Every finding on record at Magnolia Hospice of Macon, LLC

Based on clinical record reviews and staff interview, it was determined that the hospice agency failed to ensure the care and services were provided in accordance with the plan of care for one Patient (P) (P#3) of 11 sampled patients who are current hospice beneficiaries. The findings include: --- Review of the clinical record for P#3 revealed the patient was admitted to hospice on 5/4/2022 with an admitting diagnosis of cerebrovascular disease (a group of conditions that affect blood flow and the blood vessels in the brain). Review of the plan of care revealed a wound care order dated 12/30/2022 for a stage 2 wound to the left upper buttocks. The wound care treatment was as follows: cleanse wound with normal saline, pat dry, apply Calmoseptine ointment, cover with 4x4 gauze and secure with paper tape daily or as needed. Review of the Skilled Nurse (SN) visit note by Registered Nurse (RN) (RNBB) dated on 1/5/2023, was documented as: Cleanse wound with wound cleanser, and Allevyn butterfly patch applied to the wound. The SN visit note by RNBB dated 1/13/2023, documents the following: dressing changed as per orders. The SN visit note by RNBB lacked step by step process and supplies used to provide wound care to the patient. RNBB failed to follow the wound care orders on the plan of care. During an interview at the agency office on 1/18/2023 at 11:00 a.m., RN BB stated that the patient did not have the specific supplies as ordered on the plan of care and utilized the supplies that (P#3) had at the time of the visit. During an interview with at the agency office with the Director of Nursing (DON), on 1/18/2023 at 2:00 p.m., the DON verbalized that wound care was not provided as per the plan of care.

Based on clinical record reviews and staff interviews, the hospice agency failed to ensure the frequency of visits for the hospice aides were provided in accordance with the patients plan of care for three out of three sampled Patients (P) (P#3, P#6, and P#7). Findings include: --- 1.The interdisciplinary care plan review for (P#3) with an admission date of 5/4/2022 and a diagnosis of cerebrovascular disease (refers to a group of conditions, diseases, and disorders that affect the blood vessels and blood supply to the brain) required the hospice aide to visit P#3 one to two times a week. The interdisciplinary care plan reviews dated 12/14/2022 and 12/28/2022 reflected that there were no changes in the visit frequency for the aide. The clinical record of P#3 revealed missed visit notes dated 12/14, 12/16, and 12/23/2022 which indicated the visits were missed due to ";other" reason. The clinical record lacked documentation that the medical director (MD) was notified of the missed visits resulting in unauthorized missed visits. The agency failed to follow the plan of care for frequency of aide visits. 2.The interdisciplinary care plan review for P#6 with an admission date of 8/3/2022, and a diagnosis of congestive heart failure ( a weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs) required the hospice aide to visit the patient two times a week. The interdisciplinary care plan reviews dated 12/14/2022 and 12/28/2022, reflected that there were no changes in the visit frequency for the aide. The clinical record revealed missed visit notes dated 12/1/2022 due to patient not home, 12/8, due to no one at the door and 12/13, due to ";other" reason. The clinical record lacked documentation that the MD was notified of the missed visits resulting in unauthorized missed visits. The agency failed to follow the plan of care for frequency of aide visits. 3. The interdisciplinary care plan review for P#7 with an admission date of 10/5/2022, and a diagnosis of end stage heart failure (a disease in which the heart muscle is failing severely in its attempt to pump blood through the body), required the hospice aide to visit the patient one time a week. The interdisciplinary care plan reviews dated 12/14/2022 and 12/28/2022 reflected that there were no changes in the visit frequency for the aide. The clinical record revealed missed visit notes dated 12/1/2022 due to patient not home, 12/8, due to no one at the door and 12/13, due to ";other" reason and 12/29/2022 due to patient not home. The clinical record lacks documentation that the MD was notified of the missed visits resulting in unauthorized missed visits. The agency failed to follow the plan of care for frequency of aide visits. During an interview with at the agency office with the Director of Nursing (DON), on 1/18/2023 at 2:00 p.m., the DON verbalized that wound care was not provided as per the plan of care. An interview conducted at the agency office with the Director of Nursing on 1/19/2023 at 2:00 p.m., confirmed the agency staff failed to follow the ordered plan of care for the aide visit frequency.

