Every finding on record at Interim Health Care of the Triad, Inc

Based on observation, interview, record review and review of facility policy entitled ";Drugs and Biologicals-Administration, Use and Disposal", the hospice Registered Nurse (RN) failed to provide and update a current medication list for 3 of 3 patients (Patient #1, #2 and # 3). Record Review of the facilitys policy entitled ";Drugs and Biologicals-Administration, Use and Disposal" dated 2019 showed that the designated RN is to maintain a current medication profile for hospice patients and to verify medication changes with the hospice Medical Director or the patients attending physician. --- Findings included Observation on 01/14/25 at 9:15 AM showed Patient #1s medication list for the hospice listed Augmentin 875 mg 1 tablet by mouth twice a day for 7 days. Patient #1 caregiver reports patient has not been taking this medication ";for months". During an interview on 01/16/25, Branch Manager stated that the medication should have been removed from the list. Observation on 01/14/25 at 10:45 AM showed Patient #2s medication listed Tylenol 325 mg 1 tablet by mouth daily. Prescription bottle and caregiver report Tylenol 500 mg 1 tablet by mouth daily and as needed for pain. RN #2 verified the finding at the observation visit on 01/14/25. Observation on 01/14/25 at 12:30 PM showed Patient #3s hospice medication list reports Metoprolol tartrate 25 mg 1 table by mouth daily; caregiver reports patient taking Metoprolol tartrate 25 mg 1 tablet by mouth twice a day. Hospice medication list reports patient taking trazadone 50 mg tablet taking 1.5 tablet by mouth at bedtime; caregiver reports patient taking trazadone 50 mg tablet taking 2 tablets by mouth at bedtime. Caregiver reports patient taking Tylenol 500 mg tablets 1-2 tablets by mouth as needed for pain and Docusate 100 mg tablets, 2 tablets by mouth daily for constipation. Both of these medications are not on the hospice medication list. RN #1 verified the findings at the observation visit on 01/14/25.

Based on chart review, review of Interdisciplinary Group (IDG) notes, and interview, the hospice failed to follow the patient's Plan of Care (POC) regarding Medical Social Worker (MSW) and Home Health Aide (HHA) visit schedules for 6 out of 14 patients (Patient #4, #5, #7, #9, #12 and #14). --- The findings include: Review of Patient #4 medical record on 01/15/25 at 10:50 AM showed Start of Care (SOC) on 01/04/25 with HHA visits 2 visits for 1 week then 3 visits for 11 weeks. HHA visits are documented on 01/08/25 and 01/13/25. This does not follow the POC and there is no documentation in the chart to explain any circumstances. During chart review on 01/16/25 at 11:05 AM, Branch Manager is unable to find documentation and verifies the finding. Review of Patient #5s medical record on 01/15/25 at 11:30 AM showed SOC on 10/15/24 with HHA visits 2 visits per 1 week then 5 visits for 12 weeks. The week of 12/21/24 there is no visit on 12/25/24 and no documentation for a missed visit. During chart review on 01/16/25 at 11:15 AM, Branch Manager is unable to find documentation and verifies the finding. Review of Patient #7s medical record on 01/15/25 at 12:05 PM showed SOC on 01/08/25. There are no orders for MSW to perform an assessment visit. During chart review on 01/16/25 at 11:15 AM, Branch Manager is unable to find documentation and verifies the finding. Review of Patient #9s medical record on 01/15/25 at 12:50 PM showed SOC on 12/28/24. SN visits are scheduled as 3 visits for 1 week then 2 visits a week for 12 weeks. Week starting 01/04/25 has 1 visit by SN on 01/09/25 with no documentation for missed visit by RN that week. During chart review on 01/16/25 at 11:10 AM, Branch Manager is unable to find documentation and verifies the finding. Review of Patient #12s medical record on 01/15/25 at 2:08 PM showed SOC on 08/27/24. There are no orders for MSW to perform an assessment visit. MSW visit documented on 08/28/24. HHA visits are scheduled for 1 visit for 1 week then 2 visits a week for 12 weeks. HHA visit documented on 09/24/24 and no second visit documented that week. During chart review on 01/16/25 at 11:35 AM, Branch Manager is unable to find documentation and verifies the finding. Review of Patient #14s medical record on 01/15/25 at 2:28 PM showed SOC on 12/09/23. HHA visits are scheduled for 2 visits a week for 13 weeks. There are no documented HHA visits in the medical record. There is no documentation in the medical record why HHA visits were not completed. During chart review on 01/16/25 at 11:26 AM, Branch Manager is unable to find documentation and verifies the finding.

