Every finding on record at Interim Healthcare of Kansas City

It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the patient's plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 3: The patient elected the hospice benefit on 04/22/2025 with a diagnosis of cerebral infarction. The plan of care dated 04/22/2025 through 07/20/2025 ordered "Eliquis (anticoagulant) 5mg tablet by mouth twice daily." The plan of care did not document interventions related to the patient being at risk for bleeding. Clinical Record 7: The patient elected the hospice benefit on 11/13/2024 with a diagnosis of congestive heart failure (CHF). The plan of care dated 11/13/2024 through 02/10/2025 ordered "Eliquis (anticoagulant) 5mg tablet by mouth twice daily." The plan of care did not document interventions related to the patient being at risk for bleeding. During a joint record review on 05/08/2025, the Clinical Director confirmed the findings, stating, "These plans of care did not include interventions for bleeding risk."

It is required that each patient’s individualized written plan of care: includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the patient's plan of care included treatments necessary to meet the patient's needs. Clinical Record 4: The patient elected the hospice benefit on 03/06/2025 with a diagnosis of severe protein-calorie malnutrition. The plan of care dated 03/06/2025 through 06/03/2025 ordered "Change Foley catheter monthly and as needed for blockage." The plan of care did not include documentation of a physician's order for the size of the Foley catheter. Clinical Record 5: The patient elected the hospice benefit on 04/02/2025 with a diagnosis of Parkinson's disease. The plan of care dated 04/02/2025 through 06/30/2025 ordered "Insert indwelling Foley catheter to drain for urinary retention." The plan of care did not include documentation of a physician's order for the size of the Foley catheter. During a joint record review on 05/08/2025, the Clinical Director confirmed the findings, stating, "These plans of care did not include the size of the Foley catheter that the patient was using."

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 and interview. In 1 of 12 (8%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide was supervised by the Registered Nurse (RN) no less frequently than every 14 days to assess the quality of care and services provided. Clinical Record 4: The patient elected the hospice benefit on 03/06/2025 with a diagnosis of severe protein-calorie malnutrition. The patient resided in an assisted living facility (ALF). The plan of care dated 03/06/2025 through 06/03/2025 ordered "Aide 2wk, 11wk." The first HA visit was dated 03/10/2025. The HA supervisory visits were dated 04/07/2025 and 04/22/2025, with 15 days outstanding. During a joint record review on 05/08/2025, the Clinical Director confirmed that Hospice Aide supervisory visits were completed less frequently than every 14 days.

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 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. 2 of 11 (18%) of the clinical records reviewed revealed that the agency did not ensure that the medication profile was complete and updated. Record 4: Nursing documentation on 6/9/2022, states, “continues to apply antifungal powder under breasts.” Antifungal powder is not listed on the medication profile. Record 5: Documentation on 6/01/2022 documented that patient was using five liters of oxygen per nasal cannula. On 6/8/2022, record revealed that patient was using six liters of oxygen per nasal cannula. Oxygen is not listed on medication profile. Staff #4 Interview with Clinical Director confirmed that medication profiles were not complete. 2 of 11 (18%) of the clinical records revealed that the agency did not ensure that the medication profile was complete and updated.

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 a review of clinical records, observations, and interviews. 2 of 6 (33%) of the clinical records in which a hospice aide was accepted, revealed a lack of clear and specific written instruction for the aide assignment, thus leaving the aide to make decisions outside of the aide scope of practice. Record 7: Physician orders on 6/17/2022 for continuous oxygen as needed. Observation on a home visit on 7/12/2022 revealed the patient was wearing oxygen. Aide care plan dated 6/17/2022 and noted in progress does not mention oxygen. Staff #4 Clinical Director stated in an interview on 7/13/2022 that the aide care plans did not give specific instructions to the aides. Record 3: Physician orders on 6/25/2022 for wound care on the patient's back and orders on 7/9/2022 for wound care to the patient's right lower anterior leg. Aide care plan date 6/1/2022 was not updated to instruct the aide on handling wound dressings while bathing. 2 of 6 (33%) of the clinical records, in which a hospice aide was accepted, revealed a lack of clear and specific written instruction for the aide assignment, thus leaving the aide to make decisions outside of the aide scope of practice.

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 a review of clinical records and interviews. 5 of 6 (83%) of the clinical records with a home health aide revealed that the agency did not ensure that the hospice aide provided services as ordered by the Interdisciplinary Group and included in the plan of care. Record 2: Aide documentation on 6/30/2022, 7/8/2022, and 7/11/22 reveal documentation stating "not applicable this visit" on two tasks ordered on the aide care plan. Record 9: Aide documentation on 6/3/2022, 6/17/2022, 6/21/2022, and 6/24/2022 revealed "unable to document; not applicable this visit" on four tasks ordered on the care plan. Record 5: Aide documentation on 7/12/2022 and 7/5/2022 noted three assigned tasks on the care plan as "not applicable this visit." Aide documentation on 7/8/2022 reported four tasks as "not applicable on this visit" Aide notes on 6/28/2022 and 7/1/2022 revealed "not applicable to this visit" on two assigned tasks. Record 7: Aide documentation on 6/21/2022 reveals "unable to document: not applicable to this visit" on eight tasks included in the care plan. Aide note on 6/24/2022 indicated "unable to document: not applicable this visit" on three tasks assigned on the care plan. Aide documentation on 7/1/2022 revealed "unable to document: not applicable this visit" on six tasks ordered on the aide care plan. Notes on 7/5/2022 revealed "unable to document: not applicable this visit" on seven tasks assigned on the care plan. Record 3: Documentation on 6/29/2022 aide note reveals "unable to document" for the task of nail care. Aide documentation on 7/1/2022 indicates "unable to document" for the task of changing patient linens, bath/shower chair, water temperature check, and oral care. Aide documentation on 7/8/2021 reveals "unable to document" for task change patient linen and assist patient with dressing. Staff #4 Interview with Clinical Director confirmed that the documentation read "Unable to document" or "unable to document: not applicable to this visit." Clinical Director reported that the new clinical software has some glitches and should not be documentation options. 5 of 6 (83%) of the clinical records with a home health aide revealed that the agency did not ensure that the hospice aide provided services as ordered by the Interdisciplinary Group and included in the plan of care.