Every finding on record at Health Alliance Home Health and Hospice, Inc.

Based on record review, policy review and interview, the agency failed to ensure care services were provided in accordance with the plan of care (POC) for 4 patients (#3, #1, #13 and #18) out of a total sample of 19 patients.Findings include: --- 4. For Patient #18, the agency failed to ensure Volunteer visits were provided per the plan of care.Patient #18 was admitted to Hospice services in June 2024 with a diagnosis of Alzheimer’s disease.Review of the Hospice Plan of Care with benefit dates 6/30/25 through 8/28/25 indicated the following home visit services: Skilled Nursing and Medical Social Worker.Review of the clinical record indicated Volunteer visits were provided on 7/1/25, 8/5/25 and 8/12/25.Further review of the clinical record indicated a physician’s order for Volunteer home visit services was not obtained until 8/19/25. The order indicated the following:-8/19/25 through 8/28/25: 1 visit every week for 2 weeks.During an interview on 8/27/25 at 1:30 P.M., the President of Home Health and Hospice said all home visits, including Volunteer visits, require a physician’s order before visits can be provided. 2. For Patient #1, the agency failed to ensure Volunteer visits were included in the plan of care before home visits were provided.Patient #1 was admitted to the agency in January 2025 with a diagnosis of malignant left breast cancer.Review of the physician ordered Hospice Plan of Care, dated 4/24/25 through 7/22/25, included the following home visit services: Home Health Aide, Medical Social Worker, and Skilled Nursing. Review of the physician ordered Hospice Plan of Care, dated 7/23/25 through 9/20/25, included the following home visit services: Home Health Aide, and Skilled Nursing. Review of the clinical record indicated the patient received home visits from a Volunteer on the following days: 7/1/25, 7/8/25, 7/17/25, 7/22/25, 7/29/25 and 8/12/25.Review the clinical record indicated a physician's order for Volunteer home visit services was not obtained until 8/20/25. The order indicated the following*8/20/25 through 9/20/25: 1 to 4 Volunteer visits every month for 2 months.3. For Patient #13, the agency failed to ensure Volunteer visits were included in the plan of care before home visits were provided.Patient #13 was admitted to the agency in June 2025 with a diagnosis of Myocardial Infarction (heart attack) and Retroperitoneal Hemorrhage (bleeding behind the membrane lining the abdominal cavity).Review of the physician ordered Hospice Plan of Care, dated 6/3/25 through 8/31/25, included the following home visit services: Clergy, Home Health Aide, Medical Social Worker and Skilled Nursing. Review of the clinical record indicated the patient received home visits from a Volunteer on the following days: 7/5/25, 7/12/25, 7/13/25, 7/19/25, 7/26/25, 8/2/25 and 8/9/25.Further review of the clinical record did not include a physician's order for Volunteer home visits.  Review of the agency policy, titled Plan of Care, effective date 11/2/2020, included the following:Policy: Hospice care and services provided to the patients, and their families are in accordance with an individualized, written plan of care established by the hospice IDG (Interdisciplinary Group) in collaboration with the patient’s attending physician (if any), and, if appropriate, the patient or representative and the primary caregiver.Required Criteria for Procedure (if indicated):*The patient’s plan of care specifies the care and services necessary to meet the needs of the patient/caregiver as identified in the initial, comprehensive and updated assessments of the patients.1. For Patient #3, the agency failed to ensure Volunteer visits were provided per the plan of care.Patient #3 was admitted to the agency in April 2025 with a diagnosis of Alzheimer’s Disease.Review of the physician ordered Hospice POC for certification periods, 6/7/25 through 8/5/25 and 8/6/25 through 10/4/25, included the following home visit services: Home Health Aide (HHA), Medical Social Worker (MSW), and Skilled Nursing (SN).Review of the clinical record indicated the patient received home visits from a Volunteer on the following days: 7/2/25, 7/9/25, 7/16/25, and 7/30/25.Review the clinical record indicated a physician's order for Volunteer home visit services was not obtained until 8/20/25. The order indicated the following:*8/20/25-9/30/25: Volunteer visits 1 to 4 visits every month for 2 months.