Based on observations, interview, and review of the hospice policy entitled ";Equipment/Supply Bag Techniques", the hospice staff failed to follow standards of practice for infection control by 1 of 1 Hospice Home Aide (HA #1) and 2 of 2 Registered Nurses (RN#1, RN #2) for 3 of 3 applicable patients (Patients #1, #2 and #3). Record Review of the facilitys policy entitled ";Equipment/Supply Bag Techniques" dated 2022 showed that the floor is considered a ";dirty" area and equipment should be retrieved from the supply bag after handwashing and placed on a clean surface. --- The findings include: Observation during Patient #1s home visit on 01/14/25 at 9:15 AM showed HHA entering patients home wearing gloves and only removing same gloves at the end of the visit. During an interview on 01/14/25 at 9:45 AM, HHA #1 stated that he/she thought she had exchanged gloves inside patients home in the kitchen.Observations during Patient #2s home visit on 01/14/25 at 10:45 AM showed RN #2 placed clean barrier on floor, performed hand hygiene, donned gloves and reached into equipment bag to retrieve supplies. RN #2 used a retractable measuring tape to acquire measurements of patients right upper arm circumference then retracted the tape without first sanitizing the extended tape. RN #2 was observed reaching into equipment bag with gloved hand 2 times without removing used gloves and performing hand hygiene and reaching into equipment bag 3 times with ungloved, non-sanitized hands to retrieve equipment. During an interview on 01/16/25 at 10:45 AM, the Branch Manager reported the finding does not follow hospice policy or best standards of practice for infection control. Observation during Patient #3s home visit on 01/14/25 at 12:30 PM showed RN #1 after using stethoscope to assess patient, place stethoscope under right arm without sanitizing the stethoscope first. During an interview on 01/14/25 at 1 PM, RN #1 stated that this was not a good practice and should have sanitized the equipment after use.

Based on observation and medical record review, the hospice Registered Nurse (RN) failed to provide individualized, specific, detailed instructions for the Home Health Aide (HHA) to follow when delivering patient care for 6 out of 10 patients (Patient #1, #3, #4, #6, #10 and #14). --- Findings include Observation visit for Patient #1 on 01/14/25 at 9:15 AM showed HHA Plan of Care (POC) with instructions to ";Make bed/change linens and Shaving" which HHA did not perform. Surveyor asked why these tasks were not performed and HHA stated that caregiver/spouse always does those tasks. HHA assignment also list for Bathing/personal hygiene: Complete Bath/Tub/Shower. This is not a clear, specific individualized instruction for the HHA to follow. Patient #1 Start of Care is 03/07/24 and HHA POC documents ";current aide plan effective 03/08/24". There has been no update of Patient #1s HHA assignment since SOC and caregiver is performing some tasks. Patient #1 is also a high fall risk. There is no documentation on the HHA POC to indicate this. During an interview on 01/16/25, Branch Manager stated that the HHA POC should have been updated by the RN and more individualized. Observation visit for Patient #3 on 01/14/25 at 12:30 PM showed HHA assignment lists for Bathing/personal hygiene: Complete Bath/Tub/Shower. This is not a clear, specific individualized instruction for the HHA to follow. Patient #3 is also a high fall risk, there is no documentation on the HHA POC to indicate this. During an interview on 01/16/25, Branch Manager stated that the HHA POC should have been updated by the RN and more individualized. Review of Patient #4s medical record on 1/15/25 at 10:50 AM showed SOC on 01/04/25 with HHA visit schedule 2 visits for 1 week then 3 visits per week for 11 weeks. Patient is a high risk for falls, there is no documentation on the HHA POC to indicate this. HHA visit documentation for 01/08/25 and 01/13/25 document no care from the HHA and no indication why care was not performed. During an interview on 01/16/25 at 11:05 AM, Branch Manager stated that the HHA should have documented why care was not completed and notified the RN. Review of Patient #6s medical record on 1/15/25 at 11:30 AM showed SOC on 10/15/24 with HHA visit schedule 2 visits for 1 week then 5 visits per week for 12 weeks. Patient has diagnosis of Chronic Obstructive Pulmonary Disease and uses oxygen in the home but there is no documentation on the HHA assignment to indicate oxygen precautions. During an interview on 01/16/25 at 11:15 AM, Branch Manager stated that the RN should have added oxygen precautions on the assignment. Review of Patient #10s medical record on 1/15/25 at 1:10 PM showed SOC on 11/19/24 with HHA visit schedule 2 visits for 1 week then 2 visits per week for 12 weeks. HHA Assignment showed HHA lists for Bathing/personal hygiene: Complete Bath/Tub/Shower. This is not a clear, specific individualized instruction for the HHA to follow. During an interview on 01/16/25 at 11:20 AM, Branch Manager stated that the HHA POC should have been updated by the RN and more individualized. Review of Patient #13s medical record on 1/15/25 at 1:55 PM showed SOC on 05/24/24 with HHA visit schedule 5 visits for 12 weeks. HHA Assignment showed HHA lists for Bathing/personal hygiene: Complete Bath/Tub/Shower. This is not a clear, specific individualized instruction for the HHA to follow. During an interview on 01/16/25 at 11:21 AM, Branch Manager stated that the HHA POC should have been updated by the RN and more individualized.

