Every finding on record at Hospice of Green Country, Inc.

Based on record review and interview, the hospice failed to ensure hospice aide visits were provided in accordance with the plan of care for two (Patients #5 and 7) of 14 patients. --- Findings:Patient #5A review of the plan of care dated 03/09/25 to 05/07/25 with plan of care updates dated 03/11/25, 03/25/25, 04/04/25, 04/15/25 and 04/29/25 showed a hospice aide frequency of two visits every 15 days.  A review of the clinical record showed the following:A hospice aide missed visit note (due to refusing shower) dated 03/14/25 and a hospice aide visit dated 03/21/25 for the weeks of 03/09/25 to 03/22/25 (one of two ordered visits completed).  Documentation showed no patient/caregiver refusal of other hospice aide services, no attempts to reschedule the missed visit and no physician orders to change the ordered frequency.A hospice aide visit dated 03/28/25 and a hospice aide missed visit note dated 04/04/25 (due to the refused shower) for the weeks of 03/23/25 to 04/05/25 (one of two ordered visits completed).  Documentation showed no patient/caregiver refusal of other hospice aide services, no attempts to reschedule the missed visit and no physician orders to change the ordered frequency.Patient #7A review of the plan of care dated 03/27/25 to 05/25/25 with plan of care updates dated 04/04/25, 04/15/25, 04/29/25, 05/06/25 and 05/20/25 showed a hospice aide frequency of one visit every 15 days.  A review of the clinical record showed the following:Hospice aide missed visit notes dated 04/01/25 (due to still in bed) and 04/08/25 (due to sleeping) for the weeks of 03/30/25 to 04/12/25 (no ordered visits completed).  Documentation showed no patient/caregiver refusal of visits, no attempts to reschedule the missed visits and no physician orders to change the ordered frequency.Hospice aide missed visit notes dated 04/18/25 (due to not needing help today) and 04/22/25 (due to not needing help today) for the weeks of 04/13/25 to 04/26/25 (no ordered visits completed).  Documentation showed no patient/caregiver refusal of visits, no attempts to reschedule the missed visits and no physician orders to change the ordered frequency.Hospice aide missed visit notes dated 04/29/25 (due to not needing help today) and 05/06/25 (due to spouse refused) for the weeks of 04/27/25 to 05/03/25 (no ordered visits completed).  Documentation showed no attempts to reschedule the missed visits and no physician orders to change the ordered frequency.Hospice aide missed visit notes dated 05/13/25 (due to patient refusal) and 05/20/25 (due to no needs at this time) for the weeks of 05/11/25 to 05/24/25 (no ordered visits completed).  Documentation showed no attempts to reschedule the missed visits and no physician orders to change the ordered frequency.On 06/25/25 at 1:25 pm., Staff B stated the hospice aide frequency was not followed as ordered for Patients #5 and 7.

Based on record review and interview, the hospice failed to ensure the plan of care was revised to reflect decreased hospice aide services for one (Patient #5) of 14 patients. --- Findings:Patient #7A review of the plan of care dated 03/27/25 to 05/25/25 and plan of care updates dated 04/04/25, 04/15/25, 04/29/25, 05/06/25 and 05/20/25 showed a hospice aide frequency of one visit every 15 days.  A review of the clinical record showed the following:Hospice aide missed visit notes dated 04/01/25 showed visit was missed because patient was still in bed.  Hospice Aid visit dated 04/08/25 was missed because patient was sleeping. No ordered visits were completed for the weeks of 03/30/25 to 04/12/25.Hospice aide missed visits notes dated 04/18/25 and 04/22/25 showed visit was missed due to not needing help today. No ordered visits were completed for the weeks of 04/13/25 to 04/26/25.Hospice aide missed visit notes  dated 04/29/25 showed no visit made due to not needing help today. Hospice aide missed visit note date 05/06/25 showed visit missed due to spouse refused. No ordered visits were completed for the weeks of 04/27/25 to 05/03/25.Hospice aide missed visit notes  dated 05/13/25 showed no visit due to patient refusal. Missed visit note dated  05/20/25 showed visit missed due to no needs at this time. No ordered visits were completed for the weeks of 05/11/25 to 05/24/25.No hospice aide visits were completed during this certification period.A review of the plan of care updates showed no IDG discussion regarding the frequent missed visits or needs to reduce or cancel the hospice aid visit frequency.On 06/25/25 at 1:50 pm., Staff B stated the plan of care was not updated to reflect the decreased need for hospice aide services for Patient #7.

