Every finding on record at Progressive Home Health & Hospice

Based on record review and staff interview, the agency failed to ensure that each patient received an accurate, patient specific comprehensive assessment that included an initial bereavement assessment for 14 of 14 sample patients (Patients 1 - 14). This failed practice by the hospice placed all patients and their families at risk of unmet needs related to their bereavement plan of care. --- Findings Include: Review of clinical records for Patients 1 through 14, that included the start of care comprehensive assessment, lacked documented evidence of an initial bereavement assessment included as a part of the comprehensive assessment. During an interview on 08/13/24 at 2:45 PM, Staff A, Administrator, stated that there was really no place to document the bereavement assessment in the EMR (Electronic Medical Record). She confirmed the above findings of failing to ensure an initial bereavement assessment as part of the start of care comprehensive assessment.

Based on record review and staff interview, the Hospice failed to ensure hospice aide supervisory visits were completed no less than every 14 days as required for 6 of 7 patients reviewed (Patients 1-5, 7.) This failure to ensue supervision of hospice aide services every 14 days as required, has the potential to affect the quality of care being provided to patients and the timely adjustment of the plan of care to meet the changing needs patients. --- Findings Include: Patient 1 Review of Patient 1's Hospice Certification and Plan of Care, for the certification period dated 06/23/24 to 08/21/24, confirmed an order for hospice aide services for assistance with personal care two times per week. There were documented aide visits being made each Tuesday and Thursday throughout the episode however, there were no documented aide supervisory visits by a Registered Nurse (RN) performed during the episode. The patient's Start of Care date was found to be 10/27/23 with no documented aide supervision during services. Patient 2 Review of Patient 2's Hospice Certification and Plan of Care, for the certification period dated 06/04/24 to 08/02/24, confirmed an order for hospice aide services for assistance with personal care one time per week and two time per week starting on 06/30/24. There were documented aide visits as ordered throughout the episode however, there were no documented aide supervisory visits by an RN performed during the episode. The patient's Start of Care date was found to be 12/07/23 with no documented aide supervision during services. Patient 3 Review of Patient 3's Hospice Certification and Plan of Care, for the certification period dated 07/11/24 to 09/08/24, showed an order for hospice aide services for assistance with personal care one time per week for eight weeks. There were documented aide visits made on Thursday 07/18/24, 07/25/24, 08/01/24, and 08/08/24 however, there were no documented aide supervisory visits by an RN performed during the episode. The patient's Start of Care date was found to be 07/11/24 with no documented aide supervision during services. Patient 4 Review of Patient 4's Hospice Certification and Plan of Care for the certification period dated 06/17/24 to 09/14/24, revealed an order for hospice aide services for assistance with personal care two times per week. There were documented aide visits made on Tuesday and Thursday throughout the episode however, there were no documented aide supervisory visits by an RN performed during the episode. The patient's Start of Care date was found to be 03/19/24 with no documented aide supervision during services. Patient 5 Review of Patient 5's Hospice Certification and Plan of Care for the certification period dated 06/04/24 to 08/02/24, revealed an order for hospice aide services for assistance with personal care two times per week. There were documented aide visits made on Tuesdays and Fridays throughout the episode, however, there were no documented aide supervisory visits by an RN performed during the episode. The patient's Start of Care date was found to be 08/09/23 with no documented aide supervision during services. Patient 7 Review of Patient 7's Hospice Certification and Plan of Care for the certification period dated 07/17/24 to 09/14/24, revealed an order for hospice aide services for assistance with personal care one time per week. There were documented aide visits weekly throughout the episode however, there were no documented aide supervisory visits by an RN performed during the episode. The patient's Start of Care date was found to be 10/18/24 with no documented aide supervision during services. During an interview on 08/13/24 at 3:45 PM, Staff A, Administrator, confirmed the above finding of not performing aide supervisory visits and stated that they, "had not gotten back to doing that since COVID."

Based on review of hospice documentation and staff interview, it was determined the hospice failed to ensure that volunteers provided at least 5 percent of the total patient care and administrative service hours annually. This failed practice has the potential to affect quality of services for patients who request volunteer services. --- Findings Include: Review of agency volunteer information provided, included a form titled, "2023 Volunteer Analysis," which showed the hours worked by hospice staff and volunteers for the year of 2023. Hours worked by hospice staff were confirmed to be 7166, while volunteer worked hours were 383. The agency had determined their annual percentage to be 5.3%. However, when the actual volunteer hours documented were reviewed, several hours were found to be while the hospice aide was actually in the home to provide ordered services and care for the patient. When the hours were refigured, without using the direct patient care hours by the hospice aide, the agency's percentage fell below the 5 percent range. During an interview on 08/13/24 at 3:50 PM, Staff A, Administrator, confirmed being unaware that paying volunteers for hours of care provided to the patients was prohibited. Staff A confirmed inability to get volunteers, if they weren't paid. The Administrator confirmed the above findings of agency volunteers not meeting 5 percent of the total patient care and administrative service hours annually.