Based on chart review and interview, the hospice failed to provide documentation when patients revoke hospice care that the patients provider and/or receiving facility was provided with a written discharge summary for 2 out of 2 patients (Patient #13 and #14). --- Findings include Review of Patient #13s medical record on 1/15/25 at 1:55 PM showed patient SOC on 05/24/24 and revocation of hospice on 07/29/24. There is no clear documentation that the discharge summary was sent to the receiving facility or provider. During chart review on 01/16/25 at 11:21 AM, Branch Manager was unable to find documentation. Review of Patient #14s medical record on 1/15/25 at 2:28 PM showed patient SOC on 12/09/23 and revocation of hospice on 01/02/24. There is no clear documentation that the discharge summary was sent to the receiving facility or provider. During chart review on 01/16/25 at 11:26 AM, Branch Manager was unable to find documentation.

Based on observations, review of patient charts, and interview, the Registered Nurse (RN) failed to update the patients's medication profiles with current medications for 3 of 11 patient charts. The findings include: Patient #5 Observations with RN #1 in Patient #5's home was conducted on 2/15/2022 at 10:40 AM. During the home visit, Patient #5 reported that he/she takes Miralax Pro Re Nata (PRN) for constipation and PreserVision over the counter tablets for vision. Review of Patient #5's medication profile on 2/15/2022 at 2:22 PM revealed neither the Miralax nor the Preservision had been updated to the patient's medication profile. The medications were not documented on the patient's current medication profile. On 2/17/2022 at 9:15 AM, RN #1 confirmed the findings. Patient #6 Observations with RN #1 in Patient #6's home was conducted on 2/15/2022 at 11:42 AM. The Caregiver reported the patient no longer takes Simvastatin 20 mgs(milligrams)by mouth daily, and no longer takes Alogliptin 25 mgs by mouth daily. Review of the patient's medication profile and chart on 2/15/2022 at 2:45 PM showed Simvastatin 20 mgs(milligrams)by mouth daily and Alogliptin 25 mgs by mouth daily as the patient's current medications. The SN had not updated the patient's current medication profile. On 2/17/2022 at 9:25 AM, RN #1 confirmed the findings. Patient #10 Review of Patient #10's chart on 2/16/2022 at 9:46 AM revealed in the RN's notes that the patient started Bactrim DS 1 tablet by mouth twice a day for 10 days and Bactroban 2%(percent) ointment to be applied to the patient's left axilla 3 times a day for 10 days. The medications were not documented on the patient's current medication list in the patient's chart. On 2/17/2022 at 9:45 AM, RN #1 confirmed the findings.

