Every finding on record at Eh Health Hospice of Pennsylvania, 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. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed and home visits observed, it was revealed that the agency did not ensure the documented comprehensive assessment includes a drug profile that contained the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. Home Visit 1: The patient elected the hospice benefit on 10/28/2024 for the diagnosis of hypertensive heart disease. The patient resided in a Skilled Nursing Facility (SNF). During the home visit with the Hospice Aide (Personnel Record 7) on 02/25/2035, the hospice medication list (printed 02/24/2025) was compared to the SNF medication listed (printed 02/25/2025). The SNF listed the following medications that were not included on the hospice list: Lactobacillus 100 mg give 1 tablet daily ordered on 02/19/2025. The hospice listed the following medications that were not included on the medication list at the SNF: Deep Sea nasal spray 0.65%, spray 2 sprays in each nostril as needed for dry nares ordered on 10/20/2024; and Dextromethorphan-Guaifenesin 20-400 mg tablet, take 1 tablet every four hours as needed for cough, ordered on 10/18/2024. A review of the clinical record was conducted on 02/25/2025 with the Administrator, Regional Quality and VP of Ops. After the review, they agreed that the medication lists had not been reconciled.

It is required that a hospice aide provides services consistent with aide training. This standard was not met as evidenced by clinical record review, personnel record review, document review, and interview. In 1 of 1 (100%) Home visits performed with a hospice aide revealed the agency did not ensure the aide provided services consistent with aide training. Agency Job Description titled, "Hospice Aide Job Description” (last revised 10/18/2021), stated in relevant parts, "1. Demonstrates competency in the following areas: measures temperature, pulse, respirations and blood pressure; assists or performs bed bath, tub, shower or sponge bath; performs shampoo in bed, tub, shower or sink; checks, clears and files nails; performs skin care; assists or performs oral hygiene; assists the patient with dressing; assists with toileting and elimination using toilet, bedside commode, bedpan, urinal or adult brief; safe transfer technique and ambulation, normal range of motion and positioning; adequate nutrition and fluid intake. 2. Provides personal care for each patient in accordance with the Hospice Aide Care Plan." Personnel Record 7: Hospice Aide Skills Competency, stated in relevant part, “the aide…measures temperature, pulse, respirations and blood pressure; assists or performs bed bath, tub, shower or sponge bath; performs shampoo in bed, tub, shower or sink; checks, clears and files nails; performs skin care; assists or performs oral hygiene; assists the patient with dressing; assists with toileting and elimination using toilet, bedside commode, bedpan, urinal or adult brief; safe transfer technique and ambulation, normal range of motion and positioning; adequate nutrition and fluid intake." Home Visit 1/Clinical Record 1: The patient elected the hospice benefit on 10/18/2024 for the diagnosis of hypertensive heart failure. The patient was a resident of a skilled nursing facility (SNF). The Hospice Aide Care Plans dated 10/18/2024, 10/19/2024 and 12/18/2024 all contained the following tasks: "bathing via shower, dressing, hair care-comb and style hair, nail care, oral care, peri care, shampoo hair, skin care-apply lotion after shower, transfer client, change linens, offer fluids, empty trash, fall, aspiration, oxygen and diabetic precautions every visit." A home visit was conducted with the Hospice Aide (Personnel Record 7) on 02/25/2025. The patient was eating breakfast upon our arrival for the site visit. The aide asked about taking her down for her shower and she agreed. The patient was seated in her wheelchair and the aide began pushing her towards the "shower room." Directly across from the shower room, the aide stopped, turned, and advised, "she can't make it through the entire shower unless I change out her tank (oxygen)." The aide then proceeded to an oxygen tank storage room, obtained a tank from the room and brought it towards the patient. She was then observed to remove the patient's tank from the wheelchair carrier, added a new tank and stated, "she's on 3 liters,” turned on the new tank and attached the tubing from the old tank. The aide then took the old tank to the storage room and took the patient into the shower room. Neither the Agency Policy, Competencies or Hospice Aide Care Plan detailed the aide removing the patient's oxygen or changing out any tanks. A review of the clinical record and personnel record was conducted on 02/25/2025 with the Administrator, Regional Quality and VP of Ops. After the review, it was determined the changing of the oxygen tanks were not on the hospice aide care plan, nor did her competencies show her being checked off on changing out oxygen tanks.

