Every finding on record at Crossroads Hospice of Cleveland, LLC

It is required that hospice aides are supervised by a registered nurse who makes an on-site 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 and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review and interview. In 7 of 16 (44%) clinical records reviewed of patients receiving hospice aide services, it was revealed that the agency did not ensure the hospice aide was supervised by a registered nurse no less frequently than every 14 days. CLINICAL RECORD 4: The aide visit frequency order was two (2) times per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 01/06/2024 through 06/04/2025. There was evidence of aide supervisory visits completed on: 01/19/2024, 01/25/2024, 11/25/2024, 01/03/2025, 01/07/2025, 01/16/2025, 01/21/2025, 03/25/2025, 04/23/2025, and 05/06/2025. There was no additional documentation to address the gaps in documented aide supervision. CLINICAL RECORD 6: The aide visit frequency order was one (1) time per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 04/10/2025 through 06/04/2025. There was evidence of aide supervisory visits completed on: 02/07/2025, 03/20/2025 (which is 48 days), and 04/03/2025. (No other supervisory visits were documented and there was no additional documentation to address the gaps in documented aide supervision. CLINICAL RECORD 7: The aide visit frequency order was two (2) times per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 04/02/2025 through 06/04/2025. There was evidence of aide supervisory visits completed on: 05/13/2025 (which is 35 days from the first aide visit on 04/08/2025) and 05/27/2025. There was no additional documentation to address the gaps in documented aide supervision. CLINICAL RECORD 9: The aide visit frequency order was one (1) time per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 02/06/2025 through 06/04/2025. There was evidence of aide supervisory visits completed on: 04/03/2025, 04/22/2025, 05/13/2025, and 05/27/2025.  There was no additional documentation to address the gaps in documented aide supervision. CLINICAL RECORD 10: The aide visit frequency order was two (2) times per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 04/09/2025 through 06/04/2025. There was evidence of aide supervisory visits completed on: 04/29/2025 (which was 20 days after the first aide visit), 05/13/2025, and 06/03/2025. There was no additional documentation to address the gaps in documented aide supervision. CLINICAL RECORD 17: The aide visit frequency order was one (1) time per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 10/24/2024 through 12/19/2024. There was no evidence of aide supervisory visits being completed. There was no additional documentation to address the lack of documented aide supervision. CLINICAL RECORD 18: The aide visit frequency order was two (2) times per week. The record was reviewed for aide supervisory visits between the initial nursing assessment dated 11/06/2024 through 02/03/2025. There was evidence of aide supervisory visits completed on: 11/25/2024, 12/16/2024, and 01/15/2025. There was no additional documentation to address the gaps in documented aide supervision. This was shared with leadership on 06/03/2025, and in an interview on the same day with the Director of Nursing, she stated, "She has already identified this as a problem and had an active performance improvement project in place to monitor the progress".

It is required that a hospice aide provides services: ordered by the Interdisciplinary Group. This standard was not met as evidenced by a review of clinical records and interviews. In 3 of 16 (18%) records reviewed where patients received hospice aide services, it was revealed that the agency did not ensure that the hospice aide visits were completed as ordered on the plan of care. Clinical Record 7 - The plan of care effective from 5/24/22 and an updated order dated 8/18/22 had hospice aide visits ordered 2 times weekly. For the weeks of 8/7/22 and 8/14/22, only 1 hospice aide visit was documented as completed weekly. Clinical Record 4 - The plan of care effective from 6/2/22 to the date of review, had hospice aide visits ordered 2 times weekly. For the weeks of 7/31/22 and 8/14/22, only 1 hospice aide visit was documented as completed weekly. Clinical Record 10 - The plan of care effective 6/16/22 had hospice aide visits ordered 1 time weekly. No hospice aide visit was documented as completed during the week of 8/14/22. During a joint review of the records with the Director of Nursing it was confirmed that the hospice aide visits were not completed as ordered. The Director stated that their hospice billing week starts on Sunday. The Director of Nursing also confirmed that there were no documented reasons for missed visits.