Every finding on record at Pro Care Hospice Inc

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 9 (11%) clinical records reviewed of patients who received hospice aide services, revealed the agency did not ensure that the hospice aide was supervised by an RN no less frequently than every 14 days DOCUMENT 2: The agency policy 1-37 Hospice Aide Supervisory Visits stated in part "The frequency of supervisory visits will be based upon the needs of the patient after the plan of care is established. They must be conducted no less frequently than every 14 days." CLINICAL RECORD 10: The hospice aide plan of care was dated 10/05/2025. The hospice aide frequency was ordered once a week for twelve weeks. Hospice aide visits were documented on 10/09/2025, 10/16/2025, 10/23/2025 and 10/29/2025. There was no evidence of a nurse supervision as of the date of site visit on 11/04/2025. The Clinical Director was interviewed on 11/04/2025. She acknowledged that supervisory visits for hospice aide visits had not been documented.

It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: the hospice election form. This standard was not met as evidenced by document review, interview and observation. In 2 of 2 (100%) home visits conducted to patients residing in a Skilled Nursing Facility, revealed the agency did not ensure the hospice election form was provided to the SNF. DOCUMENT 3: The agency's Policy & Procedure 1-030 Provision of Care to Residents of SNF/NF or ICF/IID read in relevant parts, "The organization will provide the SNF/NF or ICF/IID the following information specific to each patient: hospice election form." HOME VISIT 1: During a home visit on 10/04/2025, a review of the hospice agency's patient binder located at the Skilled Nursing Facility was conducted. The binder included a section for Hospice consents. The binder was reviewed in its entirety, and a copy of the hospice election form was not located. HOME VISIT 2: During a home visit on 10/04/2025, a review of the hospice agency's patient binder located at the Skilled Nursing Facility was conducted. The binder included a section for Hospice consents. The binder was reviewed in its entirety, and a copy of the hospice election form was not located. On 10/04/2025, the Hospice Clinical Director was interviewed. She stated they delivered the election forms to the facility but was unaware of where the forms were located.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: Prescription and over-the-counter (OTC) drugs. The medication review process includes the identification of the following: The effectiveness of drug therapy; Drug side effects; Actual or potential drug interactions; Duplicate drug therapy; and Drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records, interviews and observations. In 1 of 6 (16%) clinical records the hospice did not ensure that all of the patients' current medications were included on the drug profile and included in the review of the patient's medication regimen. This finding was also confirmed during a home visit observation. Clinical Record 3 - During a home visit on 1/25/23, the patient's current medications were reviewed. During interview, the patient stated, "I take Motrin or Tylenol PRN for pain as well as Prilosec PRN for my stomach". They also reported, "I take that Novolog Flexpen on a sliding scale and take 4 units when my blood sugar is 300. I check my blood sugar three or four times a day before meals and some snacks". Review of the patient’s clinical record revealed no documented evidence of Motrin, Tylenol or Prilosec included on the patient’s medication profile and included in review of the medication regimen for side effects and interactions. The medication profile in the clinical record included documentation of, "Novolog Injection Solution 100 units/ml, dose 2 units, frequency twice daily before meals, instructions inject one unit per value twice a day before meals” and did not include documentation of the Novolog sliding scale that the patient was currently following. During interview on 1/26/23, the RN/Director Patient Care Services/Administrator reviewed and confirmed the finding. Policy " Management of Information Content of the Clinical Record", Policy number 5-005.1, revised September 2022, included, "The following information will be available in the clinical records applicable to care and services provided: any allergies to medication", and "Legible, complete and individualized diagnostic and therapeutic orders authenticated within the timeframe defined by the organization, or according to law and regulation". During an interview on 1/26/23, the RN/Director Patient Care Services/Administrator stated, "The (electronic medical record) system does not clearly allow space to enter the sliding scale so from now on I will be putting the sliding scale in a separate physician's order form". and "The patients did not tell me that they were taking those over the counter medications". Additionally during interview 1/26/23, the RN/Director Patient Care Services/Administrator stated, "NKA" on the patient medication record is an abbreviation for "no known allergies" and "The rash and swelling of the mouth are side effects and not true allergies".

