Every finding on record at Helping Hands Home Health Care & Hospice, Inc

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical record reviewed revealed that the agency did not ensure that the initial comprehensive assessment was completed no later than five calendar days after the election of hospice care. CLINICAL RECORD 14: The hospice benefit was elected on 12/30/2022. The clinical record review lacked evidence of an initial comprehensive assessment being completed no later than five calendar days after the election of hospice care. The initial nursing assessment was documented on 12/30/2022, and the social worker initial was completed on 01/05/2024 (6 days) after the hospice election. During an interview with the alternate administrator/alternate DPCS (Personnel Record 7) on 04/10/2025, she stated that they would continue to monitor the completion of the comprehensive assessment within the five-day timeframe.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, the agency did not ensure the individualized plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 6: The patient elected the hospice benefit on 07/07/2023 with a terminal diagnosis of sequelae of cerebral. The initial comprehensive assessment dated 07/07/2023 included documentation that the patient had a "left thigh wound which measured 4 cm x 2.5 cm." The plan of care did not include an intervention for the left thigh wound identified in the initial assessment. Clinical Record 7: The patient elected the hospice benefit on 12/30/2022 with a terminal diagnosis of Alzheimer's disease. The initial plan of care dated 12/30/2022 included a problem/intervention that stated, "Community Resources Problem. Refer to appropriate resources as needed. Social worker (SW) visits 1x quarter." Clinical record review revealed the patient refused SW visits for benefit periods 2, 3, 4, and 5. The problem/intervention on the plan of care remained unchanged for benefit periods 2, 3, and 4. In benefit period 5, an order was written to discontinue Social Worker visits but the problem/intervention on the plan of care was not updated and has remained the same since the start of care on 12/30/2022. Clinical Record 9: The patient elected the hospice benefit on 01/08/2024 with a terminal diagnosis of Alzheimer's disease. The initial nursing assessment dated 01/08/2024 included documentation that the patient had a sacral wound. The nursing assessment dated 01/12/2024 included documentation that the patient also had a wound to the left heel. The plan of care dated 01/08/2024 included an intervention for the patient’s sacral wound but was not updated to include an intervention for the left heel wound. Clinical Record 13: The patient elected the hospice benefit on 03/03/2023 with a terminal diagnosis of Alzheimer's disease. Clinical record review revealed the nursing assessment dated 03/15/2023 included documentation that stated, "educated caregiver on what to expect when a patient is dying." The plan of care was not updated to include interventions related to the patient exhibiting signs of imminence of death. During an interview and joint record review on 02/07/2024, the Alternate Administrator /Alternate Director of Patient Care Services confirmed that the plans of care did not include planned interventions based on problems identified in the initial comprehensive assessment and updated comprehensive assessments.

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 (registered nurse) who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 3 of 10 (30%) clinical records reviewed with aide services provided, the agency did not ensure patient care instructions prepared by the RN included specific patient care instructions to the hospice aide. Clinical Record 2: The patient elected the hospice benefit on 10/25/2023 with a terminal diagnosis of neurocognitive disorder with Lewy bodies. The initial nursing assessment dated 10/25/2023 included documentation that the patient had a stage 4 sacral pressure ulcer covered with a foam dressing. The aide care plan dated 12/24/2023 did not provide the aide with specific instructions on how to care for the wound /wound dressing during cares such as bathing and dressing and did not include instructions on what to do if the dressing became soiled, wet, or dislodged. Clinical Record 5: The patient elected the hospice benefit on 12/07/2023 with a terminal diagnosis of Alzheimer's disease. The initial nursing assessment dated 12/07/2023 included documentation that the patient had a stage 3 wound on the coccyx. The aide care plan did not provide the aide with specific instructions on how to care for the wound /wound dressing during cares such as bathing and dressing and did not include instructions on what to do if the dressing became soiled, wet, or dislodged. Clinical Record 9: The patient elected the hospice benefit on 01/08/2024 with a terminal diagnosis of Alzheimer's disease. The initial nursing assessment dated 01/08/2024 included documentation that the patient had two wounds to the sacrum. The aide care plan dated 01/08/2024 did not provide the aide with specific instructions on how to care for the wound /wound dressing during cares such as bathing and dressing and did not include instructions on what to do if the dressing became soiled, wet, or dislodged. The aide care plan was updated on 01/12/2024 to include "wound to left heel covered with adhesive foam dressing." The wound was added to the aide care plan, but specific instructions were not added to include care of the wound during bathing and what to do if the dressing became soiled, wet, or dislodged. During an interview and joint record review on 02/07/2024, the Alternate Administrator /Alternate Director of Patient Care Services confirmed that the RN did not provide specific instruction to the hospice aide on what to do with the patient's wound during cares and/or if the dressing became soiled, wet, or dislodged.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) clinical records reviewed with aide services provided, the agency did not ensure aide services were provided as ordered in the plan of care. Clinical Record 14: The patient elected the hospice benefit on 01/12/2024 with a terminal diagnosis of Parkinson's disease. The plan of care dated 01/12/2024 included an order for aide frequency of visits twice a week. Clinical record review revealed aide visits were not provide to the patient from 01/12/2024 to the patient’s death on 01/25/2024. The clinical record included a physician order for a missed aide visit on 01/18/2024 but no documentation for the other missed visits. During an interview and joint record review on 02/07/2024, the Alternate Administrator /Alternate Director of Patient Care Services confirmed there were three visits missed by the aide and no documentation in the record of physician notification of missed visits.

