Every finding on record at Dover Hospice Mo Stl Metro LLC

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 2 of 13 (15%) clinical records reviewed with aide services, it was revealed that the agency did not ensure written patient care instructions were prepared. Clinical Record 1: The record revealed physician orders dated 06/12/2024 that included wound care on the right leg. The aide care plan dated 06/12/2024 did not include instructions related to the wound dressing. Clinical Record 4: The record revealed physician orders dated 06/20/2024 that included wound care on the right buttock. The aide care plan dated 06/20/2024 did not include instructions related to the wound dressing. During an interview on 07/01/2024, the Administrator reviewed the records and confirmed the aide care plan did not include instructions.

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 and interview. In 4 of 13 (31%) clinical records reviewed with aide services, it was revealed that the agency did not ensure that aide services were provided as ordered in the plan of care. Clinical Record 1: The record revealed a physician's order dated 06/17/2024 that read, "Aide services 2x/week starting 06/17/2024." There was no documentation of any aide visits for the week of 06/16/2024-06/22/2024. No additional documentation was provided. Clinical Record 2: The record revealed a physician's order dated 06/25/2024 that read, "Aide services 3x/week starting 06/26/2024." The record revealed one aide visit for the week of 06/23/2024-06/29/2024 dated 06/26/2024. There was no documentation of two additional aide visits for the week of 06/23/2024-06/29/2024. No additional documentation was provided. Clinical Record 7: The record revealed a physician's order dated 06/17/2024 that read, "Aide services 2x/week starting 06/18/2024." There was no documentation of any aide visits for the week of 06/16/2024-06/22/2024. No additional documentation was provided. Clinical Record 8: The record revealed a physician's order dated 05/18/2024 that read, "Aide services 2x/week starting 05/19/2024." There was no documentation of any aide visits for the weeks of 05/19/2024-05/25/2024 and 05/26/2024-06/01/2024. No additional documentation was provided. During an interview on 07/01/2024, the Administrator reviewed the records, confirmed the findings, and stated "There are no missed visit notes for these missing aide visits in the EMR (electronic medical record)."