Every finding on record at Prohealth Homecare, Inc.

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 2 of 17 (12%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions to meet the patient's needs. CLINICAL RECORD 3: The patient elected hospice care on 03/19/2026 with a primary diagnosis of hypertensive heart disease. The plan of care ordered Hospice Aide services two times a week. The HA care plan assigned the HA the task of shower every visit and provided direction for the HA regarding the patient's compression stockings and use of oxygen. The initial comprehensive assessment documented that the patient had a PleurX drain. The HA care plan did not notify the HA of the presence of the PleurX drain or how to care for it during the shower. CLINICAL RECORD 4: The patient elected hospice care on 02/09/2026 with a primary diagnosis of lung cancer. The plan of care ordered Hospice Aide services two times a week. The HA care plan assigned the HA the tasks: peri care and bed bath every visit. On 03/19/2026 a Foley catheter was placed and remained intact as of review 04/15/2026. The HA care plan was not updated to include Foley catheter care. During interview on 04/16/2026, the Director of Compliance stated that the aides plans of care did not include all directions for the aide. DHS 131.26 (2)(a) (2)NURSE AIDE SERVICES. The hospice may provide nurse aide services as follows: (a) Assignment. Nurse aides are assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group. Written patient care instructions for a nurse aide shall be prepared by a registered nurse who is responsible for the supervision of a nurse aide as specified under par. (c).

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; ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 2 of 17 (12%) clinical records reviewed for patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide was supervised by a Registered Nurse no less frequently than every 14 days. CLINICAL RECORD 2: The patient elected hospice care on 02/03/2026 with a primary diagnosis of congestive heart failure. The plans of care for the certification period dated 02/03/2026 through 05/03/2026 ordered HA services one time a week. The first Hospice Aide (HA) visit was on 02/24/2026. There was no evidence of HA supervision as of 04/14/2026, with 49 days outstanding. CLINICAL RECORD 7: The hospice benefit of election was 01/22/2026 with a primary diagnosis of severe protein calorie malnutrition. The plans of care for the certification period dated 01/22/2026 through 04/21/2026 ordered HA services one time a week. The first Hospice Aide (HA) visit was on 02/20/2026. There was no evidence of HA supervision as of 04/15/2026, with 54 days outstanding. During an interview and a joint record review on 04/16/2026, the Director of Compliance stated that the supervision was not documented. DHS_131.26(2)(c)1 "(2)Nurse aide services. The hospice may provide nurse aide services as follows: (c) Supervision of nurse aides. 1. A registered nurse shall make 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 nurse aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. The nurse aide does not have to be present during this visit."

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. 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 26 (8%) clinical records reviewed, the agency did not ensure that the patient's record contained physician orders to meet the patient's needs. CLINICAL RECORD 5: The patient elected hospice care on 03/19/2026 with a primary diagnosis of protein calorie malnutrition. The initial plan of care and the plans of care updated every two weeks ordered a PICC (peripherally inserted central line catheter) dressing change. There were no orders for the frequency of the dressing change until 04/14/2026 when a physician's order was written to change the dressing weekly. CLINICAL RECORD 18: The patient elected hospice care on 03/05/2026 with a primary diagnosis of recurrent bacterial pneumonia. The initial plan of care and the plan of care updated every two weeks documented interventions for instructing on Foley catheter care, catheter problems, and signs and symptoms of infection. The plans of care did not include physician orders on when the Foley catheter should be changed or the details of the size of the Foley catheter and if a flush was needed. During interview and a joint record review on 04/16/2026, the Director of Compliance stated that the interventions were missing and did not include required detail. DHS_131.33(3)(j) (3) "Content. A patient’s clinical record shall contain all of the following: (j) Physician orders."