Based on review of agency policy, documents and clinical records (CR), and staff (EMP) interview, the governing body failed to organize, manage, and administer its resources to provide hospice care for the management of terminal illness and the accepted standards of practice (L652) and ensure supervising and field registered nurses were routinely available on a twenty-four-hour basis (L653). --- Findings include: Cross reference: 418.100 (c) Tag: 0652 Standard Services. the agency failed to be primarily engaged in providing care and services in a manner that is consistent with accepted standards of practice related to not having a Registered Nurse (RN) on duty to pronounce when death is imminent for one (1) and three (3) clinical records reviewed (CR1). 418.100(c)(2) Tag: 0653 Nursing services, physician services, and drugs and biologicals must be made routinely available on 24-hour basis 7 days a week. Other services must be available on a 24-hour basis when reasonable and necessary to meet the needs of the patient and family. The hospice failed to ensure supervising, and field registered nurses were routinely available on a twenty-four-hour basis for three (3) of three (3) days (1/19/24, 1/20/24 and 1/21/24). The cumulative effect of these systemic failures resulted in the agency's inability to organize, manage and administer its resources to provide the highest level of hospice care for the management of terminal illness.

Based on review of agency policy, documents and clinical records (CR) and staff (EMP) interview, it was determined that the agency failed to be primarily engaged in providing care and services in a manner that is consistent with accepted standards of practice related to not having a Registered Nurse (RN) on duty to pronounce when death is imminent for one (1) and three (3) clinical records reviewed (CR1). --- Findings include: A review of CR1's clinical record on 3/14/23, at approximately 9:43 a.m. indicated his start of care date was 9/13/22, and review of coordination notes indicated RN EMP 6 arrived on 1/20/24, at 9:00 a.m. and cared for the patient until they passed at 2:10 p.m. A review of the agency policy "RN Death Pronouncement" on 3/15/24, at approximately 11:30 a.m. indicated when death is imminent only a qualified RN will make the actual determination and pronouncement of death in the following manner... upon receiving a call from the family respond immediately, letting the family know their approximate time of arrival. A review of the agency "Patient Handbook" page 16 "Your Rights and Responsibilities on 3/15/24, at approximately 11:40 a.m. indicated... As a patient, you have the right: ... to 24 hour/7 Day/Week availability of nursing services by calling the office number. A review of the facility document January 2024 Hospice Schedule Pittsburgh On 3/25/23 at approximately 2:00 p.m. from 1/19/24 to 1/21/24, indicated the following: 1/19/24Agency did not have a supervising RN or field RN available that was licensed to practice in the state of Pennsylvania. 1/20/24Agency did not have a supervising RN or field RN available that was licensed to practice in the state of Pennsylvania. 1/21/24Agency did not have a supervising RN or field RN available that was licensed to practice in the state of Pennsylvania. A review of policy Scope of services on 4/1/24, at approximately 9:00 a.m. indicated Core Service are services that a hospice must routinely provide in a manner consistent with acceptable standards of practice. These services include nursing services... The registered nurse Makes the initial assessment, comprehensive assessment visit.... Regularly re-evaluates and updates the patients nursing needs. During an interview on 4/2/24, at 3:15 p.m. the Director of Operations EMP E7 indicated that RN EMP E6 called off from work on 1/19/23, and the agency failed to have an RN in the state of Pennsylvania from 1/19/24 to 1/21/24. That RN EMP E6 went to care for and pronounce CR1 on 1/20/24, after a family member called her. That they were depending on the Emergency Services System (911) to pronounce a deceased patient, due to not having a RN on duty that was licensed in the state of PA.