Based on clinical record reviews and staff interview, it was determined that the hospice agency failed to ensure the hospice aides provided services in accordance with the patients plan of care for three out of three sampled Patients (P) (P#3, P#6, and P#7). Findings include: --- 1. The interdisciplinary care plan review for (P#3) with an admission date of 5/4/2022 and a diagnosis of cerebrovascular disease (refers to a group of conditions, diseases, and disorders that affect the blood vessels and blood supply to the brain), required the hospice aide to visit the patient one to two times a week and assess vital signs at each visit notifying the skilled nurse if the vital signs fall outside of established parameters. The clinical record revealed the aide visited the patient on 12/7, 12/12, 12/28 and 12/30/2022. The clinical record lacked documentation that the aide took the patient's vital signs during each visit as ordered. The aide failed to follow the plan of care for monitoring vital signs as ordered. An interview was conducted with the Director of Nursing (DON) on 1/19/2023 at 2:00 p.m., and confirmed the aides are required to take vital signs at each visit if the plan of care directs this to be done. It was also confirmed the aides failed to take vital signs at each visit as required. 2. The interdisciplinary care plan review for #6 with an admission date of 8/3/2022 and a diagnosis of congestive heart failure (CHF), weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs. required the hospice aide to visit the patient two times a week and assess vital signs at each visit notifying the skilled nurse if the vital signs fall outside of established parameters. The clinical record revealed the aide visited the patient on 12/15, 12/20, 12/22, 12/27, and 12/29/2022. The clinical record lacked documentation that the aide took the patient's vital signs during each visit as ordered. The aide failed to follow the plan of care for monitoring vital signs as ordered. An interview was conducted with the Director of Nursing (DON) on 1/19/2023 at 2:00 p.m., and confirmed the aides are required to take vital signs at each visit if the plan of care directs this to be done. DON also confirmed the aides failed to take vital signs at each visit as required. 3. The interdisciplinary care plan review for P#7 with an admission date of 10/5/2022 and a diagnosis of end stage heart failure, (a disease in which the heart muscle is failing severely in its attempt to pump blood through the body), required the hospice aide to visit the patient one time a week and assess vital signs at each visit notifying the skilled nurse if the vital signs fall outside of established parameters. The clinical record revealed the aide visited the patient on 12/15, 12/20, 12/22, 12/27, and 12/29/2022. The clinical record lacked documentation that the aide took the patient's vital signs during each visit as ordered. The aide failed to follow the plan of care for monitoring vital signs as ordered. An interview was conducted with the Director of Nursing (DON) on 1/19/2023 at 2:00 p.m., it was confirmed the aides are required to take vital signs at each visit if the plan of care directs this to be done. It was also confirmed the aides failed to take vital signs at each visit as required.

Based on clinical record reviews and staff interviews, it was determined that the hospice aide failed to report a change in the patient's condition for one of three sampled Patients (P)(P#3) who was current hospice beneficiary. Findings include: --- The interdisciplinary care plan review for P#3 with an admission date of 5/4/2022 and a diagnosis of cerebral vascular disease, (a range of conditions that affect the flow of blood through the brain), required the hospice aide to visit the patient one to two times a week. The clinical record revealed the aide visited the patient on 12/30/2022 and P#3 reported not feeling well and felt like she was having difficulty breathing. The patient was placed on oxygen therapy by the caregiver. The clinical record lacked documentation that the aide notified the skilled nurse (SN) of a change in the patient's status as reported that the patient was experiencing respiratory problems. The aide failed to notify staff of a change in the patient's condition. During an interview with the certified nurse assistant (CNA), AA on 1/16/2023 at 3:00 p.m., it was confirmed that CNA, AA did not notify the SN of a change in the patient's condition. According to CNA, AA she did not know she was supposed to call the SN for a change in the patient's condition. During an interview with the Director of Nursing (DON) on 1/19/2023 at 2:00 p.m., it was confirmed the aides are required to notify the SN of a change in the patient's condition such as respiratory problems.

