Every finding on record at Green Mountain Healthcare Services LLC.

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care, ensure continuous assessment of each patient’s and family’s needs, and ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. In 2 of 14 (14%) clinical records reviewed revealed the hospice did not ensure the patients were provided coordination of care, ensured continuous assessments of patient's and family's needs, and that the interdisciplinary plan of care was implemented. Agency Policy 013115 Hospice-CHAP, titled, Plan of Care, stated in part, the registered nurse will coordinate the implementation of the plan of care for each patient. The registered nurse is also responsible for ensuring care coordination, case management, ongoing evaluation, and assessment of the provision of hospice care for the patient and family. Clinical Record 1: The plan of care dated 11/28/2023 included an order for hospice aide visits for three times a week. The hospice aide documented visits on 12/09/2023 and 12/30/2023. There was no documented evidence for the missed visits. Clinical Record 2: The plan of care dated 09/20/2022 included an order for skill nursing visits for one time a week. The skilled nurse documented visits on 09/20/2022, 09/21/2022, 09/29/2022, 10/09/2022 and 10/12/2022. There were no documented visits by a skilled nurse during the week of 10/02/2022 through 10/08/2022. There was no documented evidence for the missed visits. During joint clinical records reviewed on 04/03/2024, the Director of Nursing agreed patient's visits had been missed and no documented evidence for the missed visits were in the clinical records.

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. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 2 of 11 (18%) clinical records reviewed revealed that the hospice agency did not ensure the hospice aides were supervised by a registered nurse no less than every fourteen (14) days. Clinical Record 1: The documented aide supervisory notes completed were dated 12/18/2023 and 12/26/2023. They both listed an aide who had been terminated on 12/10/2023. Clinical Record 7: The documented aide visit was on 06/21/2023. There was a documented aide supervisory visit on 06/20/2023 and the next one was not documented until 07/12/2023. The aide supervisory visit was completed eight (8) days late. During an interview on 04/05/2024, the Director of Nursing agreed that a registered nurse had not made aide supervisory visits every fourteen (14) days and that she was the nurse who documented the notes and just said it was a mistake.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review, document review, and interview. In 1 of 2 (50%) clinical records reviewed for patients who were live discharges while on services revealed that the hospice did not ensure that a copy of the hospice discharge summary was forwarded to the attending physician. Agency Policy 013115 Hospice-CHAP, titled, Transfer of the Designated Hospice, stated in part, if the care of a patient is transferred to another Medicare/Medicaid facility. the hospice will notify the attending and the hospice must forward a copy of the discharge summary to the attending physician. Clinical Record 11: The patient elected their hospice benefit on 05/31/2023. The patient was later discharged on 01/26/2024 due to being transferred to another hospice. There was no documented evidence that the discharge summary was forwarded to the attending physician. During an interview on 04/05/2024, the Director of Nursing agreed a copy of the discharge summary had not been forwarded to the patient's attending physician.