Based on review of agency policy, documents and staff (EMP) interview, it was determined that the hospice failed to ensure supervising and field registered nurses were routinely available on a twenty four hours basis for three (3) of three (3) days (1/19/24, 1/20/24 and 1/21/24). --- Findings include: A review of the agency job description " Case manager licensed professional, registered nurses hospice" on 3/15/24, at approximately 11:40 a.m. indicated this is a branch field position, and primarily located at the assigned, local branch office.... Must be licensed in the state where they currently practice... Participate in on-call rotation to perform after hours weekend evaluations, visits, as directed, ensure appropriate and safe response to afterhours telephone calls. A review of the agency "Patient Handbook" page 16 "Your Rights and Responsibilities on 3/15/24, at approximately 11:40 a.m. indicated... As a patient, you have the right... to 24 hour/7 Day/Week availability of nursing services by calling the office number. A review of the facility document January 2024 Hospice Schedule Pittsburgh On 3/25/23 at approximately 2:00 p.m. from 1/19/24 to 1/21/24, indicated the following: 1/19/24Agency did not have a supervising RN or field RN available that was licensed to practice in the state of Pennsylvania. 1/20/24Agency did not have a supervising RN or field RN available that was licensed to practice in the state of Pennsylvania. 1/21/24Agency did not have a supervising RN or field RN available that was licensed to practice in the state of Pennsylvania. A review of policy Scope of services on 4/1/24, at approximately 9:00 a.m. indicated core service are services that a hospice must routinely provide in a manner consistent with acceptable standards of practice. These services include nursing services... The registered nurse Makes the initial assessment, comprehensive assessment visit.... Regularly re-evaluates and updates the patients nursing needs. During an interview on 4/2/24 3:15 p.m. the Director of Operations EMP E7 indicated that the agency failed to have an RN in the state of Pennsylvania from 1/19/24 to 1/21/24, and ensure supervising and field registered nurses were routinely available on a twenty four hour basis.

Based on review of clinical records (CR), facility policy and procedure, and interview with staff (EMP), the facility failed to ensure all services necessary were implemented for the management of patient wound care for one (1) of three (3) clinical records reviewed (CR3). --- Findings included: Review of facility policy/procedure on 3/29/23 revealed the following: Wound ulcer management with Wound etiologies...Purpose...To establish acceptable standards of practice as it relates to the overall complete assessment of patients with a wound/ulcer, or a potential for wound/ulcer development...3.3 Subsequent Assessments/Evaluations...3.3.2 The appropriately licensed professional shall evaluate the patients response to the current treatment modalities... Review of CR3 on 3/29/23 at approximately 1:20 PM; Start of care 6/13/22, certification period 12/10/22 to 2/7/23; reviewed 3-week period 1/22/23 to 2/10/23... Frequency...SN (skilled nursing) Effective 12/11/22, 2WK8 (times per week/number of weeks), 1WK1...Review of SN visits for period reviewed revealed:SN visit 2/1/23, ...Narrative: PT has 2 X 1cm (centimeter) stage 1 on coccyx. Dressings and hydrogel ordered...Physician order dated 2/1/23, Order Description: ...Cleanse wound with soap and water cover with Hydrogel and Duoderm...The physician order for wound care on 2/1/23 did not disseminate/document wound location, discipline of staff to provide wound care and/or caregiver instructions for wound care, and did not document frequency of wound care. An exit conference was conducted 3/29/23 at approximately 2:35 PM with the facility administrator (EMP1) and facility social worker (EMP2). The above finding was reviewed.

Based on review of clinical records (CR), facility policy and procedure, and interview with staff (EMP), the facility failed to ensure nursing needs of the patient were met for wound care assessments for two (2) of three (3) clinical records reviewed (CR1, CR2). --- Findings included: Review of facility policy/procedure on 3/29/23 revealed the following: Wound ulcer management with Wound etiologies...Purpose...To establish acceptable standards of practice as it relates to the overall complete assessment of patients with a wound/ulcer, or a potential for wound/ulcer development...3.3 Subsequent Assessments/Evaluations...3.3.2 The appropriately licensed professional shall evaluate the patients response to the current treatment modalities...and any events or conditions that are impeding the normal wound/ulcer healing process and notify the physician...At minimum, the wound/ulcer shall be measured...once a week or when wound care is provided if wound care is ordered less than once a week... Review of CR1 on 3/29/23 at approximately 1045 AM revealed the following: Start of care 11/18/22, Certification period 11/18/22 to 2/15/23. ...Frequency, SN (skilled nursing) 2WK13 (times per week/number of weeks), 1WK1...Orders of Discipline and Treatments: ...Skilled Nurse to observe and assess integumentary status to identify changes and intervene to minimize complications...report significant changes to physician for early intervention...Skilled Nurse to perform wound care to ulcer/pressure injury to coccyx (area) cleanse with normal saline, apply wound paste, cover with triad dressing using clean/aseptic technique, frequency of dressing change: every 2 days and PRN (as needed). SN may teach wound care to