Every finding on record at Hickory Hospice LLC

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, document review, and interview. 1 of 2 (50%) applicable records revealed the agency did not ensure the registered nurse (RN) supervised the aide services no less frequently than every 14 days. Agency policy HR.12, Employee Supervision, stated in part, " Agency will provide timely supervision of the home health aide by a registered nurse no less frequently than every 14 days to the location where the patient is receiving care." Clinical Record 2: Aide services were ordered 3 times a week and started on 5/8/23. There was no documented aide supervisory visit made by the Registered Nurse between 5/8/23 and 5/31/23. During a joint record review and interview on 5/31/23, the Nursing Supervisor confirmed the finding and stated that the supervisory visits were completed but not documented.

It is required that hospice services are made routinely available on a 24-hour basis, seven days per week to meet the needs of the patient and family. This standard was not met as evidenced by observation, document review, and interview. The agency did not ensure that hospice services were made routinely available on a 24-hour basis, seven days per week to meet the needs of the patient and family. The patient handbook documents the agency contact number and provides instruction to call the agency 24 hours a day. The hospice agency contact phone number that was listed in the patient handbook and posted on the front door of the agency office, was not in service on 5/30/23. When calling the phone number, the following recording was heard: "The line has been placed out of service. Your call cannot be processed. Please contact your administrator." During an interview, the Administrator confirmed the finding and said, "I will find out why it isn’t working and get it fixed.” On 6/1/23, the agency phone number was called and the following recording was heard, "The line has been placed out of service. Your call cannot be processed. Please contact your administrator." During an interview, the Administrator confirmed the finding and said, "I completed an incident report. I thought it was fixed." The agency did not ensure the patients had a working telephone number for the patients to access hospice if they needed assistance 24 hours a day, 7 days a week. The hospice contact telephone number, posted on the front office door of the office and given to the patient upon election to hospice, was discovered not to be working with the recording, “the line has been placed out of service. Your call cannot be processed. Please contact your administrator.” from 5/30/23 @ 9:15 am through 6/1/23 @ 10:00 am. The hospice contact phone number, (210) 729-1448, was not in service when the site visitor (SV) called upon arrival on 5/30/23 to the agency. The administrator was contacted by a CHAP director of accreditation on her personnel cell phone and was notified the hospice phone number was not working. The administrator told the site visitor (SV), “I will find out why it isn’t working and get it fixed.” SV verified this number was the same number in the patient’s hospice binder in the home and asked the patients/spouses if they knew how to get a hold of hospice if they need something. They all verbalized they would have their kids get a hold of hospice if they needed something, and one patient stated she had the number in the book. The patient handbook in the home has the contact number on the page that gives instructions on calling the hospice agency 24 hours a day. There were no other phone numbers listed to call. SV called the same phone number at the beginning of the day on 6/1/23, and the recording remained the same, “the line has been placed out of service. Your call cannot be processed. Please contact your administrator.”

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes updated comprehensive assessments and clinical notes, including the care and services provided. This standard was not met as evidenced by clinical record review, document review, and interview. 1 of 5 (20%) records revealed the agency did not ensure there were updated clinical notes, including the care and services provided to the patient. Agency policy, Timelines, states in part, "All clinical and progress notes will be written the day service is rendered". Clinical Record 2: The registered nurse (RN) completed visits on 5/1/23 and 5/15/23. As of 5/31/23, there were no updated clinical assessment notes documented.. Clinical Record 2: The aide completed visits on 5/26/23 and 5/29/23. As of 5/31/23, there were no updated visit notes documented. During an interview on 5/31/23, the Nursing Supervisor confirmed the findings.

It is required that the Interdisciplinary Group determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in their home. The plan of care identifies the IDG’s finding regarding safe self-administration and/or family administration of drugs and biologicals. If the patient and/or family cannot administer drugs or biologicals, it is noted in the plan of care, as well as how it is addressed by the IDG. This standard was not met as evidenced by observation, clinical record review, and interview. 3 of 4 (75%) home visit observations, revealed the agency did not ensure that the plan of care identified the patient and/or family could not administer drugs or biologicals and how it was addressed by the IDG. Home Visit 3: During the home visit, it was observed that the Registered Nurse (RN) filled the patient's pill box weekly. The initial nursing assessment dated 4/26/23, stated in part, "The patient and or caregivers are administering all medications appropriately and are competent to continue to manage and administer all medications." There is no medication/administration problem noted on the plan of care. Home Visit 4: During the home visit on 5/31/23, the patient and wife stated, "The pharmacy delivers the medications, and the nurse fills the pill box once a week." There is no medication/administration problem noted on the plan of care. Home Visit 1: During the home visit on 5/31/23, the nurse stated that she filled the patient's pill box. There is no medication/administration problem noted on the plan of care. During an interview on 5/31/23, the RN Case Manager confirmed the findings.