Every finding on record at Hospice of Guernsey, Inc.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a 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 7 of 11 (64%) clinical records reviewed of patients with home health aide services it was revealed that the agency did not ensure that the home health aide care plan provided the aide with clear individualized instruction. CLINICAL RECORD 1: The aIde plan of care, last updated on 03/13/2025, included orders for the aide to provide "Total care for bed bath, sponge bath, tub and shower." The aide plan of care did not provide clear direction to the aide regarding which type of bathing to provide to the patient. The patient was admitted 04/05/2025 with an initial aide care plan dated 04/05/2024 that ordered "Provide total bed bath every visit." CLINICAL RECORD 3: The patient was admitted on 04/26/2025 with a diagnosis of Chronic Obstructive Pulmonary Disease. The plan of care dated 04/26/2025 included continuous oxygen at 3-4 liters per minute per nasal cannula and a home health aide visit three times a week. The home health aide care plan included the tasks: assist patient with dressing, shampoo hair, apply lotion/barrier cream, assist with bed bath, sponge, tub, and shower. The aide care plan did not specify which type of bath should be provided every visit, and did not provide instructions to the aide related to the patient's use of oxygen. CLINICAL RECORD 4: The patient was admitted with a diagnosis of Chronic Obstructive Pulmonary Disease on 07/17/2024. The plan of care for episode 05/13/2025-07/11/2025 included continuous oxygen at 2-4 liters per minute per nasal cannula and a home health aide visit two times a week. The aide care plan updated 03/13/2025 included the tasks; assist with bed bath, sponge, tub, or shower, but did not specify which type of bathing should be provided. The plan of care did not provide the aide with information or guidance related to the patient's use of oxygen. CLINICAL RECORD 5: The patient was admitted on 04/20/2023 with a diagnosis of Peripheral Vascular Disease. The aide care plan was updated on 03/11/2025 to include a task that read, "Total care bed bath, shower, tub bath". The aide plan of care did not provide guidance or direction to the aide related to which type of bathing to perform. The skilled nursing note on 04/30/2025 noted that the patient was non-verbal and not oriented. CLINICAL RECORD 7: The patient was admitted on 04/24/2025 with Peripheral Vascular Disease and a stasis ulcer on her left shin. The plan of care dated 04/24/2025 included orders for wound care of the lower leg, including wrapping the lower leg with kerlix. The aide plan of care, effective 04/25/2025, did not mention the lower leg wound or what the aide should do with the lower leg area. The aide plan of care ordered to assist with bed bath, sponge, tub, and shower, and did not specify which type of bathing to provide to the patient. CLINICAL RECORD 8: The aIde plan of care last updated on 03/13/2025 included orders for the aide to provide "Total care for bed bath, sponge bath, tub and shower." The aide plan of care did not provide clear direction to the aide regarding which type of bathing to provide the patient. CLINICAL RECORD 14: The patient was admitted on 02/13/2025 with a diagnosis of Huntington's Disease. The aide care plan initiated on 02/13/2025 by the RN was updated on 03/13/2025 to include the task, "Total care for bed bath, sponge bath, tub and shower." The added task did not provide the aide with clear direction related to which type of bath to perform. The aide care plan prior to 03/13/2025 provided an order for the aide to give the patient a shower. In an interview with the Administrator and the Director of Clinical Services on 05/21/2025, the Director of Clinical Services stated, "We just recently changed the aide care plans (March 2025) to include all types of bathing in case the patient wanted something different on a particular day. We were thinking that would give the patient more choice, but we see what you are saying. We will change it back.