patient/caregiver. Review of SN visit wound record report assessments-Coccyx, Stage III-for period reviewed revealed the following:Week 1, 11/18/22, SN visit, Measurements Taken (Must be Taken Weekly) ... Length/Width/Depth (centimeters)...2.5 x 1 x 0.1...There was no documented evidence of patient wound care measurements taken weekly for SN visits conducted from 11/20/22 - Week 2 through 12/31/22 - Week 7. There was no documented evidence wound care/assessment was completed by SN during visits conducted on:12/1/22, SN documentation of wound care/assessment completed, Note: ";...Was wound assessed? No, caregiver completed care..." 12/12/22, SN documentation of wound care/assessment completed, Note: ";...Was wound assessed? No, caregiver completed care..."12/19/22, SN documentation of wound care/assessment completed, Note: ";...Was wound assessed? No, caregiver completed care..."12/21/22, SN documentation of wound care/assessment completed, Note: ";...Was wound assessed? No, caregiver completed care..." Review of CR2 on 3/29/23 at approximately 12:15 PM; Start of care 3/8/23, certification period 3/8/23 to 6/5/23. Frequency...SN 2WK1 (times per week/number of weeks), 3WK12, 1WK1, 1 PRN (as needed) for symptom management...Effective 3/12/23, SN 5WK1, 7WK1, 1WK1, 3 PRN for symptom management...Orders of Discipline and Treatments: ...Skilled Nurse to perform wound care to pressure ulcer/pressure injury to coccyx with wet to dry dressing. Irrigate with NSS (normal saline solution), pack wound with kerlex moistened with NSS, cover with ABD (abdominal dressing) using clean/aseptic technique. Frequency of dressing change: Change every other day or as needed for soilage. SN may teach wound care to patient caregiver...Review of SN visit wound record report assessments-Coccyx, Stage IV-for period reviewed revealed the following:Week 1, 3/8/23 SN visit, Measurements Taken (Must be Taken Weekly) ... Length/Width/Depth (centimeters)...4 x 1.5 x 2.5...There was no documented evidence of patient wound care measurements taken weekly for SN visits conducted from 3/12/23 to 3/25/23 - Week 2. An exit conference was conducted 3/29/23 at approximately 2:35 PM with the facility administrator (EMP1) and facility social worker (EMP2). The above findings were reviewed.

It is required that a hospice aide provides services: As 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 interview. In 8 of 14 (57%) applicable clinical records reviewed with hospice aide services it was revealed that the hospice aide (HA) did not provide care according to assigned tasks on the plans of care. Record #38595: Hospice aide care plan included tasks of: oral care, transfer, perineal care, assist with feeding, dressing, and bed bath. For HA visit on 4/5/2022, there was no documented evidence that the assigned tasks of oral care or transfer were completed. For HA visit on 4/8/2022, there was no documented evidence the assigned tasks of oral care, transfer or assist with feeding were completed. For HA visit on 4/12/2022, there was no evidence the assigned tasks of transfer, bed bath, perineal care or dressing were completed. For HA visit on 4/22/2022, there was no evidence that the assigned tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #58402: Hospice aide care plan included tasks of: nail care, oral care, and dressing. For HA visit on 3/7/2022, there was no documented evidence that the assigned tasks of nail care or dressing were completed. For HA visit on 3/10/2022, there was no documented evidence that the assigned task of nail care was completed. For HA visit on 3/21/2022, there was no documented evidence the assigned tasks of oral care or nail care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #72372: Hospice aide care plan included tasks of: oral care and shampoo. For HA visit on 4/25/2022, there was no documented evidence that the assigned task of oral care was completed. For the HA visit on 4/28/2022, there was no documented evidence that the assigned tasks of shampoo or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #33300: Hospice aide care plan included tasks of: transfer, shower, shampoo, hair care, skin care, perineal care, oral care and dressing. For HA visit on 1/28/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, skin care, perineal care, oral care or dressing were completed. For HA visit on 2/1/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, oral care or dressing were completed. For the HA visit on 2/8/2022, there was no documented evidence that the assigned tasks of transfer, shampoo, oral care or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #13150: Hospice aide care plan included task of: oral care. For HA visit on 4/7/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/112022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/13/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/20/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 425/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/27/2022, there was no documented evidence that the assigned task of oral care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #62292: Hospice aide care plan included tasks of: assist with feeding, change linens, shampoo, transfer, and oral care. For HA visit on 3/16/2022, there was no documented evidence that the tasks of assist with feeding or change linens were completed. For HA visit on 3/17/2022, there was no documented evidence that the tasks of assist with feeding, change linens or shampoo were completed. For HA visit on 3/28/2022, there was no documented evidence that the tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #90164: Hospice aide care plan included tasks