Every finding on record at Ecumen Hospice

Based on interview and document review, the agency failed to ensure the medical director or physician designee reviewed or provided written certification the hospice patient's life expectancy was 6 months or less for 1 of 14 patients (P5) reviewed. --- P5's plan of care (POC) 11/30/23 to 1/28/23. identified a start of care (SOC) date 11/30/23, with a primary diagnoses of heart and kidney disease. Services included skilled nurse visits, hospice aide, chaplain, music therapy and social worker visits. The admission visit was completed by a registered nurse (RN) and licensed social worker (LSW) on 11/30/23 and a plan of care (POC) was initiated. P5's medical record lacked the required certification of terminal illness from P5's primary care provider and the hospice medical director, including documentation of clinical justification for admission to hospice. During interview on 12/11/23, at 2:10 p.m., clinical director (CD)-A verified P5's medical record lacked the required certificate of terminal illness and stated the certification should be in the medical record within 48 hours of admission. During joint interview on 12/12/23, at 2:30 p.m. with the hospice director (HD) and CD-C, HD-B stated P5 certification had been missed. Patients were assigned to a hospice provider based on geographic location and P5 had been assigned to the wrong provider. Each of the two providers thought the other was completing the certification. All new admission records were audited by the health information specialist within five days of admission, but P5's lack of certification had been overlooked during the audit as well. It was the agency's practice to have the completed and signed certification of terminal illness in the patients medical record within three to five days after their admission to hospice. The agency's undated policy Certification of Terminal Illness identified the Initial Certification of Terminal Illness form specified the patient's prognosis was for a life expectancy of six months or less if the terminal illness ran it's normal course. If the hospice physician and the patient's attending physician did not sign the Initial Certification of Terminal Illness form within two calendar days of the start of care date, an oral certification would be obtained from both physicians within the two days and would be documented in the patient's clinical record.

Based on interview and document review, the agency failed to make an on-site supervising visit to observe and assess the aide while performing cares for 1 of 1 patient (P1) whose family member expressed concerns regarding care received from a hospice nursing assistant (NA). --- P1s Medical Diagnosis form indicated the following diagnoses: vascular dementia (dementia related to poor blood supply to brain) unspecified severity with anxiety, other symptoms and signs involving cognitive functions following cerebral infarction (lack of blood supply to brain causing tissue death), anxiety disorder unspecified, and depression. P1s hospice plan of care (POC) indicated the nursing assistant visited once a week for one week and then twice a week from 6/6/23 to 8/4/23. Additionally, nursing staff visited one to two times a week. NA-As visit schedule for July 2023 and August 2023, was reviewed and indicated NA-A saw P1 on 7/20/23 from 11:30 a.m. to 12:30 p.m., 7/24/23, from 11:30 a.m., to 12:30 p.m., 7/27/23, from 11:30 a.m., to 12:45 p.m., 7/31/23 from 11:20 a.m., to 12:20 p.m., and 8/3/23, from 10:15 a.m., to 11:00 a.m. Registered nurse (RN)-As visit schedule for July, and August 2023, was reviewed and indicated RN-A saw P1 on 7/24/23, from 12:35 p.m. to 1:27 p.m., 7/31/23, from 2:15 p.m. to 3:00 p.m., and on 8/3/23 from 1:45 p.m., to 2:20 p.m. P1s Skilled Nursing Visit Note form dated 7/24/23, indicated a time in at 12:35 p.m. and a time out at 1:27 p.m. The note dated 7/31/23, indicated a time in of 2:15 p.m. and a time out at 3:00 p.m. P1s Skilled Nursing Visit Note form dated 8/3/23, indicated a time in at 1:45 p.m. and a time out at 2:20 p.m. The facility Record of Complaint log was reviewed and indicated the date of the complaint was 8/1/23, FM-A reported a concern regarding NA cares. Under the heading Description of Complaint, FM-A reported P1 had a camera in the room and observed NA-A did not clean P1 completely and appeared to argue with P1. FM-A reported NA-A put his hand on P1s face and turned P1s face away from him to ";shut her up" and thought the incident occurred on 7/24/23. Under the heading, Actions taken to Correct or Address any Issues: NA-A was removed as P1s NA and additional dementia training was provided and a corrective action. NA-As Corrective Action Form dated 8/2/23, and signed 8/3/23, indicated NA-A received a written warning and under the heading, Description of Performance or Conduct Problems: on 8/1/23, family contacted hospice regarding concerns from 7/24/23, that NA-A did not complete cares for P1. NA-A put his hand to P1s face and pushed her face. The Corrective Action Form further indicated camera footage from that day was viewed and P1s siderail was left down, peri cares were not completed, and indicated NA-A appeared to push P1s face with his hand. Under the heading, Steps Employee Will Take to Correct Performance/Conduct indicated: the supervisors expectations included NA-A would complete Relias trainings today regarding the incident, that included: Assisting with activities of daily living (ADLs), Awakenings Communication for Caregivers, and Best Practices in Dementia Care Events, and additional trainings as assigned. NA-A must immediately improve patient care and dementia patient interactions. The Corrective Action Form lacked information a direct supervisory