It is required that during the initial assessment visit and in advance of providing care, the hospice obtains the patient’s or representative’s signature confirming that he or she received a copy of the Bill of Rights and Responsibilities statement. This standard was not met as evidenced by clinical record review, document review and interview. In 22 of 26 (85%) records reviewed it was revealed that the agency did not ensure that the clinical record contained the patient or representative's signature confirming the receipt of the Bill of Rights and Responsibilities statement. Prior to changing processes to obtain electronic signatures for admission paperwork the agency had a paper document titled "Fee/Admission Agreement for Hospice Services." This document contained the "notice of receipt of materials...Patient and Family Rights and Responsibilities." Per the administrator and hospice supervisor the agency transitioned to the electronic signature system during the pandemic (approximately two years ago) and when the form was recreated electronically that statement was omitted in error. Patients were provided with the bill of rights in the admission booklets, and it was confirmed in all nine home visits that patients and/or representatives had the admission booklets and were aware of the patient rights. The inpatient unit (IPU) was still utilizing the paper forms and those records had signed acknowledgements; thus, this impacted all other records reviewed, and all patients who have signed on using the electronically signed documents. Clinical Record 1: Election of benefit 1/4/23. Clinical Record 2: Election of benefit 4/19/23. Clinical Record 3: Election of benefit 4/3/23. Clinical Record 4: Election of benefit 3/15/23. Clinical Record 5: Election of benefit 5/27/23. Clinical Record 6: Election of benefit 2/24/23. Clinical Record 16: Election of benefit 5/11/23. Clinical Record 10: Election of benefit 1/29/23. Clinical Record 11: Election of benefit 3/30/23. Clinical Record 12: Election of benefit 1/4/23. Clinical Record 13: Election of benefit 8/18/23. Clinical Record 17: Election of benefit 4/13/23. Clinical Record 15: Election of benefit 5/12/23. Clinical Record 14: Election of benefit 3/30/23. Clinical Record 18: Election of benefit 12/14/22. Clinical Record 19: Election of benefit 4/15/23. Clinical Record 20: Election of benefit 1/22/23. Clinical Record 21: Election of benefit 5/2/23. Clinical Record 22: Election of benefit 11/28/22. Clinical Record 23: Election of benefit 2/15/23. Clinical Record 24: Election of benefit 3/15/22. Clinical Record 26: Election of benefit 1/2/23. Personnel Record 5: During interviews the hospice supervisor and hospice administrator both reported that they were unaware that the forms were modified when they transitioned to the electronic version and did not realize that the acknowledgement statement had been removed. Prior to changing processes to obtain electronic signatures for admission paperwork the agency had a paper document titled "Fee/Admission Agreement for Hospice Services." This document contained the "notice of receipt of materials...Patient and Family Rights and Responsibilities." Per the administrator and hospice supervisor the agency transitioned to the electronic signature system during the pandemic (approximately two years ago) and when the form was recreated electronically that statement was omitted in error. Patients were provided with the bill of rights in the admission booklets, and it was confirmed in all nine home visits that patients and/or representatives had the admission booklets and were aware of the patient rights. The inpatient unit (IPU) was still utilizing the paper forms and those records had signed acknowledgements; thus, this impacted all other records reviewed, and all patients who have signed on using the electronically signed documents.

It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient's family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and considered in the bereavement plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 26 (4%) records reviewed it was revealed that the agency did not ensure that the initial bereavement risk assessment was completed within the five-day comprehensive assessment period. Clinical Record 16: The Election of Benefit was completed 5/11/23. As of the 6/1/23 record review there was no initial bereavement risk assessment documented. The initial psychosocial note dated 5/16/23 stated "Bereavement risk for the POAH activated agent (name) not assessed." Personnel Record 5: During the joint record review, the hospice supervisor confirmed the record did not contain evidence that the initial bereavement risk assessment was completely within the required timeframe.

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, interview and observation. In 3 of 21 (14%) records reviewed, in which aide services were accepted, it was revealed the agency did not ensure the hospice aide care plans provided specific instructions to meet the physical and safety needs of the patient. Clinical Record 3: The Election of Benefit form was dated 4/13/23. During the home visit on 6/1/23 the patient was observed with a compression sleeve on the left arm and the arm was elevated on pillows. The RN questioned the patient and family if the patient had been keeping the sleeve on and the arm elevated. Aide care plan, effective 4/3/23 to current, listed relevant tasks: sponge bath at the sink and dress patient. The aide care plan did not provide instructions on if the sleeve could or could not be removed for care or for aide to elevate arm after care. Clinical Record 13: The Election of Benefit form was dated 8/18/22 with a terminal diagnosis of emphysema. The nursing note completed on 5/24/23 reported the patient was on continuous oxygen at 6 liters per nasal cannula. Aide care plan, effective 4/11/23 to current, listed relevant tasks: chair bath and shaving. The aide care plan did not alert the aide that the patient was on oxygen, to maintain oxygen precautions, or provide instructions as to if the oxygen could or could not be removed for care. Clinical Record 19: The diagnoses list, effective 5/5/23, listed Parkinson's Disease and oropharyngeal dysphagia. Interdisciplinary group (IDG) meeting notes dated 5/23/23 stated, "Patient recovering from a stroke he had 2 weeks ago...swallow still needs to be monitored carefully due to Parkinson's." Aide care plan, effective 5/5/23 to current, listed relevant task "encourage and offer fluids to patient." The aide care plan did not include aspiration precautions. Personnel Record 5: Joint clinical record reviews were performed with the hospice supervisor who confirmed that the above items should have been included in the aide care plans.

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, document review and interview. In 2 of 26 (8%) records reviewed it was revealed that the agency did not ensure that all physician orders were complete, specifically that the medications ordered on an "as needed basis" included the indication for administration. Document 1: Stated in relevant part, "Complete medication orders have the following elements...f) Purpose or indication for medications ordered on an "as needed basis." Clinical Record 1: The Election of Benefit was dated 1/4/23. The clinical record review revealed the following incomplete physician orders: Acetaminophen (Tylenol) 325 mg take 2 tabs by mouth every 4 hours as needed (ordered on 1/4/23). Metoclopramide HCL (Reglan) 5 mg take 1 tablet by mouth up to four times daily as needed (ordered on 5/16/23). Neither of these orders provided the indication or directions for when to administer "as needed." Clinical Record 6: The Election of Benefit was dated 2/24/23. The clinical record review revealed the following incomplete physician order: Lipase-protease-amylase 24,000-76,000-120,000 units take 2 capsules by mouth 3 times daily before meals and 2 capsules as needed (ordered on 3/13/23). This order did not provide the indication or directions for when to administer "as needed." Personnel Record 5: During the joint record review, the hospice supervisor confirmed that these medication orders did not contain the indication and "they should have."