Every finding on record at Hospice Advantage, 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, and written patient care instructions for a hospice aide are prepared by an 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 14 (7%) clinical records reviewed of patients who accepted Hospice Aide services, the agency did not ensure that the Registered Nurse (RN) provided proper infection control instruction for the Hospice Aide (HA). Clinical Record 9: The patient elected the hospice benefit on 10/13/2023 with the diagnosis of malignant neoplasm of the right breast. The patient resided in a nursing facility (NF). The plan of care for the benefit period dated 02/04/2025 to 04/04/2025 ordered HA services twice (2) a week. The Licensed Practical Nurse (LPN) visit note dated 02/07/2025 documented, "NH has COVID outbreak. Proper PPE utilized. Hospice team notified... nasal congestion and dry cough noted. New order for Mucinex 600mg BID x5 days. Negative for COVID..." On 02/10/2025, the LPN visit note documented, "Spoke with facility nurse. Patient tested positive for COVID Saturday. New orders obtained by facility for ZPAK..." The hospice Social Worker (SW) visit note dated 02/11/2025 documented, "Facility is under COVID protocol. Hospice offices have been alerted...Pt is visibly tired. Pt has a cough through most of visit..." On 02/10/2025, the physician ordered a ZPAK "to be taken as directed due to COVID." On 02/11/2025, the Hospice Aide missed visit note documented, "Pt refused. She is COVID-positive and stated she is not feeling good and did not want a shower or cleaned up. Floor staff nurse notified. Registered Nurse Case Manager (RNCM) notified." On 02/13/2025, a Hospice Aide missed visit note documented, "Pt refused all personal care. Very sick and cold. Wants to rest. Floor nurse (name) and (name) RNCM notified." Although the HA did not perform a complete visit, contact was made between the HA and the patient. The Hospice Aide care plan dated 02/05/2025 documented standard infection control precautions. On 02/11/2025, the care plan was updated to include standard infection control precautions. The HA care plan was not updated to alert the Hospice Aide to COVID-19 transmission-based precautions. During a joint clinical record review and interview on 03/07/2025, the Executive Director of Area Clinical Operations/RN and the Director of Clinical Services confirmed that the Hospice Aide Care Plans dated 02/05/2025 and 02/11/2025 included standard-based precautions and not transmission-based precautions related to the patient having COVID-19. No additional information was provided at the end of the site visit.

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 record review, and an interview with the Administrator. 1 of 13 (7%) records revealed that the agency had failed to ensure that the spiritual assessment component of the initial comprehensive assessment, had been completed within 5 days of admission to the hospice. Record #96054: The patient elected hospice services on 4/08/2022. For the benefit period dated 4/8/2022 through 7/6/2022, the patient's diagnoses included Heart failure, Hypertension, Atrial fib, and Mitral Valve Regurgitation. The initial spiritual assessment was documented on 4/28/2022, 20 calendar days after the admission. There was no documentation present in the record evidencing that the chaplain contacted the family/patient within five days of admission to hospice. In interviews on 4/28/2022 and 4/29/2022, the CEO/Administrator (employee record #83837) stated that the patient's initial spiritual assessment had not been completed until 4/28/2022.

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. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; [and] duplicate drug therapy. 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. (Cross reference HSIM 3.1/CFR 418.104 "A patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff....") This standard was not met as evidenced by clinical record review, and an interview with the CEO/Administrator. 1 of 13 (7%) records revealed the agency had failed to update the medication profile with complete documentation of patient allergies. This being required with the goal of providing an accurate patient history, and a current, complete, medication profile. Record # 73708: The patient, an 87 year-old female, whose diagnoses included Heart Disease, Dementia, Psychotic Disorder with Delusions, Type 2 Diabetes, and Hypertension, as well as a status of being Wheelchair Bound, elected hospice services on 2/11/2022. For the benefit period dated 4/12/2022 through 6/10/2022, the most recent history and physical, dated 5/12/2021, originating from a previous hospitalization, listed allergies as: Aspirin, Fentanyl, Iodine, PCN (penicillin) and Tetracycline. The Hospice Client Medication Sheet, generated upon admission, dated 02/11/2022, under the section, "Client Allergies" listed "Aspirin, Iodine, PCN and Tetracycline." The reported patient allergy to Fentanyl, listed on the previous Patient Medication Profile from the most recent reported hospital stay, was absent from the hospice Medication Profile. Interviews were conducted on 4/28/22 and 4/29/22 with the CEO/Administrator/ (employee record #83837) who stated that the Fentanyl allergy had not been added to the medication profile.

It is required that bags used to carry medical equipment (e.g., BP cuff) or supplies into or out of the care environment, are transported and used in a manner consistent with organizational policy to prevent the spread of infections and communicable diseases. This standard was not met as evidenced by a review of observed home visits, and an interview. 1 of 3 (33%) visits revealed the agency's skilled nurse failed to follow proper bag technique, so as to prevent the likelihood of passing microorganisms between the staff nurse and the patient, or the patient’s living environment. This conclusion is based on the staff nurse's verbalization following the previous home visit to a patient’s home, that the home had an infestation of bedbugs. On this observed visit that followed the visit to the residence reported to have bedbugs, it was noted that the nurse placed both the tablet and bag on surfaces unprotected by an appropriate barrier. Record #87089: The patient, a 70-year-old female, whose diagnoses included COPD, COVID-19 History, and Acute Respiratory Failure with Hypoxia for the benefit period dated 3/25/2022 through 5/23/2022, elected hospice services on 6/3/2020. During the observed home visit, the RN was observed to have placed the nursing bag on the coffee table and her tablet on the couch, without a barrier. In an interview with the CEO/Administrator, it was stated that the nursing bag is transported from patient home to home and may serve as a vehicle for transmitting microorganisms and the agency has established guidelines and strategies for the management of the nursing bag used by hospice staff to prevent and control the transfer of microorganisms through its use.

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; hospice election form and any advance directives; physician certification and recertification of the terminal illness. This standard was not met as evidenced by the review of clinical records, as well as an in-person tour of a long-term care facility, and an interview. 1 of 1 (100%) records present at the long-term care facility (LTCF) revealed the agency had failed to provide the most recent plan of care (POC), hospice election form, physician certification of terminal illness (CTI) and subsequent recertification documentation. Record #73708: The patient, an 87 year-old female, whose diagnoses included Heart Disease, Dementia, Psychotic Disorder with Delusions, Type 2 Diabetes, and Hypertension and with a status of being Wheelchair Bound, elected hospice services on 2/11/2022. For the benefit period dated 4/12/2022 through 6/10/2022, the hospice patient records located at the LTCF did not evidence the most recent POC, the hospice election form, the physician CTI or the recertification of the terminal illness forms. During the visit, the LTCF Director of Nurses indicated that the hospice binder was "in the bookcase". The RN case manager, (employee record #14959), on 4/28/2022, who was present at the facility and reviewed the hospice patient records, stated that they could not find the hospice "book" with the patient’s information. The floor nurse (Unit Nurse) was asked if there were any hospice documents in the facility EHR, as documented by the hospice RN case manager. The floor nurse at the LTCF looked up the information and could not locate any hospice information in the facility EHR pertaining to the most recent hospice POC, the hospice election form, any advance directives, the physician CTI or the recertification of the terminal illness forms. In an interview with the CEO/Administrator, on 4/28/2022, (employee record #83837), it was stated that the LTCF has a portal to access the hospice information.