Every finding on record at Crossroads Hospice, LLC

Based on record review and staff interview, the Hospice Agency failed to ensure care and services were provided in accordance with the plan of care as evidenced by failing to have documented evidence of: 1) Skilled Nurse (SN) visits as ordered in the plan of care for 3 (#3, 8, and 13) of 14 (#1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) sampled patients and, 2) Hospice Aide (HA) visits as ordered in the plan of care for 5 (#4, 6, 7, 10, 14) of 14 (#1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) sampled patients. --- Missing Skilled Nursing (SN) visits Patient#3 Review of the clinical record for patient #3 revealed he had a primary diagnosis of prostate cancer and a start of care date of 09/05/2024. Review of the plan of care revealed patient #3 was to receive 2 - 4 SN visits weekly. Review of the SN notes for the certification period from 12/04/2024 to 01/03/2025 revealed documentation of one SN visit provided to the patient during the week of 12/22/2024 to 12/28/2024. On 01/09/2025 at 11:49 a.m., an interview with S1Administrator confirmed patient #3 had documentation of one SN visit for the week of 12/22/2024 and the plan of care called for 2 - 4 visits weekly. Patient #8 Record review revealed patient #8 had a start of care date of 12/18/2024 with a primary diagnosis of decompensation of cirrhosis of the liver. Review of the plan of care revealed patient #8 was to receive 2 - 4 SN visits weekly. Review of the SN visits for patient #8 from 12/18/2024 - 01/06/2025 revealed documentation of one SN visit provided to the patient during the week of 12/22/2024 to 12/28/2024. On 01/09/2025 at 11:53 a.m., an interview with S1Administrator confirmed patient #8 had documentation of one SN visit for the week of 12/22/2024 and his plan of care called for 2 - 4 visits weekly. Patient#13 Review of the clinical record for patient #13 revealed a start of care date of 08/30/2024 with a primary diagnosis of Alzheimer`s disease. Review of the plan of care revealed patient #13 was to receive daily SN visits. Patient #13 expired on 9/23/2024. Review of the SN notes for patient #13 from 08/30/2024 to 09/23/2024 revealed there was no documentation of daily SN visits on 08/31/2024, 09/01/2024, 09/07/2024, 09/8/2024, 09/14/2024, 09/15/2024, 09/19/2024, 09/21/2024, and 09/22/2024. On 01/09/2025 at 11:49 a.m., an interview with S1Administrator confirmed patient #13 had no documentation of daily SN visits on 08/31/2024, 09/01/2024, 09/07/2024, 09/8/2024, 09/14/2024, 09/15/2024, 09/19/2024, 09/21/2024, and 09/22/2024. Missing Hospice Aide (HA) visits Patient #7 Record review revealed patient #7 had a start of care date of 10/30/2024 with a primary diagnosis of lung cancer. Further record review revealed the agency was to provide patient #7 with 5 HA visits per week from 11/03/2024- 01/04/2025. Review of HA visit records revealed on the week of 12/22/2024 and on the week of 12/29/2024, there were 3 recorded HA visits each week. On 01/09/2025 at 11:40 a.m., an interview with S1Administrator confirmed on the week of 12/22/2024 and on the week of 12/29/2024 there were 3 recorded HA visits for each of those weeks for patient #7. S1Administrator confirmed the plan of care called for 5 HA visits weekly. Patient #4 Record review revealed patient #4 had a start of care date of 10/24/2024 with a primary diagnosis of senile degeneration of the brain. Further record review revealed the Hospice agency was to provide hospice aide services for patient #4 three times weekly. Review of the hospice aide visits revealed there was no documented evidence of hospice aide visits three times per week for the weeks of 10/27/2024 – 11/16/2024 and 11/24/2024 – 01/05/2025 for patient #14. On 01/09/2025 at 1:15 p.m., S1Administrator was notified of the above findings. S1Administrator confirmed there was no documented evidence that patient #4 received hospice aide visits three times weekly for the weeks of 10/27/2024 – 11/16/2024 and 11/24/2024 – 01/05/2025. Patient #6 Review of patient #6s record revealed there was no documented evidence of a hospice aide visit three times per week for the weeks of 12/02/2024 – 12/07/2024, 12/08/2024 – 12/14/2024, 12/15/2024 – 12/21/2024, 12/22/2024 - 12/28/2024 and 12/29/2024 – 01/04/2025. On 01/09/2024 at 1:40 p.m., an interview with S1Administrator confirmed there was no documented evidence of hospice aide visits for the dates reviewed for patient #6. Patient #10 Review of the hospice aide visits revealed there was no documented evidence of hospice aide visits three times per week for the week of 12/30/2024 – 01/04/2025 for patient #10. On 01/09/2024 at 12:33 p.m. interview with S1Administrator confirmed that the hospice aide was to visit the home of patient #10 on 12/30/2024. S1Administrator confirmed there was no documented evidence of a hospice aide visit on 12/30/2024. Patient #14 Record review revealed patient #14 had a start of care date of 09/25/2024 with a primary diagnosis of coronary disease, anorexia, and history of myocardial infarction. Further record review revealed the hospice agency was to provide hospice aide services for patient #14 three times weekly. Review of the hospice aide visits revealed there was no documented evidence of a hospice aide visit three times per week for the week of 10/06/2024 – 10/12/2024 and there was no documented evidence of a hospice aide visit on 10/18/2024 for patient #14. On 10/09/2024 at 1:00 p.m., an interview with S1Administrator revealed that patient #14 was to have a hospice aide visit three times weekly. S1Administrator confirmed there was no documented evidence of hospice aide visits three times per week for the week of 10/06/2024 - 10/12/2024 and there was on documented evidence of a hospice aide visit on 10/18/2024 for patient #14.

