Every finding on record at Northfield Hospice

Based on interview and document review, the hospice agency failed to immediately report all allegations of neglect and financial exploitation to the administrator immediately for 2 of 2 patients (P8, P9) as directed by their policy. Findings include: P8's Vulnerable Adult Report was written on a MAARC (Minnesota Adult Abuse Reporting Center) reporting form. The report was made by a hospice nurse and was dated 8/13/21. In the report the hospice nurse indicated the family of P8 was concerned about money and cost of services at the assisted living where P8 lived. The report indicated the family wanted to limit repositioning, and to have P8 eat food provided by the family. The report also indicated a concern of funds that was not allocated for P8. The documentation did not include information regarding date and time the administrator was notified of the allegation. P9's Vulnerable Adult Report was written on a MAARC reporting form. The report was dated 8/19/21. A volunteer had reported concerns about the living condition at P9's living facility. The hospice volunteer reported P9 was unkept, the room smelled liked dead animals, and the patient was out of incontinence products. There were no towels or soap in the patient's room. The volunteer reported the room door was locked when arrived and P9 was inside of the room. The documentation did not include information regarding date and time the administrator was notified of the allegation. On 10/6/ 2021, at 2:00 p.m. the hospice director verified being aware of the two events and indicated she notified the Administrator. The director indicated the agency did not maintain a list or tracking method of events and did not have documentation the administrator was notified. On 10/6/ 2021, at approximately 2:15 p.m. the administrator verified being aware of both allegations. The administrator indicated the hospice agency did not have a system in place of recording when the administration had been notified. The policy Vulnerable Adults Abuse/Neglect Reporting, effective date December 1, 1991, directed staff C. Patients within other nursing home and care center (NH&C) Departments or facilities A workforce member who observes or suspects abuse or neglect of a patient who meets the definition of a vulnerable adult will immediately report concerns to a NH&C social worker, department director or supervisor. Any report will remain confidential. The following steps will be taken: 1. Notify administrator. The department director or supervisor will immediately report the incident or concern by phone to the appropriate administrator or the administrator on call during off hours.

Based on interview and document review, the hospice agency failed to ensure a registered nurse (RN) provided a supervisory visit of home health aide (HHA) services at least every 14 days for 2 of 8 patients (P3 and P5) reviewed. Findings include: P3's clinical record indicated P3 was admitted for hospice services on 8/26/21, with a primary diagnosis of congestive heart failure. P3's current plan of care for the certification period which started on 8/26/21, indicated P3 would have a HHA visit 1 time per week to perform personal hygiene, assist with activities of daily living skills (ADLs) and weekly showers. A review of the skilled nurse visit notes in the electronic medical record (EMR) indicated there were no supervised nursing visits documented. P5's clinical record indicated P5 was admitted for hospice services on 6/8/21, with a primary diagnosis of multiple sclerosis. P5's current plan of care for the certification period which started on 9/12/21, indicated P5 would have a HHA visit 7 time per week to perform personal hygiene, assist with ADLs and showers 2 x a week. A review of the skilled nurse visit notes in the EMR indicated there were no supervised nursing visits documented for the certification period which started on 9/12/21. On 10/7/21, at 11:00 a.m. the director of hospice and the Administrator of hospice both verified the RN supervisory visits were not documented in P3 or P5's record. A policy for RN supervisory visits was requested and the Administrator indicated on 10/7/21, at 12:08 p.m. there was not a policy for the RN supervisory visits for HHA's.