Every finding on record at Eden Home, Inc

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 a review of clinical records and interviews. 1 of 5 (20%) clinical records reviewed, in which patients had a hospice aide, revealed the agency did not ensure that the aide care plan was updated to provide the aide with clear instructions related to patient care which would allow aide to function within scope of practice. Clinical Record #3: The physician's order dated 9/6/2022, that remained active as of 10/25/2022, read, "Cleanse with wound care spray, pat dry with 4x4 gauze, apply TAO to wound bed to left palm, cover with adhesive dressing every three days until healed.” The aide care plan was not updated and did not include direction to the aide related to the wound area during bathing. The physician's order dated 10/7/2022 read, "Apply Geri sleeves to bilateral arms daily. Change out Geri sleeves q Mon. Wed. Fri. on bathing days.” The aide care plan initiated on 6/27/2022, and updated on 9/28/2022 and 10/7/2022, did not provide instruction to the aide related to the Geri sleeves. During an interview on 10/25/2022, the Director of Nursing and Administrator stated in part, "We understand why that detail should be on the aide care plans." 1 of 5 (20%) clinical records reviewed, in which patients had a aide, revealed the agency did not ensure that the aide care plan was updated to provide aide with clear instructions related to patient care which would allow aide to function within scope of practice.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, and included in the plan of care. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 5 (20%) clinical records reviewed revealed the agency did not ensure that the hospice aide provided services ordered by the interdisciplinary group included in the plan of care. Clinical Record #2: was reviewed and identified the patient elected hospice care on 6/13/2022. The plan of care was updated on 6/22/2022 to include orders for a hospice aide "3 times a week." The week of 9/4/2002 through 9/10/2022, the aide documented a missed visit dated 9/5/2022 and a completed aide visit dated 9/7/2022. There was no documentation of a missed visit in the record for the third visit that week. The weeks of 9/18/2022 through 9/24/2022 and 9/25/2022 through 10/1/2022, the aide completed visits on 9/19/2022, 9/21/2022, 9/26/2022 and 9/28/2022. The actual aide visit frequency was 2 times a week for 2 weeks. The record was missing evidence of missed visits or communication with the physician to change the aide visit frequency. During an interview on 10/26/22, the Administrator and Director of Nursing, confirmed that they could not find documentation. 1 of 5 (20%) of clinical records reveal the agency did not ensure that the aide provided services ordered by the interdisciplinary group included in the plan of care.

It is required that the hospice obtains a criminal background check on all hospice employees who have direct patient contact or access to patient records. Hospice contracts require that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. This standard was not met as evidenced by document reviews and interviews. 1 of 7 (14%) contracts reviewed revealed that the agency did not ensure the contract included language requiring employees with direct patient contact to obtain a criminal background check. The Independent Contractor Agreement for the Nurse Practitioner signed and effective on 4/28/2022, did not contain language requiring a background check. During an interview on 10/26/2022, the Administrator confirmed the finding and stated, "I understand. We can get an addendum." 1 of 7 (14%) contracts reviewed revealed that the agency did not ensure the contract included language requiring employees with direct patient contact to obtain a criminal background check.