Based on record reviews and interviews, the Agency failed to ensure the Plan of Care (POC) was updated and reflected the discontinuation of specific discipline home visits for three Patients (#5, #10 and #13), out of 13 records reviewed. Findings include: Review of the Agency policy titled Patient Care Hospice Policies, dated 1/5/22, indicated but not limited to: A. Once accepted into the Hospice program, a patient assessment will be performed and documented on the initial visit. B. Assessment is an ongoing process that is performed and documented on each visit according to the Plan of Care, when the patient's condition significantly changes, when the diagnosis changes, or when the patient's care environment or support changes. C. The ongoing assessment process ensures that the patient's current problems and needs are continuously evaluated, and the care or services provided are adjusted accordingly. The assessment and reassessment information gathered is communicated to team members, the physician, and others as appropriate via written orders, telephone contacts, team meetings, and other mechanisms as appropriate..... 1. For Patient #5, the POC was not updated to reflect the discontinuation of Medical Social Worker (MSW) home visits. Patient #5 was admitted to Hospice services in August 2021 with a diagnosis of Progressive Supranuclear Opthalmoplegia (brain cells in certain parts of the brain are damaged as a result of a build up of a protein) . Review of a MSW home visit note, dated 8/24/21, indicated MSW was needed for Family/Significant Other Needs with interventions including MSW community resource planning, assess family/caregiver needs and instruct family/caregiver on Hospice and ancillary services. Review of the Hospice Plan of Care Notes dated 6/22/22, 7/6/22, 7/20/22, 8/3/22 and 8/17/22 indicated the Family/Significant Other Needs Problem and Care Plan Visit Documentation for the MSW was current. Review of the clinical record contained no evidence that a MSW home visit had occurred since the initial 8/24/21 home visit. During an interview with the Director of Finance and Business Operations on 8/24/22 at 4:00 P.M., she said the MSW visits were discontinued in 8/2021 and the POC for the MSW visits was not updated to reflect the discontinuation of MSW visits as required. 2. For Patient #10, the POC was not updated to reflect the discontinuation of Home Health Aide (HHA) home visits. Patient #10 was admitted to Hospice services in April 2022 with a diagnosis of malnutrition. Review of a Nurse Note, dated 4/29/22, indicated the Patient would like to stop HHA visits. Review of the Hospice Plan of Care Notes dated 5/11/22, 5/25/22, 6/8/22, 6/22/22, 7/6/22, 7/20/22, 8/3/22 and 8/17/22 indicated to continue with HHA visits. There was no documentation found in the clinical record to indicate HHA home visits had occurred. During an interview with the Clinical Manager on 8/30/22 at 2:45 P.M., she said the POC was not updated to reflect the discontinuation of HHA visits as required. 3. For Patient #13, the POC was not updated to reflect the discontinuation of MSW home visits. Patient #13 was admitted to Hospice services in February 2021 with diagnosis of Ischemic Cardiomyopathy (a narrowing of the coronary arteries which supply blood to the heart). Review of a MSW visit note, dated 2/20/21, indicated the Patient and Caregiver were not in need of MSW services. Review of the Hospice Plan of Care Notes dated 5/3/21 and 7/26/21 indicated for MSW visits to provide emotional support. Review of the clinical record contained no evidence that MSW home visits had occurred. During an interview with the Clinical Manager on 8/30/22 at 1:35 P.M., she said the POC was not updated to indicate MSW services were not needed as required.

Based on policy review, personnel record review and interview, the Agency failed to ensure that: 1) The Abuse Policy contained reporting timelines consistent with the state regulations, and 2) The Nurse Aide Registry check and licensure verification was completed during the hiring process for one Employee (#2) out of five personnel records reviewed. Findings include: 1. The Agency failed to ensure the Abuse Policy contained reporting timelines of allegations of abuse consistent with the State regulations. Review of the Massachusetts State Regulation 105.CMR.155.004 indicated: (A) Any mandatory reporting individual, as defined in 105 CMR 155.003, shall immediately make an oral report of suspected patient or resident abuse, neglect, mistreatment or misappropriation of patient or resident property to his or her supervisor or employer whenever he or she has reasonable cause to believe that any patient or resident has been abused, neglected or mistreated or had property misappropriated. Upon receiving such report, said supervisor or employer shall immediately notify the Department by oral communication, electronically transmitted report or facsimile in accordance with such guidelines as may be established by the Department...... Review of the Agency policy titled, Abuse, Neglect, Mistreatment and Exploitation, dated 11/19/20, included but limited to: - Alleged violations of abuse, neglect, mistreatment and/or exploitation involving a Hospice employee or contractor are brought to the attention of the Administrator immediately. - If a violation is verified, the Administrator: a. takes appropriate corrective action in accordance with State laws; b. Ensures that verified violations are reported to the State and local bodies having jurisdiction (including the State Survey and Recertification Agency) within 5 days of becoming aware of the violation. During an interview with the Clinical Manager on 8/30/22 at 1:00 P.M., she said the Abuse Policy did not reflect to immediately report allegations of abuse to the Department of Public Health, as required. 2. The Agency failed to complete a Nurse Aide Registry check and licensure verification for one new hired employee. Review of the Agency policy titled Employment Practices, revised 1/2018, included but not limited to: - The background of all potential Health Alliance-Clinton employees will be thoroughly reviewed during the hiring process. Verification/reference checks may include, but not limited to: * Employment references * Personal references * Confirmation of claimed academic and professional qualifications (certifications, degree, awards, et cetera) * Professional license validation * Criminal Offender Record Information (CORI) check for designated positions...... Employee #2 was hired on 5/20/19. Review of the Employee #2 personnel file indicated the Nurse Aide Registry check was completed on 5/23/19 and the Licensed Certified Social Worker (LCSW) verification was completed on 6/4/19. During an interview with the Manager of Human Resources (HR) Operations on 8/30/22 at 11:00 A.M., she said the Nurse Aide Registry check and license verifications for Employee #2 were not completed during the hiring process as required.