Every finding on record at Heart to Heart Hospice of the Gulf Coast, LLC

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 and interview. In 1 of 17 (6%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the hospice did not ensure that the HA care plan provided specific instructions to the HA. CLINICAL RECORD 6: The patient elected hospice care on 09/17/2024 with a diagnosis of Alzheimer's disease. The patient resided in a skilled nursing facility (SNF). HA services were ordered five (5) times a week. The HA care plan dated 07/21/2025 assigned the HA the tasks: "Bathing - Bed Bath every visit and Bathing - Shower every visit." The HA visit notes dated 09/04/2025, 09/05/2025, 09/08/2025, and 09/12/2025 documented "Bathing - Bed Bath, Completed: Y [yes], and Bathing - Shower, Completed: Y." The care plan did not provide clear instructions to the HA regarding the type of bath. During a joint clinical record review and interview on 10/30/2025, the Executive Director/Registered Nurse agreed that the instructions on the Hospice Aide care plan were not specific.

It is required that hospice aide services include: providing hands-on personal care; performing simple procedures as an extension of therapy or nursing services; assisting in ambulation or exercises; and assisting in administering medications that are ordinarily self-administered. This standard was not met as evidenced by clinical record review and interview. In 1 of 17 (6%) clinical records reviewed of patients receiving Hospice Aide services, the agency did not ensure that the HA care plan included assigned tasks that are within the HA's scope of practice. CLINICAL RECORD 6: The patient elected hospice care on 09/17/2024 with a diagnosis of Alzheimer's disease. The patient resided in a skilled nursing facility (SNF). HA services were ordered five (5) times a week. The HA care plan dated 07/21/2025 assigned the HA the task: "Diet: Review Patient Diet." Reviewing the patient's diet is outside the scope of practice for a Hospice Aide. During a joint clinical record review and interview on 10/30/2025, the Executive Director/Registered Nurse agreed that the instructions on the Hospice Aide care plan were outside the scope of practice for a Hospice Aide.

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 clinical record review and interview. In 2 of 17 (12%) clinical records of patients who received Hospice Aide services, the agency did not ensure that the Hospice Aide notified the Registered Nurse (RN) of changes in the patient’s needs. CLINICAL RECORD 6: The patient elected hospice care on 09/17/2024 with a diagnosis of Alzheimer's disease. The patient resided in a skilled nursing facility (SNF). HA services were ordered five (5) times a week. The HA care plan dated 07/21/2025 assigned the HA the tasks: turn and position in bed; transfer client from bed/chair; transfer client from chair/bed; bathing - bed bath; bathing - shower; shampoo; hair care; skin care; perineal care; oral care; nail care; dressing; glasses; change linens; tidy patient area; review patient diet; standard precautions; seizure; fall; wheelchair bound; output - date of last BM [bowel movement]; companionship/support; no identified safety issues; RN notified of changes..." The HA visit note dated 09/09/2025 documented "Bathing - Bed Bath, Completed: Y [yes], and Bathing - Shower, Completed: N, Note: Per Frequency Not Required This Visit, and RN notified of changes, Completed: N [no], Note: No Changes." A clinical record review revealed no evidence that the Registered Nurse was notified of changes to the plan of care. CLINICAL RECORD 18: The patient elected hospice care on 05/22/2024 with a primary diagnosis of chronic pulmonary disease with acute exacerbation. The patient resided in a SNF. The HA care plan dated 09/09/2024 assigned the HA the tasks: assist to toilet; bathing - bed bath; dressing; foot care; hair care; nail care; oral care; perineal care; skin care; offer fluids; tidy patient area; two-person transfer; wheelchair bound; companionship/support; no identified safety issues; RN notified of changes..." The HA visit note dated 10/07/2025 documented "assist to toilet, bathing - bed bath, perineal care, and dressing" as tasks "already completed by: Facility... RN notified of changes, Completed: N [no], Note: No changes." A clinical record review revealed no evidence that the Registered Nurse (RN) was notified of changes to the plan of care. During a joint clinical record review and interview on 10/30/2025, the Executive Director/ Registered Nurse confirmed that the HA documentation lacked notification to the RN of changes in the plan of care.

