Every finding on record at Hospice Care of Georgia, 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. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #2-001 Addendum 2-001.B Practice Act Supervision Requirements read in part "Certified Nursing Assistants (Hospice Aides): A supervisory visit will be conducted by the Registered Nurse for each Hospice Aide not less than every 14 days." In 1 of 14 (7%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that a Registered Nurse (RN) made 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 HA. Clinical Record 2: The patient elected hospice care on 06/18/2024 with a diagnosis of Alzheimer's Disease. The recertification plan of care effective 09/16/2024 through 12/14/2024, ordered Hospice Aide visits twice weekly, beginning 09/16/2024. HA visits were provided as ordered beginning 09/17/2024. HA supervisory visits were completed on 09/30/2024, 10/07/2024, 10/14/2024, 11/08/2024, and 11/14/2024. A clinical record review revealed no evidence that HA supervisory visits were completed every 14 days per agency policy, with 25 days outstanding between 10/14/2024 and 11/08/2024. During a joint record review and interview on 11/22/2024, the Manager of Accreditation and Regulatory Compliance confirmed that a hospice supervisory visit was not completed every 14 days per agency policy, stating, "I did a training on supervision with the team within the last couple of months."

It is required that the Hospice Interdisciplinary Group (IDG), 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 clinical record review and interview. 1 of 11 (09%) records reviewed revealed the initial comprehensive assessment by the IDG members was not completed within five calendar days after the election of hospice. Record #69714: The patient elected hospice care on 12/22/2021. The Medical Social Work (MSW) Initial Assessment was completed on 12/29/2021, seven days after the Hospice benefit election. The MSW provided a note in the clinical record on 12/27/2021, which indicated that the MSW was unaware that the initial visit had been scheduled for 12/24/2021 but did not indicate why the visit was not completed until 12/29/2021. The Administrator was interviewed on 1/5/2021 and agreed that the assessment was late and had no additional information to provide.

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, and other alternative treatments that could affect drug therapy. 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 a review of clinical records and observation during a home visit. 3 of 11 (27%) records reviewed revealed the Medication Profile was not updated to reflect the patient's current medications. Record #47888: The patient elected hospice care on 7/8/2021. During an observation home visit conducted on 1/4/2021, it was revealed that there were several medications on the medication profile that the wife stated the patient was no longer taking: Dexamethasone 4mg PR QAM; Simethicone 125mg QID PRN; Ibuprofen 800mg TID PRN; Methimazole 5mg PO QD; Mucinex 100mg/5ml 10ml Q4 hours PRN; and Spironolactone 25mg PO QDay. Record #28249: The patient elected hospice care on 12/17/2021. The Hospice Comfort Kit medications were included on the initial plan of care on 12/17/2021 but are not on the medication profile. These medications include: Haloperidol 0.5mg /Q4hours PRN; Promethazine 25mg Q 4-6 hours PRN; Acetaminophen 650mg suppository Q 4-6 hours PRN; Hyoscyamine 0.125mg SL Q4 hours PRN; Bisacodyl 10mg suppository 1 suppository PR QDay PRN; Lorazepam 0.5mg Q2hours PRN. Record #69714: The patient elected hospice care on 12/22/2021. The Hospice Comfort Kit medications were identified on the initial plan of care on 12/22/2021 but were not present on the medication profile. These medications include: Haloperidol 0.5mg /Q4hours PRN; Promethazine 25mg Q 4-6 hours PRN; Acetaminophen 650mg suppository Q 4-6 hours PRN; Hyoscyamine 0.125mg SL Q4 hours PRN; Bisacodyl 10mg suppository 1 suppository PR QDay PRN; Lorazepam 0.5mg Q2hours PRN. The Administrator was interviewed on 1/5/2021 and 1/6/2021 and agreed that the medication profiles were not updated and had no additional information to provide.

It is required that Medical Social Services are provided per the plan of care. This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) records reviewed revealed that psychosocial services were not meeting visit frequencies identified in the plan of care. Record #28249: The patient elected hospice care on 12/17/2021. A physician order was written on 12/20/2021 for Medical Social Work (MSW) one time a week for thirteen weeks. A MSW visit was missing for the week of 12/26/2021. There was no documentation in the record for why the visit was missed. The Administrator was interviewed on 1/5/2021 and agreed there was a MSW visit missing and stated that there was no additional information to provide.

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. 2 of 10 (20%) applicable clinical records for patients that received hospice aide services reviewed revealed that aide services provided were not consistent tasks assigned on the plan of care. Record #41347: The patient elected hospice care on 5/18/2021. A physician order was written on 7/3/2021 for Hospice Aide services five times a week. Hospice Aide visits were missed on 08/18/2021, 08/20/2021, 08/27/2021. There was no documentation in the record about why these visits were missed. Record #85946: The patient elected hospice care on 9/30/2021. A physician order was written on 9/30/2021 for Hospice Aide services two times a week. Only one hospice aide visit was made on the week of 11/7/2021, and there was no documentation about why this visit was missed. The Administrator was interviewed on 1/5/2021 and agreed that hospice aide visits were missed and there was no additional information to provide.

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services, and, as necessary, provides in-service training and education programs where required. The hospice has written policies and procedures describing the method(s) of assessing competency. This standard was not met as evidenced by personnel record review, document review, and interview. Agency Policy #HR-039-Competency Program stated in part, "Skill proficiency can be determined by verbal or written exam, skill demonstration in a lab setting or patients home or by completion of a specialized training course specific to a clinical procedure." 5 of 10 (50%) records reviewed revealed that clinical competency testing was not being completed at the time of orientation. Record #98939: The employee was hired on 9/8/2021. There is no evidence that clinical competencies were assessed during the employee's orientation. Record #26925: The employee was hired on 12/7/2021. There is no evidence that clinical competencies were assessed during the employee's orientation. Record #95264: The employee was hired on 8/4/2021. There is no evidence that clinical competencies were assessed during the employee's orientation. Record #51210: The employee was hired on 8/3/2021. There is no evidence that clinical competencies were assessed during the employee's orientation. Record #75895: The employee was hired on 5/11/2021. There is no evidence that clinical competencies were assessed during the employee's orientation. The Administrator was interviewed on 1/5/2021 and stated that there were no clinical competency checklists. She explained that the current process was for each clinician to complete a self-assessment upon hire to identify areas that are self-identified as requiring additional education. The other identified education was to be provided during orientation. However, the orientation checklist does not include all of the areas that were identified in the self-assessment.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary and the patient's record, if requested. This standard was not met as evidenced by clinical record review and interview. 1 of 1 (100%) applicable record for a patient that revoked hospice services reviewed revealed that the discharge summary was not sent to the patient's attending physician. Record #26127: The patent revoked hospice services and was discharged on 7/7/2021. The record contained no documentation that the patient's attending physician was notified of discharge or sent a discharge summary. The Administrator was interviewed on 1/5/2021 and agreed that there is no documentation that a discharge summary was sent to the patient's attending physician and provided no additional information.