Based on observations, patient chart review, and interview, the Registered Nurse (RN) failed to ensure continuous assessments for patient and family needs in development and updating Certified Nurse Assistant (CNA) assignments for 5 of 9 patients ordered CNA services. (Patient #2, #4, #6, #8 and #11) The findings include: Patient #2 On 2/142022 at 12:17 PM, review of Patient #2's chart revealed the hospice had no documentation of the "CNA Care Assignment" sheet. During an interview on 2/17/2022 at 8:50 AM, RN#1 confirmed the findings. Patient #4 On 2/15/2022 at 1:30 PM, review of Patient #4's chart revealed the CNA visit schedule decreased on 1/28/2022 to 4 times a week from 5 times a week. Review of the CNA's assignment sheet revealed the patient was to receive a shower on Monday, Wednesday, and Friday, and receive a sponge bath on Tuesday and Thursday. Review of the CNA's assignment form revealed the patient was to receive denture care and oral care every visit and change patient bed linens every visit. On 2/15/2022 at 9:40 AM, CNA #1 revealed the caregiver performs the patient's oral care in the mornings after breakfast. The CNA reported the patient was exposed to COVID-19 during the week of 1/24/2020, but there was no documentation in the CNA's assignment to reflect the patient was exposed to COVID - 19. On 2/17/2022 at 8:57 AM, RN #1 confirmed the finding. Patient #6 On 2/15/2022 at 2:45 PM, review of Patient #6's chart revealed the CNA assignment sheet was updated on 4/17/2020, 7/20/2020, 10/15/2020, 12/10/2020 and 2/4/2022. There was no documentation of the CNA assignment sheets 2021. Review of the current CNA Assignment sheet revealed "Assist Bath in Chair every visit" as "Pt/Cg(Patient/Caregiver) request" with shower. Observation during a home visit on 2/15/2022 at 11:42 AM revealed the patient is bed bound and requires a Hoyer lift. There was no documentation in the CNA's assignment for use of a Hoyer lift for the patient. On 2/17/2022 at 9:25 AM, during interview, RN #1 confirmed the finding. Patient #8 On 2/16/2022 at 12:00 PM, review of Patient #8's chart revealed no documentation on the assignment sheet of patient transfer from home to ALF. During interview on 2/17/2022 at 10:20 AM, RN #1 reports patient was admitted in his/her home and now resides in an Assisted Living Facility (ALF). On 2/17/2022 at 10:20 AM, during interview RN #1 confirmed the finding. Patient #11 On 2/16/2022 at 10:19 AM, review of Patient # 11's chart revealed CNA assignment sheet updates documented on 12/29/2020, 9/13/2021 and 11/24/2021 with no documentation of updates for the present episode beginning 12/23/2021 and between 1/1/2021 to 9/13/2021. On 2/17/2022 at 9:40, during interview RN #1 confirmed the finding.