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 1 of 17 (6%) clinical records of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide was supervised by the Registered Nurse, no less frequently than every 14 days, to assess the quality of care and services provided. CLINICAL RECORD 6: The patient elected hospice care on 09/17/2024 with a diagnosis of Alzheimer's disease. The patient resided in a skilled nursing facility (SNF). HA services were ordered five (5) times a week. The HA care plan dated 07/21/2025 assigned the HA the tasks: "Bathing - Bed Bath every visit and Bathing - Shower every visit." The HA visit notes dated 09/04/2025, 09/05/2025, 09/08/2025, and 09/12/2025 documented "Bathing - Bed Bath, Completed: Y [yes], and Bathing - Shower, Completed: Y." The Registered Nurse (RN) comprehensive assessments dated 09/10/2025 and 09/18/2025 documented, "Does the aide follow the plan of care? Yes... Any changes needed in the plan of care? No." The HA supervisory visits did not include documentation that the RN assessed the services provided by the HA or ensured that the services provided were ordered by the hospice Interdisciplinary Group (IDG) and met the patient’s needs. During a joint clinical record review and interview on 10/30/2025, the Executive Director/Registered Nurse confirmed that the record lacked evidence that the RN had assessed the quality of care and services provided by the HA.

It is required that each patient’s individualized written plan of care reflects patient and family goals, with measurable outcomes anticipated from implementing and coordinating the plan of care. The documentation in the patient’s record is in accordance with the hospice’s policies and procedure. This standard was not met as evidenced by a review of clinical records, document reviews, and interviews. In 13 of 13 (100%) Clinical records reviewed revealed the Hospice did not ensure the Plan of Care (POC) reflected patient and family goals, identified planned interventions based on problems identified in the initial comprehensive assessment with measurable outcomes anticipated from implementing and coordinating the POC. The documentations are not in accordance with the hospice's policies and procedure. AGENCY POLICY TX.06 TITLED PLAN OF CARE PROCESS REVISED 01/01/2020, states in part, "The Plan of Care includes measurable outcomes anticipated from implementing and coordinating the plan of care. The documentation in the patient’s record is in accordance with the hospice’s policies and procedure." Clinical Record 9: The POC identified the "need for skilled teaching regarding cardiopulmonary symptom management " as a problem on 11/09/2022 with the goal of "patient/caregiver verbalize/demonstrate understanding of measures to manage immediate cardiac/respiratory symptoms and if not effective to call the hospice nurse." Clinical Record 10: The POC identified the "need for medication management " as a problem on 03/18/2022 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." Clinical Record 12: The POC identified the "need for medication management " as a problem on 09/17/2021 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." Clinical Record 8: The POC identified the "need for medication management " as a problem on 01/09/2020 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." Clinical Record 11: The POC identified the "need for medication management " as a problem on 10/11/2022 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." Clinical Record 6: The POC identified the "need for skilled teaching regarding cardiopulmonary symptom management " as a problem on 09/28/2022 with the goal of "patient/caregiver verbalize/demonstrate understanding of measures to manage immediate cardiac/respiratory symptoms and if not effective to call the hospice nurse." Clinical Record 5: The POC identified the "need for medication management " as a problem on 07/03/2019 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." Clinical Record 3: The POC identified "altered genitourinary status " as a problem on 05/25/2021 with the goal of "patient/caregiver verbalize/demonstrate measures to protect skin integrity from incontinence." Clinical Record 4: The POC identified the "need for skilled teaching regarding pain/altered comfort. " as a problem on 05/28/2022 with the goal of "patient/caregiver verbalize/demonstrate understanding of pain management measures." Clinical Record 7: The POC identified the "need for skilled teaching regarding cardiopulmonary symptom management " as a problem on 05/24/2021 with the goal of "patient/caregiver verbalize/demonstrate understanding of measures to manage immediate cardiac/respiratory symptoms and if not effective to call the hospice nurse." Clinical Record 1: The POC identified the "need for medication management " as a problem on 12/29/2021 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." Clinical Record 2: The POC identified the "need for skilled teaching regarding pain/altered comfort. " as a problem on 08/25/2022 with the goal of "patient/caregiver verbalize/demonstrate understanding of pain management measures." Clinical Record 13: The POC identified the "need for medication management " as a problem on 06/17/2019 with the goal of "patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance." An interview with the Regional VP of Clinical Operations on 12/27/2022 during a joint review of the clinical record revealed that the POC did not include measurable outcomes anticipated from implementing and coordinating the POC in accordance with the Hospice's policies and procedures. She stated that these findings were self-identified and that they already have a Plan of Correction that will be implemented in January 2023. No further information was provided.