for 3 of 8 sampled patients (Patient #3, #4, and #7) receiving hospice aide services. Failure to perform the supervisory visit limited the Hospices' ability to ensure hospice aide services met the patients' needs. --- -Review of patient #7's medical record occurred on April 30-May 1, 2024. The patient's plan of care for the certification period 2/13/24-5/12/24 identified home health aide services with a visit frequency of one time per week. The record showed the aide visits occurred as scheduled. Patient #7's record identified RN supervisory visits occurred one time per month on 2/23/24, 3/19/24, and 4/22/24, therefore missing three required supervisory visits during this period. During an interview on 05/01/24 at 10:58 a.m., an administrative staff member (#2) confirmed the record lacked evidence the RN completed the required supervisory visits. Findings include: Review of the facility policy titled "Supervision" occurred on 05/01/24. This policy, dated 12/01/11, stated, ". . . Procedure: . . . A registered nurse . . . will be available whenever home health aide services are provided. Home health aide services will be supervised every fourteen (14) days by a registered nurse . . ." - Review of Patient #4's medial record occurred on April 30-May 1, 2024. The patient's plan of care for the certification period from 02/05/24 to 05/04/24 identified hospice aide services with a visit frequency of one time a week. The record showed the aide visits occurred as scheduled, with a certified nurse aide/physical therapy aide (PTA) completing the aide duties identified in the aide care plan. Patient #4's record lacked evidence an RN performed six on-site supervisory visits required in the 12 weeks between 02/05/24 and 04/28/24. During an interview on 04/30/24 at 4:40 p.m., a supervisory nurse (#1) stated a PTA provided the aide services for Resident #4 and "didn't think they needed supervisory visits as often." The nurse (#1) confirmed Patient #4's record lacked evidence an RN completed the required supervisory visits. Review of Patient #3s medical record occurred on April 30 – May 1, 2024. The patients plan of care for the certification period from 03/12/24 to 05/10/24 identified hospice aide services with a visit frequency of one time a week. The record showed the aide visits occurred as scheduled. Patient #3s record lacked evidence an RN completed a supervisory visit between 03/27/24 and 04/15/24 (20 days). During an interview on 04/30/24 at 4:00 p.m., a supervisory nurse (#1) confirmed a missed RN supervisory visit between 03/27/24 and 04/15/24 for Patient #3.

Based on review of policy and procedure, review of the hospice volunteer requirement report, and staff interview, the Hospice failed to ensure volunteers provided services which equaled five percent of the total patient care hours of all paid hospice employees and contract staff within a one-year period (April 2023 to April 2024). This resulted in the failure to use volunteers to the extent specified. --- Findings Include: Review of the policy titled "Volunteer Program - Hospice" occurred on 05/01/24. This policy, dated December 2010, stated, ". . . Cost Saving: It is the intention of hospice to utilize volunteers to supplement the care being provided by the paid staff who work directly with clients and their families, both in the client home and the inpatient setting. It is expected volunteers will provide administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract staff . . ." Review of the hospice volunteer requirement report occurred on 04/30/24. This document identified the Hospice provided 2609.08 total hospice patient hours and 93.30 total volunteer hours in the one-year period of April 2023-April 2024. The division of these values calculated a total of 3.57 percent and did not equal the required five percent minimum. During an interview the morning of 05/01/24, two administrative staff members (#2 and #3) confirmed the number of volunteer hours did not meet the required five percent minimum.

Based on observation, record review, and staff interview, the Hospice failed to ensure the hospice aide received patient specific care instructions for 1 of 1 patients observed during an aide home visit (Patient #5). This failure had the potential to limit the quality of care and services provided by the aide. Observation of a home visit for Patient #5 occurred on 03/08/22 at 10:00 a.m. with a hospice aide (#1). During the visit, the aide (#1) assisted Patient #5 into a walk-in tub for a whirlpool bath. After the bath, the hospice aide (#1) applied Corona cream (a skin protectant) to a reddened area on Patient #5's buttocks. While getting Patient #5 dressed, the aide (#1) applied compression stockings to the patient's bilateral lower legs. The aide assisted the patient to transfer with a walker and a wheelchair. Review of Patient #5's medical record occurred on March 8-9, 2022. The most recent plan of care, dated 01/17/22, identified hospice aide visits two times a week for assistance with personal care, hygiene, and activities of daily living. The aide care plan, effective 10/19/21, showed tasks for the hospice aide to complete at each visit and included the following, ". . . Review Plan of Care . . . ADL [Activities of Daily Living] Services - As Patient Will Allow, Provide Assistance With: Apply lotion, Assist to toilet, Assist with shower, Dressing, Nail care, Oral care, Perineal care, Shampoo, Skin care . . ." The aide care plan failed to include the individualized tasks observed with Patient #5 during the home visit on 03/08/22, such as the patient's mobility (transfer with wheelchair, walker, assist of one), tub/whirlpool bath, application of Corona cream, and application of compression stockings. During an interview on the afternoon of 03/09/22, an administrative staff member (#2) confirmed Patient #5's aide care plan did not include the individualized tasks performed by the aide at the time of the home visit. The staff member (#2) stated the aide care plan must include individualized patient information and be updated as needed, prior to providing care to the patient.