Every finding on record at Desert Sky Hospice, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review, and interview. In 2 of 14 (14%) clinical records reviewed, it was revealed that the agency did not ensure that all current medications were included in the patient's drug profile. Agency Policy #2-004, Medication Profile (dated 10/2019), read in part, "Upon admission to hospice, the admitting nurse will initiate a medication profile to document the current medication regimen including name, dose, strength, route, frequency, date and time of administration. A drug regimen review will be performed at the time of initial and comprehensive assessment, when updates to the comprehensive assessment are performed, when care is resumed when a patient has been placed on hold, and with addition of new medication." CLINICAL RECORD 2: The patient elected the hospice benefit on 08/13/2024. The initial plan of care dated 08/13/2024-10/11/2024 read in part, "Oxygen 3 liters per nasal cannula continuously." The drug profile dated 08/13/2024 did not include oxygen. The drug profile was not updated to include oxygen until 12/10/2024. CLINICAL RECORD 9: The patient elected the hospice benefit on 11/07/2024. The record revealed a nursing assessment dated 01/20/2024 that read in part, "Patient to use oxygen as needed." The drug profile dated 02/04/2025 did not include oxygen. In an interview on 02/04/2025, the Director of Nursing reviewed the records, confirmed the findings and stated, "There was not oxygen on the medication profiles."

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, it was revealed that the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the patient's individualized written plan of care. HOME VISIT 3/Clinical Record 9: During the home visit on 02/04/2025, an oxygen concentrator was observed at the bedside of the patient. The current plan of care dated 01/05/2025-03/02/2025 was reviewed at the home visit and did not include oxygen supplies. In an interview on 02/04/2025, the Director of Nursing reviewed the record, confirmed the finding and stated, "There is not oxygen listed as DME (durable medical equipment) on the plan of care but there should have been."

It is required that the hospice provides nursing care under the supervision of a registered nurse. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 14 (7%) clinical records reviewed with licensed practical nurse visits it was revealed that the agency did not ensure that Licensed Practical Nurse (LPN) supervisory visits were completed no less frequently than every 30 days as per agency policy. Agency Policy #8-025, LPN Supervisory Visit Policy (no date), read in part, "An RN (Registered Nurse) will conduct an in-person supervisory visit at least every 30 days for each patient receiving care from an LPN." CLINICAL RECORD 3: The patient elected the hospice benefit on 09/14/2024. The plan of care dated 09/14/2024-12/12/2024 ordered "SN 1x/week." The record revealed Licensed Practical Nurse visits dated 10/09/2024, 10/16/2024, and 11/06/2024. The first LPN supervisory visit was dated 11/21/2024, 43 days later and 13 days outstanding. On 02/03/2025, the Director of Nursing reviewed the record and confirmed the above finding that Licensed Practical Nurse supervisory visits were not completed at least every 30 days per policy.

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 clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, with hospice aide services provided, it was revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. CLINICAL RECORD 6: The patient elected the hospice benefit on 09/05/2024. A physician's order dated 12/30/2024 included orders for wound care with a wound dressing to a wound on the patient's right heel. The plan of care dated 12/04/2024-02/01/2025 ordered "Hospice Aide 2x/week." The aide care plan dated 12/31/2024 included relevant instructions of "Shower at every visit." The aide care plan did not include instructions regarding the wound dressing on the patient's right heel should the dressing become wet or dislodged during the shower. CLINICAL RECORD 8: The patient elected the hospice benefit on 10/24/2024. A physician's order dated 12/11/2024 included orders for wound care with a wound dressing to a wound on the patient's left heel. The plan of care dated 10/24/2024-01/21/2025 ordered "Hospice Aide 2x/week." The aide care plan dated 12/12/2024 included relevant instructions of "Bed bath at every visit." The aide care plan did not include instructions regarding the wound dressing on the patient's left heel should the dressing become wet or dislodged during the bed bath. CLINICAL RECORD 11: The patient elected the hospice benefit on 09/21/2023. A physician's order dated 11/03/2023 included orders for wound care with a wound dressing to a wound on the patient's left leg. The plan of care dated 09/21/2023-12/19/2023 ordered "Hospice Aide 2x/week." The aide care plan dated 11/04/2023 included relevant instructions of "Bed bath at every visit." The aide care plan did not include instructions regarding the wound dressing on the patient's left leg should the dressing become wet or dislodged during the bed bath. CLINICAL RECORD 13: The patient elected the hospice benefit on 08/30/2024. A physician's order dated 10/21/2024 included orders for wound care with a wound dressing to a wound on the patient's sacrum. The plan of care dated 08/30/2024-10/26/2024 ordered "Hospice Aide 2x/week." The aide care plan dated 10/24/2024 included relevant instructions of "Bed bath at every visit." The aide care plan did not include instructions regarding the wound dressing on the patient's sacrum should the dressing become wet or dislodged during the bed bath. In an interview on 02/04/2025, the Director of Nursing reviewed the records, confirmed the findings, and stated, "There are no wound dressing instructions on the aide care plans."