visit was completed following notification of the complaint. P1s Aide Visit Note dated 8/3/23, with a time in of 10:15 a.m. and a time out indicated 11:00 a.m. on 8/3/23 and was electronically signed by NA-A. and all interventions were documented as completed except P1 declined to have nails filed or trimmed, declined a hair dryer after a shampoo, declined to go outside for a walk in the wheelchair, and it was documented not applicable this visit for reporting changes in skin condition, and assisting with meal preparation, set-up, feeding, and contacting P1s FM-A prior to visits. P1s registered nurse (RN) skilled nursing visit with supervision note dated 8/3/23, indicated RN-A conducted the visit on 8/3/23, with a time in of 1:45 p.m., and a time out of 2:20 p.m., on 8/3/23. The note indicated a hospice aide supervisory visit was completed but did not indicate the visit was a direct supervising visit, who the NA was that the supervisory visit was conducted on, and indicated that P1 was satisfied, the aide demonstrated competency with assigned tasks, complied with infection control policies and procedures and created interpersonal relationships with P1 and family, and reported changes in P1s condition when necessary. Additionally, the note indicated P1 was non-communicative, or impairment not corrected; and confused. FM-B submitted two videos on 8/21/23 via email. One video indicated a date time stamp of 7/27/23, and the second video indicated a date time stamp of 7/31/23. During interview on 8/21/23, at 9:14 a.m., family member (FM)-B verified NA-As name and stated NA-A was a hospice NA. FM-B stated she observed in a video P1 swearing and NA-A laid P1 down, when P1 swore again, NA-A reached up and tapped P1s mouth. FM-B stated this occurred on 7/27/23. FM-B stated on 7/31/23, P1 was in the chair and stated she observed in the video the top of P1s head turn as NA-As hand went up. FM-B stated her sister reported the concern on 7/28/23, and was informed NA-A would be placed on administrative leave and added the following Monday, NA-A was back in P1s room. and added Registered Nurse Clinical Operations Manager (RNCOM) requested a copy of the video. FM-B stated NA-As role was completing bed baths and added NA-A did not do nails and added NA-A used to document in a green hospice book except for NA-As last three visits and the last time, FM-B stated she went on the speaker in the room, and he got someone else to finish what he was doing. During interview 8/21/23, at 11:24 a.m., RNCOM stated hospice social worker (SW)-A received a call from FM-A on 8/1/23, who reported concerns regarding a camera video of NA-A who was not speaking appropriately to P1. RNCOM stated she followed up with FM-A on 8/1/23, at 9:51 a.m. and FM-B sent RNCOM the video of NA-As interactions with P1 on 8/1/23, at 11:57 a.m. RNCOM stated the date on the video was 7/27/23, but FM-A indicated the date of the incident happened on 7/24/23. RNCOM verified P1 was the patient in the video and NA-A was the hospice agencies NA. RNCOM stated NA-A was aware there was a camera in P1s room and stated it looked like NA-A put his hand on P1s face and her head turned. RNCOM stated NA-A was interviewed on 8/1/23, and placed on administrative leave, and they determined on 8/2/23, abuse did not occur, but added there were concerns with how NA-A interacted with P1, and NA-A also left P1s side rail down and as a result, NA-A was given a written warning. RNCOM stated NA-A started seeing patients again on 8/3/23, and saw P1 on 8/3/23, when P1-s daughters voice came over the microphone telling NA-A to leave. RNCOM stated due to the familys reaction to seeing NA-A with P1 on 8/3/23, it was determined NA-A would no longer provide cares to P1. During interview on 8/21/23, at 1:15 p.m., social worker (SW)-A stated she spoke with FM-A who reported concerns NA-A was not patient with P1 when providing cares, but stated she did not recall the date the discussion occurred. During interview on 8/21/23, at 1:41 p.m., registered nurse (RN)-A stated P1 was confused and yelled out and would swear at times. RN-A stated she had done direct supervisory visits with NA-A in the past and added they completed indirect supervising visits and sometimes visits coincided. During interview on 8/21/23, at 1:53 p.m., NA-A stated P1s daughter reported P1s peri cares were not completed, and the side rail was not raised. NA-A stated there was a camera in P1s room and was about to get P1 in the chair when a voice came on instructing NA-A to leave P1s room. NA-A stated he was off work while the hospice agency completed an investigation and stated no staff conducted a direct supervising visit after he returned to work. During interview 8/21/23 at 2:49 p.m., the director of hospice clinical operations (DHCO) stated she became aware of the video on 8/1/23 and after viewing the video, felt NA-A needed to be retrained and further stated men of different cultures talk more gruffly and added they were concerned NA-A did not clean P1 well enough. DHCO stated the RN saw P1 on the date of the event and added they were told on 7/24/23, but the time stamp on the camera indicated 7/27/23 and the RN case manager saw P1 after NA-A on 7/24/23. During interview on 8/21/23, at approximately 2:49 p.m., the clinical director (CD) stated a vulnerable adult report was not completed because they did not feel abuse occurred, but there were issues with NA-As approach and cares provided to P1. During interview on 8/21/23, at 3:44 p.m., CD and RNCOM stated RN case manager saw P1 on 7/24/23, right after NA-As visit and additionally saw P1 on 7/31/23, and again on 8/3/23. CD stated NA-A saw P1 on 8/3/23, before being reassigned and added the RN case manager saw P1 after NA-A left on 8/3/23.