Every finding on record at Ohio Living Village Hospice

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 7 of 19 (37%) clinical records reviewed of patients receiving hospice aide services revealed that the agency did not ensure that written patient care instructions prepared by a Registered Nurse included all the required information based on the comprehensive assessments. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/25/2025 with a primary diagnosis of Chronic Obstructive Pulmonary Disease. The current plan of care includes a physician order for continuous oxygen at 2 liters per minute via nasal cannula. However, the hospice aide plan of care dated 10/25/2025 did not include oxygen as part of the patient’s needs, nor did it provide instructions regarding whether oxygen may be removed during bathing. CLINICAL RECORD 2: The patient elected the hospice benefit on 10/15/2025. Hospice aide services were ordered at a frequency of twice weekly to assist with personal care needs. The assigned hospice Registered Nurse (RN) completed a Hospice Aide Plan of Care on 10/15/2025 outlining delegated tasks and supervision requirements. However, the comprehensive assessment conducted on 10/15/2025 identified the patient as a high fall risk. The fall risk was not included on the hospice aide plan of care. CLINICAL RECORD 3: The patient elected the hospice benefit on 03/12/2025. Hospice aide services were ordered at a frequency of twice weekly to assist with personal care needs. The assigned hospice Registered Nurse (RN) completed a Hospice Aide Plan of Care on the same date, outlining delegated tasks and supervision requirements. However, the comprehensive assessment conducted on 03/12/2025, identified the patient as a high fall risk. The fall risk was not included on the hospice aide plan of care. Additionally, the patient has a documented history of multiple falls in the skilled nursing facility. CLINICAL RECORD 7: The patient elected the hospice benefit on 09/06/2025. Hospice aide services were ordered at a frequency of twice weekly to assist with personal care needs. The assigned hospice Registered Nurse (RN) completed a Hospice Aide Plan of Care on 09/06/2025 outlining delegated tasks and supervision requirements. However, the comprehensive assessment conducted on 09/06/2025 identified the patient as a high fall risk. The patient also has a history of multiple falls at the skilled nursing facility. The fall risk was not included on the hospice aide plan of care. CLINICAL RECORD 10: The patient elected the hospice benefit on 05/02/2025. Hospice aide services were ordered at a frequency of twice weekly to assist with personal care needs. The assigned hospice Registered Nurse (RN) completed a Hospice Aide Plan of Care on 05/02/2025 outlining delegated tasks and supervision requirements. However, the comprehensive assessment conducted on 05/02/2025 identified the patient as a high fall risk. The fall risk was not included on the hospice aide plan of care. CLINICAL RECORD 11: The patient elected the hospice benefit on 07/11/2025. Hospice aide services were ordered at a frequency of twice weekly to assist with personal care needs. The assigned hospice Registered Nurse (RN) completed a Hospice Aide Plan of Care on 07/11/2025 outlining delegated tasks and supervision requirements. However, the comprehensive assessment conducted on 07/11/2025 identified the patient as a high fall risk. The fall risk was not included on the hospice aide plan of care. This patient requires a Sara lift to stand for all transfers, and this is also not noted on the plan of care. CLINICAL RECORD 14: The patient elected the hospice benefit on 07/02/2025 with a primary diagnosis of Chronic Obstructive Pulmonary Disease. The current plan of care includes a physician order for continuous oxygen at 3-4 liters per minute via nasal cannula. However, the hospice aide plan of care dated 07/02/2025 did not include oxygen as part of the patient’s needs, nor did it provide instructions regarding whether oxygen may be removed during bathing. Also, the patient was a high fall risk, and this was not noted on the hospice aide plan of care. Following a joint record review and interview with the Executive Director on 11/20/2025, it was confirmed and acknowledged that the Hospice Aide Plans of Care had not been updated to reflect changes identified in the patient’s comprehensive assessment.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (16%) clinical records reviewed with ordered hospice aide services; it was revealed that the agency did not ensure the aide reported changes in the patient's needs related to the current hospice plan of care. CLINICAL RECORD 5: The patient elected the hospice benefit on 02/13/2025, with hospice aide services ordered twice weekly. The hospice aide’s plan of care dated 02/13/2025 specified bathing as a shower. Review of hospice aide documentation for visits on 10/03/2025, 10/22/2025, 10/27/2025, 10/29/2025, 11/03/2025, 11/05/2025, and 11/12/2025 indicates that a shower was not provided due to patient refusal. Despite repeated refusals, the aide documented “no, not required this visit” in the section instructing to notify the RN Case Manager of changes in condition or abilities. There is no evidence that the RN Case Manager was notified of the patient’s ongoing inability or unwillingness to complete the planned bathing task. CLINICAL RECORD 10: The patient elected the hospice benefit on 05/02/2025, with hospice aide services ordered twice weekly. The hospice aide’s plan of care dated 05/02/2025 specified bathing as a shower. Review of hospice aide documentation for visits on 09/10/2025, 10/01/2025, 10/06/2025, 10/16/2025, 10/22/2025, 10/23/2025, 10/27/2025, 10/30/2025, 11/10/2025 indicates that a shower was not provided. The hospice aide documented that "shower not required" but patient actually refused the care ordered. There is no evidence that the RN Case Manager was notified of the patient’s ongoing inability or unwillingness to complete the planned bathing task. CLINICAL RECORD 17: The patient elected the hospice benefit on 05/16/2025 with hospice aide services ordered twice weekly. The hospice aide's plan of care dated 05/16/2025 specified bathing as a shower. Review of the hospice aide documentation for visits on 09/03/2025 and 09/04/2025 bathing was listed as not completed and not required this visit. On 09/04/2025 the aide documented change in condition as reason for not completing shower. There was no evidence that there was any notification to the nurse. During a joint record review and interview on 11/20/2025 with the Executive Director, it was confirmed that the hospice aide’s documentation did not demonstrate completion of the bathing tasks (shower) as ordered in the plan of care, and there was no evidence that the registered nurse was notified of the patients' repeated refusals or change in condition. Per documentation review of the skilled nursing visits during that time, the nurse was aware of the patient's decline in condition.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed revealed that the agency did not ensure that orders were obtained for all necessary services. CLINICAL RECORD 6: The patient elected the hospice benefit on 10/20/2025 and was admitted at her residential home. A review of the clinical record included documentation that the patient was admitted to inpatient respite care on 11/11/2025 and returned home on 11/16/2025. While the record contained a physician order authorizing the change in level of care from routine home care to respite care, there was no documented physician order authorizing the discharge from respite care, transfer back to the home setting, and transition to routine home care. CLINICAL RECORD 14: The patient elected the hospice benefit on 07/02/2025 with a primary diagnosis of Chronic Obstructive Pulmonary Disease. The plan of care dated 07/02/2025 had the oxygen order at 3-4 liters via NC continuously. Skilled nurse visit note 09/30/2025 stated, "Patient continues to utilize oxygen 2 liters via nasal cannula (NC). On 10/14/2025 the documentation noted was "wearing oxygen via NC at 2 liters. On 11/21/2025 the documentation noted was "SPO2 95 on 2 liters" and on 11/05/2025 the documentation noted was "oxygen at 2 liters via NC". There was no documented evidence of a physician order changing the oxygen from 3-4 liters via NC continuously to 2 liters. During a joint record review and interview with the Executive Director on 11/20/2025, it was confirmed that the clinical record lacked a physician order authorizing the patient’s discharge from respite care, transfer back to the home setting, and transition to routine hospice care. There was no order changing the rate of the oxygen.