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 needs. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed, with hospice aide services provided, it was revealed that the agency did not ensure that hospice aide supervisory visits were completed no less frequently than every 14 days. CLINICAL RECORD 1: The patient elected the hospice benefit on 05/20/2024. The plan of care dated 05/20/2024-07/18/2024 ordered "Hospice Aide 2x/week." A hospice aide supervisory visit was dated 06/03/2024. The next hospice aide supervisory visit was dated 06/18/2024, 15 days later and 1 day outstanding. CLINICAL RECORD 2: The patient elected the hospice benefit on 08/13/2024. The plan of care dated 08/13/2024-10/11/2024 ordered "Hospice Aide 2x/week." A hospice aide supervisory visit was dated 06/03/2024. The next hospice aide supervisory visit was dated 06/19/2024, 16 days later and 2 days outstanding. CLINICAL RECORD 7: The patient elected the hospice benefit on 10/22/2024. The plan of care dated 10/22/2024-01/19/2025 ordered "Hospice Aide 2x/week." A hospice aide supervisory visit was dated 12/30/2024. The next hospice aide supervisory visit was dated 01/14/2024, 15 days later and 1 day outstanding. In an interview on 02/04/2025, the Director of Nursing reviewed the records, confirmed the above findings, and stated, "There are no other aide supervisory visits for these patients."

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, it was revealed that the agency did not ensure that all physician's orders were included in the patient's clinical record. CLINICAL RECORD 9: The patient elected the hospice benefit on 11/07/2024. The record revealed a nursing assessment dated 01/20/2025 that read in part "Patient to use oxygen as needed." The record lacked a physician's order for oxygen. On 02/04/2025, the Director of Nursing reviewed the record and confirmed the above finding that an oxygen order was not in the patient's clinical record.

It is required that a hospice aide provide services ordered by the Interdisciplinary group. This standard was not met as evidenced by clinical record review and staff interview. 4 of 5 (80%) applicable records, in which the hospice aide was accepted, revealed the hospice did not ensure services were consistent with the plan of care. Record #36001 (election of benefit 3/5/2022): Hospice aide plan of care order, (effective 3/5/22) the aide did not document the type of bath given (tub/shower) on 3/7/2022, 3/11/2022 and 3/18/2022. The Aide plan of care did not delineate tub or shower on the care plan. Record #79038 (election of benefit 12/27/2021): Hospice aide plan of care order (effective 12/27/2021) was for a complete bed bath. The aide did not indicate what type of bath she provided the patient. Bath was marked as given, however, no indication the bath was a complete bed bath as ordered. Record #89614 (election of benefit 3/5/2022): Hospice aide plan of care order (effective 3/5/2022) was shave-electric 2 times per week and hand/footcare: clean/file nails two times per week. Aide visit note on 3/8/2022, 3/11/2022, 3/15/2022, 3/18/2022, 3/22/2022, 3/25/2022, 3/29/2022, 4/1/2022, 4/5/2022, 4/8/2022, 4/12/2022 did not indicate the patient was shaved or provided hand/footcare as ordered. The clinical documentation did not indicate the patient refused. Record 26030 (election of benefit 3/25/2022): Hospice aide plan of care order (effective 3/25/2022) was for a shower two times per week. The documentation included a checkmark a bath was given but did not indicate the bath was a shower as ordered on the following dates: 3/28/2022, 4/1/2022, 4/4/2022, 4/9/2022, 4/11/2022, 4/16/2022, 4/18/2022, 4/23/2022 and 4/25/2022. An interview with the Alternate Administer (Staff ID: 27757) on 5/5/2022 acknowledged that the aide did not follow the plan of care orders.

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 staff interview. 1 of 4 (25%) clinical records revealed the agency failed to provide an aide supervisory visit every 14 days. Record #89614 (election of benefit 3/5/2022): RN failed to provide aide supervisory visit the following weeks: 3/20/2022, 4/3/2022, 4/17/2022 and 4/31/2022. An interview with the Alternate Administer (Staff ID: 27757) on 5/5/2022 acknowledged that the aide supervision did not occur.