Every finding on record at Lighthouse Hospice Care LLC

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 9 of 20 (45%) clinical records with aide services ordered reviewed revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 1: The record revealed a physician's order dated 02/28/2024 that read in part "Utilize aspiration precautions". The aide care plan dated 02/28/2024 read in part "Offer patient sips of fluids.". The aide care plan lacked instructions to the aide to utilize aspiration precautions. Clinical Record 3: The record revealed a physician's order dated 01/02/2024 that included wound dressing orders for a wound to the right leg. The aide care plan dated 01/02/2024 lacked instructions related to the wound dressing on the right leg. Clinical Record 4: The record revealed a physician's order dated 05/16/2024 that included wound dressing orders for a wound to the sacrum. The aide care plan dated 05/16/2024 lacked instructions related to the wound dressing on the sacrum. The record also revealed an initial nursing assessment dated 05/16/2024 that read in part "patient has a foley catheter". The aide care plan dated 05/16/2024 lacked instructions for catheter care. Clinical Record 9: The record revealed a physician's order dated 04/21/2024 that included wound dressing orders for wounds to the right hip, right thigh and sacrum. The aide care plan dated 04/22/2024 lacked instructions related to the wound dressings on the right hip, right thigh and sacrum. Clinical Record 13: The record revealed a physician's order dated 05/22/2024 that included wound dressing orders for wounds to both lower extremities. The current aide care plan in the record was dated 10/03/2023 and lacked instructions related to wound dressings. Clinical Record 15: The record revealed a physician's order dated 05/02/2024 that included wound dressing orders for a wound to the left heel. The aide care plan dated 05/02/2024 lacked instructions related to the wound dressing on the left heel. Clinical Record 18: The record revealed a physician's order dated 12/19/2023 that included wound dressing orders for a wound to the right foot. The aide care plan dated 12/19/2023 lacked instructions related to the wound dressing on the right foot. Clinical Record 19: The record revealed a physician's order dated 05/16/2024 that included orders to insert and maintain an 18Fr foley catheter. The aide care plan dated 05/16/2024 lacked instructions for catheter care. Clinical Record 20: The record revealed a physician's order dated 07/10/2023 that included wound dressing orders for wounds to the right ankle and right side of the scalp. The aide care plan dated 07/11/2023 lacked instructions related to the wound dressings on the right ankle and right side of the scalp. In an interview on 06/21/2024, the VP of Clinical Operations reviewed the records, confirmed the findings, and stated "I understand what you are saying. There should have been instructions for the wound dressings and catheter care.".

It is required that a hospice aide provides services: 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 clinical record review and interview. In 1 of 20 (5%) clinical records reviewed with aide services ordered revealed that the agency did not ensure that the aide only performed care included in the plan of care. Clinical Record 20: The record revealed aide visit notes dated 10/25/2023, 10/27/2023, 10/31/2023, 11/03/2023, 11/07/2023 and 11/08/2023 that read in part "catheter bag emptied". The aide care plan dated 09/28/2023 lacked instructions to empty the catheter bag. On 06/21/2024, the VP of Clinical Operations reviewed the record and confirmed the findings.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 20 (5%) clinical records reviewed revealed that the agency did not ensure that all physician orders were included in the patient's clinical record. Clinical Record 7: The record revealed an initial nursing assessment dated 03/04/2024 that read in part "Patient's 16Fr foley changed this visit.". The record lacked physician's orders to change the foley catheter until 05/20/2024. On 06/21/2024, the VP of Clinical Operations reviewed the record and confirmed the findings.