of: assist with feeding, nail care, shampoo, and hair care. For HA visit on 4/29/2022, there was no documented evidence that the tasks of assist with feeding, nail care or shampoo were completed. For HA visit on 4/20/2022, there was no documented evidence that the tasks of assist with feeding, hair care, shampoo or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #74294: Hospice aide care plan included tasks of: shower, shampoo, and shaving. For HA visit on 2/7/2022, there was no documented evidence that the tasks of shower or shampoo were completed. For HA visit on 2/14/2022, there was no documented evidence that the tasks of shower, shampoo or shaving were completed. There was no documented evidence the HA communicated any of these changes to the RN. The Administrator was interviewed on 5/4/2022 and stated there was no communication documentation between the hospice aide and a nurse within the clinical records identified nor was there any additional information to provide.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a Registered Nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by a review of clinical records and interview. In 8 of 14 (57%) applicable records with hospice aide services reviewed revealed that the hospice aide (HA) did not provide care according to assigned tasks on the plans of care or update nurse of these changes. Record #38595: Hospice aide care plan included tasks of: oral care, transfer, perineal care, assist with feeding, dressing, and bed bath. For HA visit on 4/5/2022, there was no documented evidence that the assigned tasks of oral care or transfer were completed. For HA visit on 4/8/2022, there was no documented evidence the assigned tasks of oral care, transfer or assist with feeding were completed. For HA visit on 4/12/2022, there was no evidence the assigned tasks of transfer, bed bath, perineal care or dressing were completed. For HA visit on 4/22/2022, there was no evidence that the assigned tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #58402: Hospice aide care plan included tasks of: nail care, oral care, and dressing. For HA visit on 3/7/2022, there was no documented evidence that the assigned tasks of nail care or dressing were completed. For HA visit on 3/10/2022, there was no documented evidence that the assigned task of nail care was completed. For HA visit on 3/21/2022, there was no documented evidence the assigned tasks of oral care or nail care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #72372: Hospice aide care plan included tasks of: oral care and shampoo. For HA visit on 4/25/2022, there was no documented evidence that the assigned task of oral care was completed. For the HA visit on 4/28/2022, there was no documented evidence that the assigned tasks of shampoo or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #33300: Hospice aide care plan included tasks of: transfer, shower, shampoo, hair care, skin care, perineal care, oral care and dressing. For HA visit on 1/28/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, skin care, perineal care, oral care or dressing were completed. For HA visit on 2/1/2022, there was no documented evidence that the assigned tasks of transfer, shower, shampoo, hair care, oral care or dressing were completed. For the HA visit on 2/8/2022, there was no documented evidence that the assigned tasks of transfer, shampoo, oral care or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #13150: Hospice aide care plan included task of: oral care. For HA visit on 4/7/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/112022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/13/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/20/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 425/2022, there was no documented evidence that the assigned task of oral care was completed. For HA visit on 4/27/2022, there was no documented evidence that the assigned task of oral care was completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #62292: Hospice aide care plan included tasks of: assist with feeding, change linens, shampoo, transfer, and oral care. For HA visit on 3/16/2022, there was no documented evidence that the tasks of assist with feeding or change linens were completed. For HA visit on 3/17/2022, there was no documented evidence that the tasks of assist with feeding, change linens or shampoo were completed. For HA visit on 3/28/2022, there was no documented evidence that the tasks of transfer, assist with feeding or oral care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #90164: Hospice aide care plan included tasks of: assist with feeding, nail care, shampoo, and hair care. For HA visit on 4/29/2022, there was no documented evidence that the tasks of assist with feeding, nail care or shampoo were completed. For HA visit on 4/20/2022, there was no documented evidence that the tasks of assist with feeding, hair care, shampoo or nail care were completed. There was no documented evidence the HA communicated any of these changes to the RN. Record #74294: Hospice aide care plan included tasks of: shower, shampoo, and shaving. For HA visit on 2/7/2022, there was no documented evidence that the tasks of shower or shampoo were completed. For HA visit on 2/14/2022, there was no documented evidence that the tasks of shower, shampoo or shaving were completed. There was no documented evidence the HA communicated any of these changes to the RN. The Administrator was interviewed on 5/4/2022 and stated there were no communication documentation between the hospice aide and a nurse within the clinical records identified nor was there any additional information to provide.