Based on record review and interview, the hospice failed to ensure the hospice aide notified the supervising nurse of missed and incomplete visits for two (Patients #5 and 7) of 14 patients. --- Findings:Patient #5A review of the plan of care dated 03/09/25 to 05/07/25 with plan of care updates dated 03/11/25, 03/25/25, 04/04/25, 04/15/25 and 04/29/25 showed a hospice aide frequency of two visits every 15 days.  A review of the clinical record showed the following:A hospice aide missed visit (due to the refusing shower) dated 03/14/25 and a hospice aide visit dated 03/21/25 for the weeks of 03/09/25 to 03/22/25 (one of two ordered visits completed).  Documentation showed no notification to the supervising nurse of the missed or incomplete visits.A hospice aide visit dated 03/28/25 and a hospice aide missed visit dated 04/04/25 (due to the refused shower) for the weeks of 03/23/25 to 04/05/25 (one of two ordered visits completed).  Documentation showed no notification to the supervising nurse of the missed or incomplete visits.Patient #7A review of the plan of care dated 03/27/25 to 05/25/25 with plan of care updates dated 04/04/25, 04/15/25, 04/29/25, 05/06/25 and 05/20/25 showed a hospice aide frequency of one visit every 15 days.  A review of the clinical record showed the following:Hospice aide missed visits dated 04/01/25 (due to still in bed) and 04/08/25 (due to sleeping) for the weeks of 03/30/25 to 04/12/25 (no ordered visits completed).  Documentation showed no notification to the supervising nurse of the missed or incomplete visits.Hospice aide missed visits dated 04/18/25 (due to not needing help today) and 04/22/25 (due to not needing help today) for the weeks of 04/13/25 to 04/26/25 (no ordered visits completed).  Documentation showed no notification to the supervising nurse of the missed or incomplete visits.Hospice aide missed visits dated 04/29/25 (due to not needing help today) and 05/06/25 (due to spouse refused) for the weeks of 04/27/25 to 05/03/25 (no ordered visits completed).  Documentation showed no notification to the supervising nurse of the missed or incomplete visits.Hospice aide missed visits dated 05/13/25 (due to patient refusal) and 05/20/25 (due to no needs at this time) for the weeks of 05/11/25 to 05/24/25 (no ordered visits completed). Documentation showed no notification to the supervising nurse of the missed or incomplete visits.On 06/25/25 at 1:40 pm., Staff B stated there was no documentation of the hospice aide notifying the supervising nurse of missed or incomplete visits for Patients #5 and 7.

Based on record review and interview, the hospice failed to ensure volunteers provided services that equaled 5% of the total patient care hours of all paid hospice employees for 2024. --- Findings:A review of volunteer records and hours showed the hospice volunteers provided services that equaled 3.01% of the total patient care hours of all paid hospice employees for 2024. On 06/25/25 at 1:20 pm, Staff A stated the hospice volunteer services did not provide 5% of the total patient care hours of all paid hospice employees for 2024.

Based on record review and interview, the hospice failed to ensure the comprehensive assessment included data elements (with the exception of pain) that allowed for measurement of outcomes for four (Patients #3, 4, 10 and 11) of 11 patients. Findings: Patient #3 A review of the Initial Assessment dated 05/23/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. Patient #4 A review of the Initial Assessment dated 07/18/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. Patient #10 A review of the Initial Assessment dated 06/28/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. Patient #11 A review of the Initial Assessment dated 08/04/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. On 08/17/22 at 12:11 pm, Staff B stated pain was the only data element which was documented on the initial comprehensive assessments for Patients #3, 4, 10 and 11.

Based on record review and interview, the hospice failed to ensure skin assessments were provided in accordance with the plan of care frequency for one (Patient #10) of 11 patients. Findings: Patient #10 A review of the plan of care dated 06/28/22 to 09/25/22 showed a skilled nurse frequency of four visits in a 15 day period and documented orders to monitor wounds weekly for size/measurements. A review of the electronic medical record showed the following: Skilled nurse assessments dated 07/05/22 and 07/07/22 for the week of 07/02/22 to 07/08/22 (two of two assessments) documented no measurements and no assessment of the wound/wounds in accordance with the plan of care. On 08/17/22 at 12:25 pm, Staff B stated wound assessments were not followed as ordered for Patient #10.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for two (Patients #5 and 7) of 11 patients reviewed. Findings: Patient #5 A plan of care dated 05/26/22 to 07/24/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #7 A plan of care dated 06/05/22 to 08/03/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. On 08/17/22 at 12:22 pm, Staff B stated the plans of care for Patients #5 and 7 failed to include services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to ensure the plan of care was revised to reflect increased hospice aide services for one (Patient #4) of 11 patients. Findings: Patient #4 A review of the clinical record showed a plan of care dated 07/18/22 to 10/15/22 and plan of care updates dated 07/19/22, 08/02/22 and 08/16/22 which showed no orders for a hospice aide frequency. A review of the clinical record showed: Hospice aide visits dated 07/26/22 and 07/29/22 (two total visits) for the week of 07/23/22 to 07/29/22. Hospice aide visits dated 08/02/22 and 08/05/22 (two total visits) for the week of 07/30/22 to 08/05/22. Hospice aide visits dated 08/09/22 and 08/12/22 (two total visits) for the week of 08/06/22 to 08/12/22. On 08/17/22 at 12:16 pm, Staff B stated the plan of care should have been updated to reflect the increased hospice aide services provided for Patient #4.