Based on clinical record reviews and staff interviews, it was determined that the hospice agency failed to perform complete supervisory aide visits by a Registered Nurse (RN) every two weeks to assess the effectiveness of the services provided by the home health aides for three of three sampled Patients (P) (P#3, P#6, and P#7) who received hospice aide services. Findings include: --- 1. The interdisciplinary care plan review for P#3 with an admission date of 5/4/2022 and a diagnosis of cerebrovascular disease (conditions that affect blood flow to your brain), required the hospice aide to visit the patient one to two times a week and assess vital signs at each visit notifying the skilled nurse if the vital signs fall outside of established parameters. The clinical record revealed the aide visited the patient on 12/7, 12/12, 12/28 and 12/30/2022. The clinical record lacked documentation that the aide took the patient's vital signs during each visit as ordered. The aide failed to follow the plan of care for monitoring vital signs as ordered. Furthermore, the clinical record revealed the aide visited P#3 on 12/30/2022 and P#3 reported not feeling well and felt like she was having difficulty breathing. The patient was placed on oxygen therapy by the caregiver. The clinical record lacked documentation that the aide notified the skilled nurse (SN) of a change in the status of P#3 as reported that P#3 was experiencing respiratory problems. The aide failed to notify staff of a change in the patient's condition. During aide supervisory visits that were conducted every two weeks. the SN failed to review the aide visit notes to ensure that the aide followed the aide care plan and ensure that the document was complete and accurate in providing care to the patient. The SN failed to ensure that aides furnish the care identified in the plan of care and assess the adequacy of the aide services in relationship to the needs of the patient and family. 2. The interdisciplinary care plan review for P#6 with an admission date of 8/3/2022 and a diagnosis of congestive heart failure (CHF) a weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs, required the hospice aide to visit the patient two times a week and assess vital signs at each visit notifying the skilled nurse if the vital signs fall outside of established parameters. The clinical record revealed the aide visited the patient on 12/15, 12/20, 12/22, 12/27, 12/29/2022. The clinical record lacked documentation that the aide took the patient's vital signs during each visit as ordered. The aide failed to follow the plan of care for monitoring vital signs as ordered. During aide supervisory visits that were conducted every two weeks, the SN failed to review the aide visit notes to ensure that the aide followed the aide care plan and ensure that the document was complete and accurate in providing care to the patient. The SN failed to ensure that aides furnish the care identified in the plan of care and assess the adequacy of the aide services in relationship to the needs of the patient and family. 3. The interdisciplinary care plan review for P#7 with an admission date of 10/5/2022 and a diagnosis of end stage heart failure, a disease in which the heart muscle is failing severely in its attempt to pump blood through the body, required the hospice aide to visit the patient one time a week and assess vital signs at each visit notifying the skilled nurse if the vital signs fall outside of established parameters. The clinical record revealed the aide visited the patient on 12/15, 12/20, 12/22, 12/27, and 12/29/2022. The clinical record lacked documentation that the aide took the patient's vital signs during each visit as ordered. The aide failed to follow the plan of care for monitoring vital signs as ordered. During aide supervisory visits that were conducted every two weeks, the SN failed to review the aide visit notes to ensure that the aide followed the aide care plan and ensure that the document was complete and accurate in providing care to the patient. The SN failed to ensure that aides furnish the care identified in the plan of care and assess the adequacy of the aide services in relationship to the needs of the patient and family. During a phone interview with the certified nurse assistant (CNA), AA on 1/16/2023 at 3:00 p.m., it was confirmed that CNA AA did not notify the SN of a change in the patient's condition because she did not know she was supposed to call the SN for a change in the patient's condition. The CNA AA also confirmed that vital signs were not taken as ordered in the aide care plan. An interview was conducted at the agency office with RN BB and Director of Nursing (DON) on 1/19/2023 at 2:00 p.m. It was confirmed the aides are required to take vital signs at each visit if the plan of care directs this to be done. It was confirmed the aides failed to take vital signs at each visit as required. The DON and RN BB confirmed the RN did not review the aide visit notes to confirm that the aide was following the aide care plan.