Based on chart review, review of Interdisciplinary Group (IDG) notes, and interview, the hospice failed to follow the patient's Plan of Care (POC) regarding Certified Nurse Assistant (CNA) and Registered Nurse (RN) visit schedules for 9 of 11 patient charts. (Patient #1, #3, #4, #6, #7, #8, #9, #10 and #11) The findings include: Patient #1 On 2/14/2022 at 12:52 PM, review of Patient #1's the Start of Care (SOC) dated 11/16/2021 and the patient's Admission IDG Plan of Care revealed Skilled Nurse(SN) visits 2 times a week and 3 prn (as needed) visits. Review of the week (11/17/2021) showed only 1 RN visit documented that week. On 2/17/2022 at 8:34 AM, RN #1 verified the finding. Patient #3 On 2/14/2022 at 1:46 PM, review of the Patient #3's IDG Plan of Care dated 12/17/2021 revealed SN visits 2 times a week and 3 prn. Review of the weeks (12/20/2021 and 12/27/2021) revealed only 1 SN visit documented each week. On 2/17/2022 at 8:25 AM, RN #1 verified the finding. Patient #4 On 2/15/2022 at 1:30 PM, review of the Patient #4's IDG Plan of Care dated 1/28/2022 revealed SN visits 1 time a week and 3 prn. Review of the weeks (1/24/2022 and 2/7/2022) revealed there were no documented SN visits each week. On 2/17/2022 at 8:57 AM, RN #1 verified the finding. Patient #6 On 2/15/2022 at 2:45 PM, review of Patient #6's IDG Plan of Cares dated 12/31/2021,1/14/2022, and 1/28/2022 revealed SN visits 1 times a week and 3 prn. Review of the weeks (1/3/2022 and 2/7/2022) revealed there were no documented SN visits. Review of the patient's IDG Plan of Care dated 1/14/2022 revealed CNA(Certified Nursing Assistant) visits 5 times a week. Review of week (1/17/2022) revealed only 4 CNA visits documented. On 2/17/2022 at 9:25 AM, during RN #1 verified the findings. Patient #7 On 2/15/2022 at 3:37 PM, review of Patient #7's IDG Plan of Care dated 1/28/2022 revealed SN visits 2 times a week. Review of week (2/7/2022) revealed 1 documented RN visit. On 2/17/2022 at 10:57 AM, RN #1 verified the finding. Patient #8 On 2/16/2022 at 8:12 AM, review of Patient #8's IDG Plan of Care dated 1/28/2022 revealed SN visits 2 times a week and 3 prn. Review of weeks (1/31/2022 and 2/7/2022) revealed only 1 documented SN visit. Review of the patient's IDG Plan of Care dated 1/14/2022 revealed CNA visits 5 times a week. Review of week (1/24/2022) revealed only 4 CNA visits documented. On 2/17/2022 at 10:20 AM, RN #1 verified the findings. Patient #9 On 2/16/2022 at 9:09 AM, review of Patient #9's IDG Plan of Cares dated 12/31/2021 and 1/28/2022 revealed SN visits 2 times a week and 3 prn. Review of the weeks (1/10/2022, 1/24/2022, 1/31/2022 and 2/7/2022) revealed only 1 documented SN visit. On 2/17/2022 at 10:00 AM, RN #1 verified the findings. Patient #10 On 2/16/2022 at 9:46 AM, review of Patient #10's IDG Plan of Care dated 1/28/2022 revealed SN visits 2 times a week and 3 prn. Review of weeks (1/31/2022 and 2/7/2022) revealed only 1 documented SN visit. On 2/17/2022 at 9:45 AM, RN #1 verified the findings. Patient #11 On 2/16/2022 at 10:19 AM, review of Patient #11's IDG Plan of Care dated 1/28/2022 revealed SN visits 1 time a week and 3 prn. Review of weeks (1/25/2022, 1/31/2022 and 2/7/2022) revealed no documented SN visits. On 2/17/2022 at 9:40 AM, RN #1 verified the findings.

Based on review of patient charts and interview, the hospice failed to document individualized measurable outcomes for the goals listed in the patient's Plan of Cares (POC) for 9 of 11 patient charts. (Patient # 3, #4, #5, #6, #7, #8, #9, #10 and #11) The findings include: Patient #3 On 2/14/2022 at 1:46 PM, review of Patient #3's POCs dated 12/17/2021 and 12/31/2021 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 8:25 AM, RN #1 verified the findings. Patient #4 On 2/15/2022 at 1:30 PM, review of Patient #4's POCs dated 1/28/2022 and 2/11/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 8:57 AM, RN #1 verified the findings. Patient #5 On 2/15/2022 at 2:22 PM, review of Patient #5's POCs dated 1/28/2022 and 2/22/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 9:15 AM, RN #1 verified the findings. Patient #6 On 2/15/2022 at 2:45 PM, review of Patient #6's POCs dated 12/31/2021,1/14/2022, 1/28/2022, and 2/11/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 9:25 AM, RN #1 verified the findings. Patient #7 On 2/15/2022 at 3:37 PM, review of Patient #7's POCs dated 12/31/2021, 1/14/2022, and 1/28/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 10:15 AM, RN #1 verified the findings. Patient #8 On 2/16/2022 at 8:12 AM, review of Patient #8's POCs dated 12/31/2021, 1/14/2022, 1/28/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 10:20 AM, RN #1 verified the findings. Patient #9 On 2/16/2022 at 9:09 AM, review of Patient #9's POCs dated 12/31/2021,1/28/2022, and 2/11/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 10:00 AM, RN #1 verified the findings. Patient #10 On 2/16/2022 at 9:46 AM, review of Patient #10's POCs dated 1/28/2022 and 2/11/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 9:45 AM, RN #1 verified the findings. Patient #11 On 2/16/2022 at 10:19 AM, review of Patient #11's POCs dated 12/31/2021, 1/14/2022, 1/28/2022, and 2/11/2022 revealed the hospice had no measurable outcomes for the goals listed in the patient's active POC. The patient's POCs revealed "Pt(Patient) is progressing towards desired goals/outcomes" and "yes" was checked. There was no documentation of measurable data as to how or when outcomes would be achieved from implementation and coordinating the patient's plan of care. On 2/17/2022 at 9:40 AM, RN #1 verified the findings.

