Every finding on record at Hospice Advantage, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 19 (5%) clinical records reviewed and home visits observed, the agency did not ensure that the initial comprehensive assessment included documentation of a drug profile that contained the patient's current prescription and over-the-counter drugs that could affect drug therapy. Clinical Record 14/Home Visit 3: The patient elected hospice care on 10/20/2023 with the diagnosis of chronic obstructive pulmonary disease (COPD). During a joint home visit with the Registered Nurse (RN) [Personnel Record 3] on 04/09/2024, a review of the patient's medications with the patient's wife revealed the patient was using Mucinex 30 mg-60 mg one (1) by mouth (PO) every (q) 12 hours (hrs) and Albuterol 2 puffs every 4 hrs as needed (prn). Mucinex and Albuterol were not included in the patient's medication profile. There was no documented evidence that Mucinex and Albuterol were reviewed with the patient's medication regimen. On 04/09/2023, during a joint record review, interview, and observation, the Director of Nursing (DCS), present at the home visit, confirmed that the two medications were not included in the medication profile.

It is required that each patient’s individualized written plan of care: includes all services necessary for the palliation and management of the terminal illness, including the following: measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 11 of 19 (58%) clinical records reviewed, the hospice did not ensure that the plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 1: The patient elected hospice care on 01/24/2024. The plan of care (POC) identified the problem: ""A need for comfort" and the patient goal: " Patient /caregiver will have decreased fear and anxiety regarding death and dying process." The goal statement did not include a description of how "decreased fear and anxiety regarding death and dying process" would be measured. Clinical Record 2: The patient elected hospice care on 03/22/2024. The POC identified the problem: "A need for comfort" and the patient goal "Patient /caregiver will understand symptom scales, how to manage symptoms and report changes to hospice." The goal statement did not include a description of how "understanding the symptom scales," and how to "manage symptoms, and report changes" would be measured. Clinical Record 3: The patient elected hospice care on 01/11/2024. The POC identified the patient's problem with pain and the patient's goal: "Patient's pain is managed at (standardized pain measure scale) score using a numeric scale." The goal statement did not include a description of how the patient's pain would be measured using the pain scale. Clinical Record 4: The patient elected hospice care on 03/08/2024. The POC identified the problem: "A need for comfort" and the patient goal: "Patient /caregiver will have decreased fear and anxiety regarding death and dying process." The goal statement did not include a description of how "decreased fear and anxiety regarding death and dying process" would be measured. Clinical Record 5: The patient elected hospice care on 02/16/2024. The POC identified the problem: "safety" and the patient goal: " Patient /caregiver will have safety needs met." The goal statement did not include a description of how "safety needs met" would be measured. Clinical Record 7: The patient elected hospice care on 01/05/2024. The POC identified the problem: "A need for comfort" and the patient goal "Patient /caregiver will understand symptom scales, how to manage symptom and report changes to hospice." The goal statement did not include a description of how "understanding the symptom scales," and how to "manage symptoms, and report changes" would be measured. Clinical Record 9: The patient elected hospice care on 01/21/2023. The POC identified the problem: "safety" and the patient goal: " Patient /caregiver will have safety needs met." The goal statement did not include a description of how "safety needs met" would be measured. Clinical Record 10: The patient elected hospice care on 02/07/2024. The POC identified the problem: "safety" and the patient goal: " Patient /caregiver will have safety needs met." The goal statement did not include a description of how "safety needs met" would be measured. Clinical Record 11: The patient elected hospice care on 02/16/2023. The POC identified the problem: "safety" and the patient goal: "Patient's safety will be observed and assessed for fall risks and safety needs will be met." The goal statement did not include a description of how "safety needs met" would be measured. Clinical Record 13: The patient elected hospice care on 10/13/2024. The POC identified the problem: "A need for comfort" and the patient goal: "Patient /caregiver will have decreased fear and anxiety regarding death and dying process." The goal statement did not include a description of how "decreased fear and anxiety regarding death and dying process" would be measured. Clinical Record 14: The patient elected hospice care on 10/20/2023. The POC identified the problem: "A need for comfort" and the patient goal: "Patient /caregiver will have decreased fear and anxiety regarding death and dying process." The goal statement did not include a description of how decreased fear and anxiety regarding death and dying process" would be measured. During a joint clinical record review and interview on 04/10/2024, the Director of Clinical Services confirmed that the plans of care did not include goals with measurable outcomes.

