Every finding on record at Heart to Heart Hospice of Southgate, 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. Hospice care and services provided to patients and families follow the individualized plan of care established by: the hospice IDG in collaboration with the attending physician (if any); the patient or patient representative if any of them so desire; [and] the primary caregiver in accordance with the patient’s needs if any of them so desire. This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed of patients with wounds, the agency did not ensure that hospice care and services provided to patients and families followed the individualized plan of care established by the hospice IDG in collaboration with the attending physician. Clinical Record 11: The patient elected hospice care on 11/21/2024 with a diagnosis of cerebral atherosclerosis. The skilled nursing (SN) assessment dated 12/11/2024 documented a wound on the patient's right foot. The physician ordered "Right foot eschar scab, cleanse area with wound cleaner, pat dry, cover with dry dressing, perform by hospice 2 x week." This order continued for the benefit periods dated 11/21/2024 through 02/18/2025 and 02/19/2025 through 05/19/2025. The SN assessment dated 12/11/2024 documented that wound care was provided. Wound care was documented as provided by the skilled nurse (SN) twice a week until 12/24/2024. Wound care was documented as provided on 12/31/2024, 01/07/2024, 01/14/2025, and then 01/21/2025, once weekly. There was no evidence that wound care was provided two (2) times a week as ordered, and no evidence of communication with the physician or change in the visit frequency. The IDG (interdisciplinary group) meetings on 12/18/2024, 12/31/2024, 01/15/2025, 01/29/2025, and 02/15/2025 documented the wound and its treatment but did not provide an update on why wound care orders were not followed. The wound was noted to be non-healing. During the interview on 05/14/2025, the Area Clinical Manager and the Case Manager stated that the family had been trained to change the dressing and did it when the nurse did not document it. They agreed that the clinical record did not document this, and the order indicated the hospice nurse would change the dressing.

It is required that the Interdisciplinary Group, in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan: As frequently as the patient's condition requires; but no less frequently than every 15 calendar days. A revised plan of care includes: information from the patient’s updated comprehensive assessment; [and] record of the patient’s progress toward the outcomes and goals specified in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 19 (21%) clinical records reviewed, the agency did not ensure that the updated plan of care included the patient’s progress toward the outcomes and goals specified in the plan of care. Clinical Record 1: The patient elected hospice care on 08/21/2023 with a diagnosis of cerebral atherosclerosis. The patient resided in a facility. On 08/29/2023, the physician ordered Physical Therapy (PT) services for five (5) visits for safety and strengthening. The Interdisciplinary Group (IDG) meeting dated 09/06/2023 and 09/20/2023 documented that PT was to visit. The IDG meetings did not include documentation of an update to the patient's progress toward the outcomes and goals of the PT services. Additionally, massage therapy services were ordered and provided two (2) times a month from 11/29/2024 through 02/12/2024. The IDG meeting did not include documentation of an update to the patient's progress toward the outcomes and goals of the massage therapy services. Massage therapy services were re-ordered on 04/21/2025, two (2) times a month. The IDG meeting dated 04/30/2025 did not include documentation of an update toward the patient's outcomes and goals from massage therapy services. The next IDG was scheduled for 05/14/2025. Clinical Record 5: The patient elected hospice care on 01/12/2024 with a diagnosis of congestive heart failure (CHF). On 01/16/2024, the physician ordered Physical Therapy (PT) services to evaluate and treat. The PT visits were documented on paper with written goals and interventions. The IDG meetings dated 01/31/2024, 02/23/2024, 02/14/2024, and 02/28/2024 did not include documentation of an update to the patient's progress toward the outcomes and goals of the PT services. Clinical Record 12: The patient elected hospice care on 02/03/2025 with a diagnosis of Alzheimer's Disease. On 02/12/2025, the physician ordered PT and Occupational Therapy (OT) to evaluate and treat. On 02/14/2025, the referral and order for OT and PT services were sent to the therapy group. Therapy completed four (4) visits through 03/13/2025, working toward strengthening, gait training, and transfer techniques for safety. The IDG meetings dated 02/19/2025, 03/05/2025, 03/19/2025, 04/02/2025, 04/16/2025, and 04/30/2025 did not include documentation of an update from the therapy services to the patient's progress toward goals for PT and OT services. Clinical Record 14: The patient elected hospice care on 02/17/2025 with a diagnosis of cerebral atherosclerosis. On 02/19/2025, the physician ordered PT to evaluate. The PT visited the patient on 02/26/2025 and 03/03/2025, documenting that strengthening, balance, and transfers were worked on. The IDG meeting on 03/05/2025 documented the ordered PT services. The IDG meeting did not include documentation of goals or progress toward goals and outcomes for PT services. The IDG meetings dated 03/19/2025, 04/02/2019, and 04/16/2029 did not include documentation of goals or progress toward goals and outcomes for PT services. During the interview on 05/14/2025, the Area Clinical Manager and the Executive Director, who stated that it can be difficult to get the information from therapy, agreed that the updated plans did not document the progress toward all goals.