It is required that the hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed of patient currently residing in a skilled nursing facility (SNF), revealed that the agency did not ensure that the hospice plan of care identified the care and services that are needed and specify which provider is responsible. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/25/2025 and currently resides in a skilled nursing facility. The initial plan of care, dated 10/25/2025, included wound care orders as follows: cleanse bilateral lower extremities with normal saline, apply Xeroform and wrap with gauze once daily; apply Silvadene to bilateral buttocks twice daily for staphylococcal scalded skin lesions, followed by Aquaphor. However, the plan of care did not specify whether these treatments were to be performed by facility staff or hospice personnel. During a joint record review and interview conducted on 11/20/2025 with the Executive Director he agreed that the wound care orders were specific related to the care needed but did not specify who would be providing the wound care, hospice, or the facility staff.

It is required that the hospice provides information on advance directives upon initiation of hospice care. Whether or not the patient has executed an advance directive is documented in a prominent part of the patient’s record. This standard was not met as evidenced by a review of clinical records and interviews. In 3 of 13 (23%) records reviewed in which the patient admitted to hospice services and was documented to have a "Do Not Resuscitate" (DNR) status, there were no Advanced Directives or DNR paperwork attached to the patient chart. Clinical Record 5 - Patient elected hospice benefit on 12/10/22. Admission assessment stated patient is a "Do Not Resuscitate" (DNR) and that papers are on file, however there was no DNR paperwork located in the patient chart. Clinical Record 6 - Patient elected hospice benefit on 10/13/22. Admission assessment stated patient is a "Do Not Resuscitate" (DNR) and that papers are on file, however there was no DNR paperwork located in the patient chart. Clinical Record 7 - Patient elected hospice benefit on 6/24/22. Admission assessment stated patient is a "Do Not Resuscitate" (DNR) and that papers are on file, however there was no DNR paperwork located in the patient chart. In a joint record review and interview with the Executive Director, he acknowledged that the charts stated the patients had a DNR status however the documentation was missing.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IDF representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was no met as evidenced by record review, observation, and interview. In 9 of 9 (100%) records reviewed for patients receiving hospice services in a skilled nursing facility (SNF) it was revealed the agency did not ensure that the plans of care included documentation that identified which provider was responsible for performing the interventions on the plan of care (POC). Clinical Record 2 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 3 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. During a home visit observation (Home Visit 1) to the facility where the patient resided, interviews with the hospice nurse and facility nurse revealed communication of patient needs was occurring verbally and there was no evidence of interventions not being coordinated and provided as ordered on the patient's plan of care. Clinical Record 4 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 6 -During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 7 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 8 -During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 9 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 10 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. Clinical Record 12 - During joint review of the record with the Executive Director it was discovered that the plan of care did not state whether the hospice or the facility was responsible for the specific interventions ordered in the plan of care. There was no documented evidence of interventions ordered for the patient not being completed by hospice and/or facility staff. During interview, the Executive Director stated that the hospice had not been including documentation on the plans of care that specifically identified which organization was responsible for performing the interventions ordered on the plans of care. They stated that this information is directly communicated and coordinated between the hospice staff and the facility staff when visits are made to the patients, and/or via phone contacts between the organizations.