Every finding on record at Mountain Regional Hospice

Based on clinical record review and staff interview it was determined the Registered Nurse (RN) failed to develop an individualized aide care plan for each patient. Specifically, the plan of care/aide care plan failed to include which tasks specifically must be performed and the specific frequency of these tasks for ten (10) of eleven (11) clinical records in the survey sample. Ten (10) clinical records in the survey sample were of patient's receiving home health aide services (Clinical records #1, #2, #3, #4, #5, #6, #7, #8, #10 and #11) Findings: Eleven (11) clinical records and two (2) bereavement records were reviewed in the agency 06/15/2022 with the assistance of the Director of Nursing (DON) who served as the navigator for the agency's electronic medical record (EMR) with the following findings: 1. Clinical record #1 was reviewed for the certification period 05/12/2022 to 07/10/2022. According to patient #1's plan of care the patient was to receive home health aide services one (1) time per week for one (1) week then five (5) times a week for eight (8) weeks. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Change linen per patient/caregiver request Complete bed bath per patient/caregiver request Partial bed bath per patient/caregiver request Nail care as needed Shampoo per patient/caregiver request. 2. Clinical record #2 was reviewed for the certification period 05/26/2022 to 07/24/2022. According to patient #2's plan of care the patient was to receive home health aide services one (1) time per week for one (1) week then three (3) times a week for eight (8) weeks. The following tasks were included on the patient's plan of care and aide care plan and assigned with a frequency of per patient/family request or PRN (as needed): Companionship visit PRN if patient refuses her bath Bath Complete per patient)/family request Bath Partial per patient/family request Nail care per patient/family request Shampoo per patient/family request 3. Clinical record #3 was reviewed for the certification period 06/07/2022 to 08/05/2022. According to patient #3's plan of care the patient was to receive home health aide services one (1) time per week for one (1) week then two (2) times a week for eight (8) weeks. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Companionship visit PRN if patient refused bath Change patient linen or make bed per patient request Bath partial per patient choice Bath Shower Chair per patient choice Nail Care if needed Shampoo per patient choice Shave per patient request 4. Clinical record #4 was reviewed for the certification period 05/26/2022 to 07/24/2022 . According to patient #4's plan of care the patient was to receive home health aide services one (1) time per week for one (1) week then three (3) times a week for eight (8) weeks. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Assist with transfers to/from bed/chair per patient/family request Companionship visit if patient declines bathing per patient/family request Make bed/change linen per patient/family request Bath Complete per patient)/family request Bath Partial per patient/family request Nail care per patient/family request Shampoo per patient/family request Skin care per patient/family request 5. Clinical record #5 was reviewed for the certification period 05/23/2022 to 07/21/2022. According to patient #5's plan of care the patient was to receive home health aide services three (3) times per week for eight (8) week then two (2) times a week for one (1) week. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Companionship visit if patient declines bathing per patient/family request Change adult diapers per patient/family request during bathing/dressing Empty Foley per patient/family request Change patient linen weekly and PRN per patient/family request Make patient bed per patient/family request Bath Bed per patient)/family request Bath Partial per patient/family choice PRN Denture care per patient/family request Nail care weekly and PRN per patient/family request Oral Care per patient/family request Shampoo per patient/family request Shave per patient/family request Skin care per patient/family request 6. Clinical record #6 was reviewed for the certification period 06/04/2022 to 08/02/2022. According to patient #6's plan of care the patient was to receive home health aide services one (1) time per week for eight (8) weeks. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Companionship visit if patient declines bathing per patient/family request Change patient linen/make bed per patient request Clean living area of the patient per patient request Bath Partial per patient request Nail Care per patient request Shampoo per patient request Skin care per patient request 7. Clinical record #7 was reviewed for the certification period to 02/04/2022 to 04/04/2022 According to patient #7's plan of care the patient was to receive home health aide services five (5) times per week for eight (8) weeks. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Companionship visit PRN if patient/family refuses bath Bath Complete per patient/family choice Bath Partial per patient/family choice Nail care as needed Shampoo per patient/family request 8. Clinical record #8 was reviewed for the certification period 02/19/2022 to 04/19/2022. According to patient #8's plan of care the patient was to receive home health aide services five (5) times per week for eight (8) weeks then two (2) times a week for one (1) week. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Change patient linen weekly and PRN Bath Complete per patient/family choice Bath Partial per patient/family choice Nail care weekly and PRN Shampoo weekly and PRN If patient refuses care, HHA (home health aide) may provide companionship visit PRN 9. Clinical record #10 was reviewed for the certification period 05/27/2022 to 07/25/2022. According to patient #10's plan of care the patient was to receive home health aide services one (1) time per week for one (1) week then five (5) times a week for eight (8) weeks then one (1) time a week for one (1) week. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Change linen PRN Bath Complete per patient/caregiver request PRN Bath Partial per patient/caregiver request PRN Nail care weekly and PRN Shampoo weekly and PRN 10. Clinical record #11 was reviewed for the certification period to 05/28/2022 to 07/26/2022. According to patient #11's plan of care the patient was to receive home health aide services five (5) time per week for eight (8) week then two (2) times a week for one (1) week. The following tasks were included on the patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Assist with transfers/ ambulation per patient/family request Companionship visit if patient declines bathing per patient/family request HHA (Home Health Aide) prepares patient protein smoothie for lunch per patient/family request Bath Partial per patient/family request Nail Care per patient/family request Shampoo per patient/family request Skin Care per patient/family request The Registered Nurse (RN) failed to develop an individualized aide care plan for the above noted patients that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient is cognitively and functionally able to choose and perform each task in which "as requested or per patient/family request/choice" was identified. Aide plans of care cannot use PRN (as needed) or per patient choice for any task as it is out of the scope of practice for the aide to determine what tasks need to be done and when. The above noted findings were acknowledged by the Director of Nursing/Alternate Administrator during the clinical record reviews and by the Administrator and Director of Nursing/Alternate Administrator during the exit conference conducted in the agency on 06/15/2022.