It is required that a hospice aide provides services: ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; [and] consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 5 of 14 (36%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA provided services included in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 01/24/2024. The plan of care (POC) dated 01/24/2024 assigned the HA the relevant task: shampoo the patient's hair one (1) time a week. The HA visit notes dated 01/29/2024 and 02/02/2024 documented that the HA shampooed the patient's hair two (2) times for the week. There was no evidence of a change in the aide care plan. Clinical Record 2: The patient elected the hospice benefit on 03/22/2024. The POC dated 03/22/2024 assigned the HA the relevant task: shampoo the patient's hair one (1) time a week. The HA visit notes dated 03/25/2024 and 03/27/2024 documented that the HA shampooed the patient's hair two (2) times for the week. There was no evidence of a change in the aide care plan. Clinical Record 10: The patient elected the hospice benefit on 02/07/2024. The POC dated 02/07/2024 assigned the HA the relevant tasks: shampoo and shave once a week. The HA visit notes dated 02/12/2024 and 02/15/2024 documented the completion of shaving and shampoo two (2) times for the week. There was no evidence of a change in the aide care plan. Clinical Record 13: The patient elected the hospice benefit on 10/13/2024. The POC dated 10/13/2024 assigned the HA the relevant task: shave Monday and Wednesday. The HA visit notes dated 10/18/2024 and 10/20/2024 documented the completion of shaving two (2) times for the week. There was no evidence of a change in the aide care plan. Clinical Record 14: The patient elected the hospice benefit on 10/20/2023. The POC dated 10/20/2023 assigned the HA the relevant task: nail care weekly. The HA visit notes dated 10/24/2023 and 10/27/2023 documented the completion of nail care two (2) times for the week. There was no evidence of a change in the aide care plan. During a joint record review and interview on 04/09/2024, the Director of Clinical Services (DCS) confirmed that the HA did not follow the HA plan of care with respect to the frequency of tasks.

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 5 of 14 (36%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA reported changes in the patient's needs to the Registered Nurse (RN). Clinical Record 1: The patient elected the hospice benefit on 01/24/2024. The plan of care (POC) dated 01/24/2024 assigned the HA the relevant task: shampoo the patient's hair one (1) time a week. The HA visit notes dated 01/29/2024 and 02/02/2024 documented that the HA shampooed the patient's hair two (2) times for the week. There was no evidence that the RN was notified of the added tasks provided. Clinical Record 2: The patient elected the hospice benefit on 03/22/2024. The POC dated 03/22/2024 assigned the HA the relevant task: shampoo the patient's hair one (1) time a week. The HA visit notes dated 03/25/2024 and 03/27/2024 documented that the HA shampooed the patient's hair two (2) times for the week. There was no evidence that the RN was notified of the added tasks provided. Clinical Record 10: The patient elected the hospice benefit on 02/07/2024. The POC dated 02/07/2024 assigned the HA the relevant tasks: shampoo and shave once a week. The HA visit notes dated 02/12/2024 and 02/15/2024 documented the completion of shaving and shampoo two (2) times for the week. There was no evidence that the RN was notified of the added tasks provided. Clinical Record 13: The patient elected the hospice benefit on 10/13/2024. The POC dated 10/13/2024 assigned the HA the relevant task: shave Monday and Wednesday. The HA visit notes dated 10/18/2024 and 10/20/2024 documented the completion of shaving two (2) times for the week. There was no evidence that the RN was notified of the added tasks provided. Clinical Record 14: The patient elected the hospice benefit on 10/20/2023. The POC dated 10/20/2023 assigned the HA the relevant task: nail care weekly. The HA visit notes dated 10/24/2023 and 10/27/2023 documented the completion of nail care two (2) times for the week. There was no evidence that the RN was notified of the added tasks provided. During a joint record review and interview on 04/09/2024, the Director of Clinical Services (DCS) confirmed the findings.