Based on record review, and staff interview the hospice agency skilled staff failed to ensure the patient's pain was managed in a timely manner in 1 of 10 sample patients (Patient 3). Failure to ensure the patient's pain is managed timely has the potential to create unmet needs and inadequate care of the patient. --- Findings include: Patient 3 Review of Patient 3' clinical record showed the Hospice Benefit Period Start date of 07/18/23 and an end date of 08/27/23 due to death. Patient was admitted to hospice services on 01/19/23 with a diagnosis of End Stage COPD (Chronic Obstructive Pulmonary Disease) and lived in his own home with his daughter checking on him. Patient was moved to a LTC (Long Term Care) unit in June and documentation in the record indicated that by 08/09/23 he was bed bound. Review of a document titled, Medication Profile showed the patient was allergic to Morphine and Lorazepam. Medication Profile indicated that at the time of admission to the LTC unit the patient had Tramadol 50 mg tablet by mouth TID (three times per day) ordered for pain relief. The Medication Profile also showed that Hydromorphone 2.5 mg, 1 tablet every 6 hours as needed by mouth was orders for pain on 08/04/23. On 08/16/23 the Hydromorphone was increased to every 4 hours as needed by mouth. Review of LPN (Licensed Practical Nurse) note dated 08/25/23, contained documentation by the LPN stating that the patient had become more unresponsive, that the staff were crushing medications in a little water, the patient had no oral intake, and the daughter was present at the bedside. On the LPN note dated 08/26/23, at 6:30 PM documentation indicated that the patient only responds when repositioned by face grimacing. LPN also documented the daughter stated he has been uncomfortable and having pain, that the LTC staff had been crushing pain medication and putting in small amount of water but that was no longer working because the patient was unable to swallow. The LPN documented "requested sublingual pain medication and Tylenol suppository for fever, pharmacy to deliver". Review of a document titled, "LPN/LVN Death Visit", dated 08/27/23, showed documentation by the LPN of "absent heart sounds, absent carotid pulse, no respirations" at 3:22 AM. Review of a document titled, "Fax Message", dated 08/26/23 indicated an order was sent to the pharmacy for "Oxycodone liquid 7.5 mg TID (Three times per day) PRN (as needed) SL (sublingual) and Tylenol suppository 500 mg every 4 hours PRN (as needed) fever per rectal". There was no documentation in the clinical record to indicate if the medications were delivered by the pharmacy or given to the patient by the LTC staff at any time between being ordered on 08/26/23 and 3:22 AM on 08/27/23 when the patient expired. During an interview on 10/16/23 at 4:10 PM, Staff E, LPN stated that she was unaware if the medications were ever delivered by the pharmacy or given to the patient by the LTC staff. During an interview on 10/17/23 at 8:30 AM, Staff A, Administrator confirmed that there was no evidence in the record of the patent having his pain symptoms managed prior to or at the time of his death.

Based on review of personnel records, and staff interview the hospice agency failed to ensure assessment of the skills and competencies for Licensed Practical Nurses (LPN) in 2 of 3 sample personnel records. This deficient practice places all patients at risk for unmet needs, as well as inappropriate care and services. --- Findings include: Review of an agency Policy No. 1-026.1 titled, "Competency Assessment" showed a section titled, "Orientation and Probationary Period" which stated as part of the orientation process that a preceptor would be assigned to each new person. The procedure also indicated that the preceptor was to use a "Competency Skills Performance Checklist" while observing the new personnel performing the required skills and activities. Review of a document titled, "Initial Competency Assessment Skills Checklist-Licensed Practical/Vocational Nurse" for Staff B and Staff D both indicated that a self-assessment had been documented by each LPN. However, there was no documentation of an observation or evaluation performed by a preceptor for either LPN. During an interview on 10/16/23 at 4:10 PM, Staff B, when asked about her orientation to hospice, stated that she works on the home health side and just saw Patient 3 because he was her patient previously. During an interview on 10/17/23 at 8:30 AM, Staff A, Administrator confirmed that there was no evidence of competencies being assessed for Staff B and Staff D prior to these two LPNs providing care to the hospice patients.