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 4 of 15 (27%) clinical records reviewed of patients who received Hospice Aide services, the agency did not ensure that Hospice Aides were supervised by a Registered Nurse, no less frequently than every 14 days. Clinical Record 1: The patient elected hospice care on 08/21/2023 with a diagnosis of cerebral atherosclerosis. The patient resided in a facility. The plans of care dated 02/11/2025 through 04/11/2025 ordered Hospice Aide services two (2) times a week for personal care. The HA completed all ordered visits. The RN documented HA supervisory visits on 02/25/2025 and 04/14/2025, with 48 days outstanding. Clinical Record 2: The patient elected hospice care on 05/16/2024 with a diagnosis of senile degeneration. The plans of care dated 05/16/2024 through 08/13/2024, and 08/14/2024 through 11/11/2024 ordered Hospice Aide services three (3) times a week. The RN documented HA supervisory visits on 06/20/2024 and 07/08/2024, with 18 days outstanding. The RN documented HA supervisory visits on 08/19/2024 and 09/10/2024, with 21 days outstanding. Clinical Record 8: The patient elected hospice care on 03/04/2024 with a diagnosis of pancreatic cancer. The plans of care dated 03/29/2025 through 05/27/2025 ordered Hospice Aide services three (3) times weekly for personal care. The RN documented HA supervisory visits on 04/10/2025 and 04/30/2025, with 20 days outstanding. Clinical Record 9: The patient elected hospice care on 01/17/2025 with a diagnosis of cerebral atherosclerosis. The plans of care dated 01/17/2025 through 04/16/2025, and 04/17/2025 through 07/15/2025 ordered Hospice Aide services two (2) times weekly for personal care. The RN documented HA supervisory visits on 03/05/2025 and 04/21/2025, with 46 days outstanding. During the interviews on 05/13/2025 and 05/14/2025, the Executive Director and the Area Clinical Manager stated that the supervision had not been documented, and they will have to follow up with this.

It is required that the 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. In 3 of 11 (27%) records of patients receiving hospice aide services, the aides did not provide care as ordered on the plans of care and assigned by the RN on the aide assignment sheets. Record 3: For the benefit period 5/23/22-7/21/22, the visit frequency ordered for the hospice aide on the Plan of Care (POC) dated 6/3/22 was 2 times/week. The aide care plan assigned the aide to provide nail care and shampoo weekly. The visits dated 6/6/22 and 6/9/22 documented that a shampoo and nail care was provided at both visits. The visits dated 6/13/22 and 6/16/22 documented nail care was provided at both visits. The visits dated 6/27/22 and 6/30/22 documented nail care and shampoo were provided at both visits. Record 6: For the benefit period 6/13/22-9/10/22, the visit frequency ordered for the hospice aide on the POC dated 6/13/22 was 2 times/week. The aide plan of care assigned nail care and linen change weekly. The aide documented on every visit, (dates: 6/16/22, 6/20/22, 6/23/22, 6/27/22, 6/30/22, 7/4/22, and 7/7/22), that linen changes and nail care was provided. There were no additional orders found to change the task frequency for nail care and linen changes from weekly to every visit. Record 11: For the benefit period 6/24/22-8/22/22. the visit frequency ordered for the hospice aide on the POC, effective 6/24/22, was 2 times/week. The aide plan of care assigned weekly baths. The week beginning 6/26/22, the aide documented a bath was provided during the visits dated 6/27/22 and 6/30/22. No additional documentation was found to support provision of a bath at each visit. The findings were discussed with the Area Clinical Manager, who stated the agency's Patient Care Manager has already put a plan together to address. The aide did not provide care as ordered on the plan of care and ordered by the RN on the aide assignment sheet.

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services, and, as necessary, provides in-service training and education programs where required. The hospice has written policies and procedures describing the method(s) of assessing competency and maintains a written description of the in-service training provided during the previous 12 months. This standard was not met as evidenced by a review of documents, interviews and review of personnel records. 1 of 15 (7%) records of staff employed a year, or longer revealed that required annual competency evaluations were not completed per agency policy. Staff 16: Social worker hired in 2014 documented a clinical competency in 2019, and a clinical competency was documented in 2021. There was no evidence of documented clinical competency in 2020 and no documentation for why it was not documented. Agency Policy HR.7 Staff Competency [revised date 05/30/2018] stated, "The agency will provide for competency assessments qualified individuals on hire and annually to assess direct care staff." An interview with the Area Clinical Manager on 07/07/2022 stated that he likely was on a leave of absence but could not locate evidence of this. Once it was realized it was missed, it was completed. Agency Policy HR.7 Staff Competency [revised date 05/30/2018] stated in part, "The agency will provide for competency assessments qualified individuals on hire and annually to assess direct care staff."