Based on observations, interview, and review of the hospice policy, the hospice staff failed to follow standards of practice for infection control by 1 of 2 Hospice Aides (HA #1) and 1 of 1 Registered Nurses (RN#1). The findings include: Patient #4 Observations during Patient #4's home visit on 2/15/2022 between 9:10 AM and 9:42 AM revealed HA#1 failed to change soiled gloves after peri-care was performed. During an interview on 2/16/2022 at 3:35 PM, the Clinical Management Coordinator reported the finding does not follow hospice policy. Patient #5 Observations during Patient #5's home visit on 2/15/2022 between 10:40 AM and 11:20 AM revealed RN #1 placed a clipboard on the patient's table without using a barrier under the clipboard. RN #1 used a retractable measuring tape to obtained the patient's arm circumference, retracted the tape into the case without sanitizing the tape. RN #1 patted and kissed the patient's dog, but did not perform hand hygiene after petting the dog. RN #1 carried un-sanitized loose equipment bundled in a dirty barrier back to his/her car and placed the soiled bundle of items in the trunk of the car without sanitizing the equipment. RN #1 failed to perform hand hygiene at the end of the visit. On 2/17/2022 at 9:15 AM, RN #1 verified the findings.

Based on patient chart review and interview, the Registered Nurse (RN) failed to provide specific individualized instructions for the Certified Nurse Aide (CNA) assignments for 9 of 9 patients receiving CNA services. (Patient #1, #2, # 4, #6, #7, #8, #9, #10 and #11) The findings include: Patient #1 On 2/14/2022 at 12:52 PM, review of Patient #1's chart revealed vague nonspecific instructions on the CNA assignment sheet regarding the patient's shower and chair bath. On 2/17/2022 at 8:34 AM, RN #1 confirmed the finding. Patient #2 On 2/14/2022 at 12:17 PM, review of Patient #2's chart revealed there was no documentation of a CNA assignment sheet in the patient's chart. On 2/17/2022 at 12:17 PM, RN #1 confirmed the finding. Patient #4 On 2/15/2022 at 1:30 PM, review of Patient #4's chart revealed vague, non-patient specific instructions on the CNA assignment sheet regarding the patient's tub bath/shower/partial bath schedules. On 2/17/2022 at 8:57 AM, RN #1 confirmed the finding. Patient #6 On 2/15/2022 at 2:45 PM, review of Patient #6's chart revealed vague, non-patient specific instructions on the CNA assignment sheet. Patient is bed bound and has Hoyer lift, but this information was not on the CNA assignment and CNA assignment reports for "assist bath in chair/shower seat". The CNA assignment sheet did not reflect Patient #6's current bed bound condition. On 2/17/2022 at 9:25 AM, RN #1 confirmed the finding. Patient #7 On 2/15/2022 at 3:37 PM, review of Patient #7's chart revealed vague, non-patient specific instructions on the CNA assignment sheet regarding the schedule for the patient's shower/partial bed bath/bath in chair. On 2/17/2022 at 10:15 AM, RN #1 confirmed the finding. Patient #8 On 2/16/2022 at 8:12 AM, review of Patient #8's chart revealed vague, non-patient specific instructions on the CNA assignment sheet regarding the patient's shower/chair bath schedules and changing patient linens. Patient resides in an Assisted Living Facility, but the CNA assignment sheet did not reflect that information. On 2/17/2022 at 10:20 AM, RN #1 confirmed the finding. Patient #9 On 2/16/2022 at 9:09 AM, review of Patient #9's chart revealed vague, non-patient specific instructions on the CNA assignment sheet regarding the patient's complete bed bath schedule. On 2/17/2022 at 10:00 AM, RN #1 confirmed the finding. Patient #10 On 2/16/2022 at 9:46 AM, review of Patient # 10's chart revealed vague, nonspecific instructions on CNA assignment sheet regarding the patient's schedule for chair bath, shampoo, hair care, nail care and changing briefs. On 2/17/2022 at 9:45 AM, RN #1 confirmed the finding. Patient #11 On 2/16/2022 at 10:19 AM, review of Patient #11's chart revealed vague, nonspecific instructions on the CNA assignment sheet regarding the patient's schedule for shower, chair bath, shampoo and nail care. Patient #11 had an admitting diagnosis of Lung Cancer, but there were no precautionary considerations noted regarding: respiratory issues, if patient has a caregiver, incontinence, or fall precautions. On 2/17/2022 at 9:40 AM, RN #1 confirmed the finding.