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. This standard was not met as evidenced by clinical record review and interview. In 4 of 11 (36%) clinical records reviewed of patients that received aide services, it was revealed that the agency did not ensure that the home health aide reported changes in the care that was ordered to be provided to a registered nurse. CLINICAL RECORD 3: Hospice aide services were ordered three times a week. The tasks included on the aide care plan were apply lotion, assist patient with dressing, assist with bed bath, sponge, tub, and shower, change bed linens, and shampoo hair. The aide documented, "Patient refused" for every task for the visit notes dated 04/30/2025 and 05/14/2025. There was no documentation to indicate that the nurse was notified that the patient refused all services. CLINICAL RECORD 4: Hospice aide services were ordered two times a week. The aide visit notes dated 05/13/2025 and 05/20/2025 noted that the patient refused the ordered tasks of shaving face, and dental care. The aide documented "not applicable this visit" for the task to apply lotion/barrier cream. There was no notation that the aide notified the registered nurse related to changes in the care provided versus the care plan. CLINICAL RECORD 5: Hospice aide services were ordered twice a week. The aide care plan, last updated 03/11/2025, included oral care, and total care bed bath, shower, tub bath. The aide documented on 05/15/2025 that oral care was "not applicable to this visit". The aide documented "done" for total care bed bath, shower, tub bath and documented shower given under narrative notes. There was no documentation that the registered nurse was notified that oral care was not provided. CLINICAL RECORD 7: The patient was admitted on 04/24/2025 with a diagnosis of peripheral vascular disease. The plan of care developed on 04/24/2025 ordered an aide one time a week per patient preference. The aide care plan tasks included apply barrier cream, assist patient with dressing, assist with bed bath, sponge bath, tub and shower, change patient bed linens, provide incontinence care and shampoo hair. The aide provided a visit on 05/07/2025. The aide documented on her visit note that applying lotion, changing bed linens, and shampooing hair were not applicable this visit and the remaining tasks of assist patient with dressing, assist with bed bath, sponge, tub and shower, and provide incontinence care were all refused. There was no documentation that the registered nurse was notified. CLINICAL RECORD 9: The patient was admitted on 05/15/2025 with a diagnosis of malignant neoplasm of the female breast. The plan of care included a home health aide twice per week. The aide care plan created on 05/15/2025 included change patient bed linens, shampoo hair and swab mouth. The aide documented in her visit note on 05/20/2025 that the above ordered tasks were not applicable to the visit. The plan of care indicated that the tasks were ordered for each visit. There was no documented notification to the registered nurse. The Director of Clinical Services stated in an interview on 05/23/2025, " I understand, we need to edit our EMR and teach the staff."

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescriptions and over-the-counter (OTC) drugs. 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 interviews. In 6 of 13 (46%) records, review of patients' drug profiles revealed the agency did not ensure the use of all ordered prescription medications were added to the drug profiles. Clinical Record 4 - The patient was admitted to service on 5/31/2022. The Plan of Care ordered oxygen 2 liters per nasal cannula. Oxygen was not documented on the drug profile. Clinical Record 7 - The patient was admitted to hospice care on 11/10/2020. The initial Plan of Care and all subsequent plans of care included orders for oxygen, 2-4 liters per nasal cannula. Oxygen was not documented on the initial drug profile nor any subsequent drug profiles. Clinical Record 2 - The patient was admitted to hospice care on 12/6/2021. The initial Plan of Care ordered oxygen 2-4 liters per nasal cannula. Oxygen was not documented on the initial drug profile nor any subsequent drug profiles. Clinical Record 1 - The patient was admitted to hospice care on 1/31/2022. The initial plan of care and all subsequent plans of care ordered oxygen at 3 liters per nasal cannula. Oxygen was not documented on the initial drug profile nor any subsequent drug profiles. Clinical Record 6 - The patient was admitted to service 3/4/2022. The initial Plan of Care and all subsequent plans of care ordered oxygen 2-4 liters per nasal cannula. Oxygen was not documented on the initial drug profile nor any subsequent drug profiles. Clinical Record 11 - The patient was admitted to service on 12/29/21. The initial Plan of Care and all subsequent plans of care documented oxygen 2-10 liters PRN. Oxygen was not documented on the initial drug profile, nor any subsequent drug profiles. Clinical Supervisor The Clinical Supervisor stated in interview on 8/3/22 during a joint review of the clinical records that oxygen could not be added to the drug profile.

It is required that each patient’s individualized written plan of care: identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; and includes all services necessary for the palliation and management of the terminal illness, including drugs and treatments necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records and interviews. In 1 of 13 (7%) clinical records reviewed, the plan of care did not include orders that described the frequency the ordered wound care was to be provided. Clinical Record 1 - The benefit period reviewed was 6/8/2022 - 9/5/2022. Wound care ordered on 7/7/22 documented: "Cleanse with saline and cover with telfa and ABD pad". The order did not include the frequency the wound care was to be performed. The Clinical Supervisor stated in interview on 8/3/22 during a joint review of the clinical records that the order did not include the frequency for the wound care was to be performed.

It is required that a hospice aide provides services that are 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 a review of clinical records and interviews. In 1 of 8 (12%) records of patients that received Hospice aide services, revealed the agency did not ensure the aide services were provided as directed on the aide plan of care. Clinical Record 11 - The benefit period covered 6/27/22 - 8/25/22 and Aide services were ordered as "2w12". The aide plan of care assigned the aide to complete a "tub bath 1 time/week" and a "shower 1 time/week". During the week of 7/11/22, the patient received a shower at both aide visits. The Clinical Supervisor stated on 8/3/22 during a joint review of the clinical records and interview that the aide would have to review the previous documentation to determine what type of bath needed to be provided.