It is required that bags used to carry medical equipment (e.g., BP cuff) or supplies into or out of the care environment are transported and used in a manner consistent with organizational policy to prevent the spread of infections and communicable diseases. This standard was not met as evidenced by a review of document reviews, interviews, observations and personnel records. In 1 of 3 (33%) applicable home visits made to patients, the hospice did not ensure that the RN was compliant with the agency's infection control policy and procedure for bag technique. The agency's policy, "Infection Prevention and Control Bag Technique", Policy number 9-014.1, revised September 2022, included, "The bag will be placed on a clean dry surface (i.e., a surface that can be easily disinfected) ... Paper towels/newspapers used as a protective barrier for bag placement in the patient's home will be discarded". Clinical Record 2 - During a home visit on 1/25/23, the RN was observed not adhering to the agency's policy and procedure for bag technique. The RN entered the patient's home and placed the nursing bag on top of the bar stool next to the patient without using a barrier or disinfecting the surface of the bar stool. Additionally, the RN removed a box of disposable gloves and a multiuse sanitizing wipes container and placed them on top of the countertop surface without a barrier or disinfecting the surface. At the end of the visit, the RN placed the container of sanitizing wipes into the "clean" section of the nursing bag and placed the box of disposable gloves into the "dirty" section of the nursing bag. Review of the personnel record for this employee revealed the general orientation checklist and "Skills Competency Evaluation" dated 1/23/23 included documentation of training that was completed on infection control and skills competency evaluation for hand washing and bag technique. During interview on 1/25/23, the RN stated, "I was trained by (Alternate Director of Patient Care Services) to not place the nursing bag on anything in the home. I do not know why I placed the bag on top of the bar stool without a barrier and why I did not use a barrier or disinfect the surface for the gloves and wipes, but I was nervous during the visit". During interview on 1/26/23, the RN/Director Patient Care Services/Administrator stated, "The nurse is new and was oriented on infection control and was nervous". Policy, "Infection Prevention and Control Bag Technique", Policy number 9-014.1, revised September 2022, included, "The bag will be placed on a clean dry surface (i.e a surface that can be easily disinfected )", and "Paper towels/newspapers used as a protective barrier for bag placement in the patients home will be discarded". L579/418.60(a)

It is required that all entries in the patient record are legible, complete, appropriately authenticated, and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. The hospice has the means to authenticate entries or to identify the author of each entry. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. In 2 of 6 (33%) clinical records, the hospice did not ensure the signature associated with the name of the clinician completing the clinical note included their credentials, as described in agency policy. The agency's policy, "Management of Information Entries into the Clinical Record", Policy number 5-006.1, revised September 2022, included: "A Clinical record will be initiated and maintained for each patient receiving care of services according to organization policies and will include at a minimum signature authorization of clinical documentation and will include the staff member's name and credentials (as specified on professional licenses and/or certification documents". Clinical Record 4 - The initial spiritual assessment dated 12/23/22 included documentation of the electronic signature of the spiritual counselor without documentation of their credentials. Clinical Record 1 - The initial spiritual assessment dated 12/23/22included documentation of the electronic signature of the spiritual counselor without documentation of their credentials. During joint clinical record review and interview 1/25/23, the Alternate Administrator confirmed the missing credentials after the electronic spiritual counselor signatures on the initial spiritual counselor assessments. Policy, "Management of Information Entries Into the Clinical Record", Policy number 5-006.1, revised September 2022, included, "A Clinical record will be initiated and maintained for each patient receiving care of services according to organization policies and will include at a minimum signature authorization of clinical documentation and will include the staff member's name and credentials (as specified on professional licenses and/or certification documents". During joint clinical record review and interview 1/25/23, the Alternate Administrator confirmed the missing credentials after the electronic spiritual counselor signatures on the initial spiritual counselor assessments.