Based on chart review, review of Interdisciplinary Team (IDT) notes, and interview, the Certified Nurse Assistant (CNA) failed to follow the CNA delegated assignment for 6 of 9 patients. (Patient #1, #6, #7, #8, #9 and #10) The finding includes: Patient #1 On 2/14/2022 at 12:52 PM, review of Patient #1's chart revealed the patient's POC dated 1/5/2021 revealed "Shower every week as Pt/Cg(Patient/Caregiver) request" and "Assist bath in chair every visit/every week as Pt/Cg request". CNA documentation dated 11/18/2021 showed no documentation for "Complete Bath-Tub or Shower". CNA documentation dated 12/7/2021 had no documentation for "Complete Bath-Tub or Shower". On 2/17/2022 at 8:34 AM, RN#1 confirmed the findings. Patient #6 On 2/15/2022 at 2:45 PM, review of Patient #6's chart revealed the CNA assignment sheet instructs "Assist Bath in Chair every visit" as "Pt/Cg request" with shower sheet. Observations during the home visit on 2/15/2022 at 11:42 AM revealed patient was bed bound and received full bed bath. On 2/17/2022 at 9:25 AM, RN #1 confirmed the finding Patient #7 On 2/15/2022 at 3:37 PM, review of Patient #7's chart revealed the CNA assignment sheet instructed "Oral Care every visit, Check last BM(Bowel Movement) every visit". There was no documentation on 2/7/2022, 2/8/2022, 2/9/2020, 2/10/2022, or 2/11/2022 that oral care was completed and no documentation that the patient had a BM (bowel movement). On 2/17/2022 at 10:15 AM, RN #1 confirmed the finding. Patient #8 On 2/16/2022 at 8:12 AM, review of Patient #8's chart revealed the CNA assignment sheet instructed "Check last BM every visit". There was no documentation of the patient's last BM by the CNA on any Aide Weekly Records. On 2/17/2022 at 10:20 AM, RN #1 confirmed the finding. Patient #9 On 2/16/2022 at 9:09 AM, review of Patient #9's chart revealed CNA Assignment sheet instructs "Hair Care every visit" and "Check Last BM". Weekly Aide Record documents hair care not completed 2/7/2022 and 2/9/2022 and no documentation of BM on any Aide Weekly Records. On 2/17/2022 at 10:00 AM, RN #1 confirmed the finding. Patient #10 On 2/16/2022 at 9:46 AM, review of Patient #10's chart revealed the CNA assignment sheet instructed "Apply Powder every visit", "Oral Care every visit", and "Foot Care every visit". Weekly Aide Record documentation on 2/7/2022, 2/8/2022, 2/9/2022, 2/10/2022, and 2/11/2022 showed no powder was applied, no foot care was completed, and no oral care was completed. On 2/17/2022 at 9:40 AM, RN #1 confirmed the finding.

Based on review of hospice's in-service and external training data and interview, the hospice had no training or in- services related to education of facility staff on the hospice care and philosophy at an assisted living facility where patient receiving hospice services resides. The finding includes: Observations of care were conducted for a hospice patient in the assisted living facility on 2/16/2022. On 2/16/2022 at 3:33 PM, when the surveyor requested the education and training materials conducted by the hospice for the assisted living staff, the Administrator revealed the hospice had no training or in-service documentation that staff in facilities where hospice patients reside was conducted.