Every finding on record at Comfort Care Hospice, LLC

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation, and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 1 (100%) home visits that were conducted in a private home, the agency did not ensure that the hospice aide provided services as ordered by the Interdisciplinary Group and included in the plan of care. CLINICAL RECORD 3/HOME VISIT 3: This patient elected the hospice benefit on 07/01/2025 with a terminal diagnosis of benign neoplasm of the meninges. The effective date of the hospice aide (HA) care plan was 09/29/2025-12/27/2025. The hospice plan of care reviewed for the dates of 09/29/2025-12/27/2025 ordered hospice aide visits 2 times a week. The HA care plan directed the HA to provide bathing-seated shower using chair/bench. An observed home visit was conducted with the HA [PERSONNEL RECORD 3] on 11/24/2025. The HA was observed to give the patient personal care. The HA provided a sponge bath while the patient sat on the toilet. The HA stated that the patient decided between a sponge bath on the toilet or a shower using the shower bench. The HA did not provide a seated shower using a chair/bench as assigned in the HA care plan. An interview was conducted with the Executive Director on 11/24/2025 and it was stated that the HA did not follow the HA care plan. The Executive Director stated that the HA care plan would be updated to reflect the goals of the patient.

It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: the hospice election form and any advance directives, physician certification and recertification of the terminal illness. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 1 (100%) home visits that were conducted in a skilled nursing facility, the agency did not ensure that the skilled nursing facility was provided with the hospice election form, any advance directives, or the physician certification and recertification of the terminal illness. CLINICAL RECORD 1/HOME VISIT 1: This patient elected the hospice benefit on 12/21/2024 with a terminal diagnosis of severe protein calorie malnutrition. An observed home visit was conducted on 11/24/2025 in a skilled nursing facility with the Licensed Master's Social Worker [LMSW - Personnel Record 1]. The hospice binder was reviewed with the LMSW and revealed the hospice election form and advance directives were not present in the hospice binder. Additionally, the physician certification and recertification of the terminal illness were not present in the binder. An interview was conducted with the Executive Director on 11/25/2025. It was stated that the Executive Director visited the skilled nursing facility after the home visit on 11/24/2025 and confirmed the hospice election form and advance directives as well as the physician certification and recertification of the terminal illness were not present in the binder or in the facility clinical records. She reported the facility would sometimes remove documentation from the hospice binder and either place it in the facility clinical records or shred the forms.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by a review of clinical records, document review and interview. 4 of 7 (57%) clinical records reviewed of patients receiving hospice aide services revealed that the agency did not ensure that the hospice aides received specific patient care instructions. POLICY # .17.16 titled "Hospice Aide Services" states in part, "Hospice aides are assigned to a specific patient by a RN that is a member of the interdisciplinary. Written instructions for a Hospice Aide must be prepared by a RN who is responsible for the supervision of the Hospice Aide." Clinical Record 10: The patient elected hospice care on 07/19/2022 with a diagnosis of Alzheimer's. The aide plan of care dated 07/19/2022, assigned the tasks "bed bath or shower every visit." The aide did not receive specific instructions for the patient's type of bath. Clinical Record 5: The patient elected hospice care on 09/16/2022 with a diagnosis of Malignant Neoplasm unspec (unspecified) part of bronchus or lung. The aide plan of care dated 09/06/2022 assigned the tasks "shower and sponge bath every visit." The aide did not receive specific instructions on the type of bath to be provided. Clinical Record 2: The patient elected hospice care on 12/08/2022 with a diagnosis of Unspecified Protein Calorie Malnutrition. The aide plan of care dated 12/08/2022 assigned the tasks "bed bath or shower every visit." The aide did not receive specific instructions for the type of bath to be provided. Clinical Record 1: The patient elected hospice care on 11/11/2022 with a diagnosis of COPD (chronic obstructive pulmonary disease). The aide plan of care dated 11/11/2022 assigned the tasks "bed bath or shower every visit." and "May remove O2 as needed." The aide did not receive specific instructions for the type of bath to be performed or specific instructions on removing the patient's O2. The Executive Director was interviewed on 01/18/2023 and confirmed that the RNs did not assign specific instructions for the aides to follow. No further information was provided.