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. This standard was not met as evidenced by clinical record review and interview. In 5 of 10 (50%) clinical records reviewed with aide services provided, the agency did not ensure the hospice aide was supervised by a Registered Nurse no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide. Clinical Record 2: The patient elected the hospice benefit on 10/25/2023 with a terminal diagnosis of neurocognitive disorder with Lewy bodies. Clinical record review revealed the last aide supervisory visit was documented by the Registered Nurse (RN) on 12/29/2023, a total of 45 days and 31 days outstanding, as of the date of record review on 02/07/2024. Clinical Record 4: The patient elected the hospice benefit on 01/16/2024 with a terminal diagnosis of Alzheimer's disease. Clinical record review revealed no documented evidence of an aide supervisory visit by the RN, a total of 22 days and 8 days outstanding, as of the date of record review on 02/08/2024. Clinical Record 5: The patient elected the hospice benefit on 12/07/2023 with a terminal diagnosis of Alzheimer's disease. Clinical record review revealed the last aide supervisory visit was documented by the Registered Nurse on 12/29/2023, a total of 45 days and 31 days outstanding, as of the date of record review on 02/07/2024. Clinical Record 8: The patient elected the hospice benefit on 08/15/2023 with a terminal diagnosis of Alzheimer's disease. Clinical record review revealed the last aide supervisory visit was documented by the Registered Nurse on 12/29/2023, a total of 48 days and 34 days outstanding, as of the date of record review on 02/07/2024. Clinical Record 9: The patient elected the hospice benefit on 1/8/2024 with a terminal diagnosis of Alzheimer's disease. The patient elected the hospice benefit on 01/16/2024 with a terminal diagnosis of Alzheimer's disease. Clinical record review revealed no documented evidence of an aide supervisory visit by the RN, a total of 30 days, and 16 days outstanding, as of the date of record review on 02/08/2024. During an interview and joint record review on 02/07/2024, the Alternate Administrator /Alternate Director of Patient Care Service confirmed that the records were missing aide supervisory visits.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident, the most recent hospice plan of care and the physician certification and recertification of the terminal illness. This standard was not met as evidenced by observation and interview. In 1 of 1 (100%) home visit observation for a patient that resides at a skilled nursing facility (SNF), the agency did not ensure the skilled nursing facility was provided with the required documents. Home Visit 3: The patient elected the hospice benefit on 07/01/2023 with a terminal diagnosis of senile degeneration of the brain. During home visit observation, review of the binder provided by the hospice to the SNF revealed no documented evidence that the SNF was provided with the patient’s most recent hospice plan of care, the certification of terminal illness, and the recertification of terminal illness. During an interview and joint record review on 02/07/2024, the Alternate Administrator /Alternate Director of Patient Care Services confirmed that the forms had not been sent to the facility.

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by a review clinical records and interviews. In 1 of 8 (13%) clinical records reviewed revealed the hospice did not ensure that the hospice Interdisciplinary Group completed a timely initial bereavement assessment as part of the comprehensive assessment no later than five (5) calendar days after the election of hospice care. THIS IS A CONTINUING PRIOR REQUIRED ACTION Clinical Record 1: The patient elected hospice care on 12/7/21. The initial bereavement assessment was completed on 1/29/22. During interview and joint review of the clinical record 8/29/22, the Assistant Clinical Manager confirmed the initial bereavement assessment was completed 8/29/22. There was no documented coordination notes to explain why the initial bereavement assessment was completed later than five (5) days after the election of hospice care. THIS IS A CONTINUING PRIOR REQUIRED ACTION

It is required that a qualified hospice aide has successfully completed a competency evaluation program that evaluates the aide’s competency in the following subject areas by observation of the aide’s performance with a patient or a pseudo patient: Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff; reading and recording temperature, pulse, and respiration; and appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist: bed bath; sponge, tub, and shower bath; hair shampoo (sink, tub, and bed); nail and skin care; oral hygiene; toileting and elimination; safe transfer techniques and ambulation; and normal range of motion and positioning. This standard was not met as evidenced by a review clinical records and interviews. In 1 of 1 (100%) applicable personnel records reviewed of hospice aides hired after 4/30/21 revealed, the hospice did not ensure the initial Hospice Aide skills competency evaluation was completed by observing the aide's performance with a patient and/or a pseudo patient. STAFF 5: Personnel record review revealed the hospice aide's date of hire was 11/1/21. The "Initial Competency Assessment Skills Checklist Hospice Aide" dated 11/8/21 included "V" as the method of evaluation for "temperature, pulse, respirations, bed bath, shower/tub bath, nail care, skin care, oral care, shampoo, toileting/elimination, transfer techniques, range of motion, ambulation and positioning". The form included the key for "V" as "verbal test." There was no other documentation which ensured that the skills learned elsewhere were transferable in this hospice setting. During interview 8/29/22, the Clinical Director/Director of Patient Care Services Designee stated the skills evaluation was completed verbally with the hospice aide and not observed with a patient and/or a pseudo patient. Additionally during phone interview 8/29/22, the hospice aide stated, "Yes, since I have been working here at this hospice, I have completed temperature, pulse, respirations, bed bath, shower/tub bath, nail care, skin care, oral care, shampoo, toileting/elimination, transfer techniques, range of motion, ambulation and positioning with hospice patients".