Based on observations and interviews, the Hospice provider failed to ensure the hospice staff followed accepted standards of practice to prevent the transmission of infections and communicable diseases for 1 (#2) of 1 (#2) patients who received hospice services by, the hospice nurse failing to use proper infection control techniques when providing wound care and pericare to the hospice patient. --- During a home visit on 01/08/2025 at approximately 10:30 a.m., revealed patient #2 lying in bed, in her room. S1Administrator (who was also serving in the capacity of a nurse) was preparing to perform wound care to patient #2s sacral wound. During the wound care observation, S1Administrator retrieved a pair of scissors from her personal clothing pocket and began cutting a package of clean gauze that was used part of wound care procedure for patient #2. S1Administrator did not sanitize the pair of scissors after she had removed them from her pocket and prior to cutting the clean package of clean gauze. Further observation revealed patient #2 had soiled her brief. S1Administrator removed the dirty brief and began cleaning the patient. During the observation of pericare, S1Administrator was observed wiping patient #2s perineal area from the back to the front, coming in contact with patient #2s vaginal area. During an interview on 01/08/2025 at 11:30 a.m. with S1Administrator, she was notified of the findings regarding the observation during wound care for patient #2. S1Administrator confirmed that she should have sanitized the pair of scissors after she had removed them from her personal clothing pocket and prior to cutting the package of clean gauze. During an interview on 01/09/2025 at approximately 11:00 a.m., S1Administrator was notified of the findings during the pericare procedure for patient #2. S1Administrator was informed that when cleaning patient #2s perineal area, she should have wiped the perineal area from the front to the back.

Based on record review and staff interview, the hospice agency failed to ensure volunteer services were provided at a minimum of 5% of the total patient care hours of all paid hospice employees and contract staff and the agency failed to maintain records on the use of volunteers for administrative services. --- Review of the Agency's policy titled Active Volunteer Services, policy number: 2.090 with an effective date of 06/21/2007, with no revision date, revealed in part: Policy: Hospice shall maintain an active volunteer staff sufficient to provide administrative or direct patient hours that are at least five percent (5%) of the total patient care hours of paid employees. The agency shall document cost savings achieved through the utilization of volunteers. On 01/09/2025 at 11:20 a.m., an interview with S1Administrator revealed the agency had 1 active volunteer that provided some administrative volunteer work. S1Administrator reported volunteer services achieved less than one percent (1%) of the total patient care hours of all paid hospice employees and contract staff.