Every finding on record at Pulse Hospice, LLC

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group and 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 3 of 10 (30%) clinical record reviews revealed that the agency did not ensure that the registered nurse (RN) provided clear and specific written instructions for the hospice aide's care plan. Clinical Record 1: The patient’s election of benefit was 11/22/2024 with diagnosis of Interstitial Pulmonary, Atrial Fibrillation, COPD, LAD stent placement. The Plan of Care (POC) included a home health aide for the certification period of 11/22/2024 to 02/19/2024 with a frequency of three times a week for 12 weeks (3wx12). The patient’s medications included Plavix and Aspirin (antiplatelets), and Keppra (anticonvulsant). The aide care of plan did not include bleeding and seizure precautions. Clinical Record 2: The patient’s election of benefit was 11/07/2024 with a diagnosis of Atherosclerotic Heart Disease, Atrial Fibrillation, CHF, Cerebral Infarction, and UTI. The patient was admitted following a diagnosis of aspiration pneumonia and dysphagia. The Plan of Care (POC) for the certification period of 11/07/2024 to 02/04/2024 included hospice aide services for one time a week for 1 week, three times a week for 12 weeks (1xw1,3w12). The aide care plan did not include aspiration precautions. Clinical Record 3: The patient’s election of benefit was 06/10/2024 with a diagnosis of Hypertensive Heart Disease, ST Elevation (STEMI), CHF, COPD, and AIDC implant (July 2017). The Plan of Care (POC) for the certification period of 09/08/2024 to 12/06/2024 included interventions for falls related to previous falls and a fall risk assessment with a score of 10 (scale of 0 (no risk) to 10 (high risk). The aide care plan did not include fall risks. The Administrator, Director of Nursing (DON), and Assistant Director of Nursing (ADON) stated in an interview on 12/12/2024 that the aide precautions had been overlooked.