Every finding on record at Life Choice Hospice of New Hampshire II, LLC

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene. This standard was not met as evidenced by clinical record review, document review, interview, and observation. Agency policy #IPC.11_A2 "Infection Control: Bag Technique and Hand Hygiene with Competency" stated in part, "When to use hand gel (sanitizer) before direct patient contact and after patient contact, after contact with inanimate objects in the patient's environment." In 1 of 4 (25%) home visits observed, the agency did not ensure that hand hygiene was performed when indicated per the agency's policy. HOME VISIT 2/CLINICAL RECORD 2: This patient elected the hospice benefit on 06/08/2025 with a terminal diagnosis of cerebral atherosclerosis. During the home visit with the Hospice Aide (HA) [Personnel Record 2] on 09/17/2025, the HA was observed providing a bed bath for the patient. During the bed bath, the HA reached into the patient's drawer to obtain an item, then continued the patient's bath without changing gloves or sanitizing their hands. During an interview, the Hospice Area Executive of Clinical Services, who was present for the home visit, confirmed the finding and stated that the HA should have removed her gloves and sanitized her hands before reaching into the patient's drawer. A plan of correction was written, and the staff was re-educated on the infection control policy during the site visit.

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 1 of 14 (7%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions to meet the patient's needs. CLINICAL RECORD 8: The patient elected the hospice benefit on 04/01/2025 with a terminal diagnosis of cerebrovascular disease with chronic dysphagia. The Registered Nurse (RN) initial comprehensive assessment dated 04/01/2025 documented that the patient had chronic dysphagia with a recent hospitalization for aspiration pneumonia, and that the patient received regular foods with thickened fluids as per the patient's daughter and the facility staff. The plan of care dated 04/01/2025 ordered "instruct on ordered nutritional diet" and "thickened liquids, regular diet." A review of the HA care plans for the dates 04/01/2025 through 09/17/2025 revealed that the HA care plan dated 04/03/2025 assigned the HA the relevant task to provide "intake fluids every visit," and the HA care plan dated 06/18/2025 assigned the HA to "assist with breakfast and lunch." The HA care plans did not document instructions for the patient to receive thickened fluids as per the hospice plan of care. In an interview and a joint record review on 09/17/2025, the Hospice Area Executive of Clinical Operations and Director of Quality Outcomes confirmed that the Hospice Aide care plan did not include instructions for thickened liquids for the patient. They stated that the HA care plan would be updated to include instructions for thickened fluids. A plan of correction was written, and the agency's clinical staff was re-educated during the site visit.

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 and interviews. 1 of 13 (8%) clinical records reviewed in which the hospice aide was accepted, revealed a lack of clear and specific written instructions for the aide assignment thus leaving the aide to make decisions outside of the aide scope of practice. Clinical Record 2: The patient was admitted for hospice services on 1/27/22, with a primary diagnosis of Alzheimer's Disease. The aide plan of care dated 1/27/22 assigned both a bed bath daily and a partial sponge bath every visit. There was no clear direction on which bath to provide and the patient was not able to make decisions regarding personal care. An interview with the Director of Clinical Services and the Hospice Area Executive of Clinical Operations confirmed that the plan of care was not specific.