Every finding on record at Guardian Home Care, 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 clinical record review. In 1 of 10 (10%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the HA received written instructions to meet the needs of the patient. Clinical Record 13: The patient elected hospice care on 09/26/2024 with a diagnosis of Alzheimer's disease. The HA care plan dated 09/26/2024 assigned the HA the following tasks every visit: "shower, shampoo, shaving, assistance to the toilet, perineal care, dressing, and oral care." The HA care plan was not updated when the patient's condition changed and was determined to be imminent, and they started receiving bed baths on 10/08/2024. .

It is required that hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 10 (30%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the HA provided services included in the plan of care. Clinical Record 2: The patient elected hospice care on 08/30/2022 with a diagnosis of cerebral infarction. The patient resided in an assisted living facility (ALF). The HA care plan dated 08/30/2022 assigned the HA the task: "Shampoo is to be completed with every aide visit." The HA visit note dated 07/12/2024 documented, "Shampoo not completed this visit." Clinical Record 5: The patient elected hospice care on 09/24/2024 with a diagnosis of heart failure. The patient resided in an ALF. The HA care plan dated 09/24/2024 assigned the HA the task: "Shaving is to be completed with every visit." A review of the HA visit notes revealed that "shaving" was documented as "not required" on every HA visit note. Clinical Record 8: The patient elected hospice care on 09/18/2024 with a diagnosis of traumatic subdural hematoma. The patient resided in an ALF. The HA care plan dated 09/18/2024 assigned the HA the task: "shower every visit." The HA visit note dated 10/10/2024 documented a "full bed bath, not a shower." During a joint clinical record review and interview on 10/23/2024, the Director of Operations agreed the hospice aides had not completed all the required tasks on the care plans.

It is required that a patient clinical record contains correct clinical information including physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed revealed agency did not ensure the clinical record contained correct physician orders. Clinical Record 6: A physician order dated 08/06/2024 stated, "Cleanse wound with wound cleanser. Pat dry with sterile gauze. Apply thin layer collegex. Apply hydrocolloid dressing." The order did not describe who would perform the wound care, how often to perform the wound care, or provide any "as needed instructions for dressing changes. This is an incomplete wound care order. During an interview with the Branch Director on 10/22/2024, she confirmed the wound care order was missing the required elements.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment relative to the terminal illness and associated conditions. This standard was not met as evidenced by clinical record review and staff interview. 1 of 13 (8%) clinical records revealed the agency failed to ensure the plan of care addressed the needs identified in the assessment and failed to ensure the plan of care specified the hospice care and services required to meet the patient's needs. Record #38550 Start of Care (SOC) 6/28/2021, Diagnosis: Heart Disease: Nursing visit note dated 10/6/2021 stated that the patient "fell last Friday." The patient plan of care (effective 9/26/2021) revealed no safety care plan or any care plan problem that addressed falls. An interdisciplinary team (IDT) meeting note dated 10/20/2021 stated the RN provided fall safety education to the family. Still, there was no revision/update to the care plan to include any problems with falls or safety. During an interview with the agency administrator, conducted on 11/3/2021, she confirmed the care plan was not updated to include any problems, goals, or interventions related to fall safety after the fall occurred and stated, "the RN should have added it."

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 joint clinical record review and staff interview. 1 of 12 (8%) applicable records in which the hospice aide was accepted revealed the agency RN failed to provide specific patient care instructions for the hospice aide. Record #51466: Start of Care (SOC) 6/9/2021, Diagnosis: Heart Disease: Aide plan of care (last revised 9/23/2021) lists “peri care” to be completed every visit. The patient had a Foley catheter inserted on 10/22/2021 (Physician order 10/22/21), aide plan of care was not updated to include catheter care. Clinical documentation revealed the hospice aide completed a visit on 10/27/2021. During the home visit on 11/2/2021, the patient still had the Foley catheter in place. Administrator states in an interview conducted on 11/3/2021 that the RN should have updated the aide plan of care to indicate the patient had a catheter and if catheter care was to be provided.