Every finding on record at Riverside Hospice and Homecare Services 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. 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. 2 of 14 (14%) applicable clinical records with hospice aide services revealed a lack of clear and specific written instructions for the hospice aide assignment, thus leaving the aide to make decisions that are outside of the aide's scope of practice. Clinical Record 3: This patient was admitted on 03/09/2022 with a diagnosis of Alzheimer's. The patient resided in a skilled nursing facility. The hospice aide assignment plan initiated by the Registered Nurse (RN) on 03/09/2022 assigned the hospice aide to assist the patient with bed bath, shower, and sponge bath. The clinical record documentation revealed the patient was receiving a bed bath. There was no documented evidence in the clinical record of any communication between the hospice aide and the supervising RN related to the aide assignments. The RN did not provide the aide with specific instructions regarding the type of bath the patient was to receive and how to complete this task assignment. Clinical Record 5: This patient was admitted 03/13/2023 with a diagnosis of Chronic Systolic Heart Failure. The hospice aide assignment plan initiated by the RN on 03/13/2023 assigned the hospice aide to assist the patient with transfers if needed. The RN did not provide specific instructions that described how the aide was to complete the intervention. The RN Clinical Manager was interviewed on 06/13/2023 and confirmed the findings and stated the RN did not assign specific instructions for the aide to follow in the records identified.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care permitted to be performed under state law and regulation and is consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. 6 of 14 (43%) clinical records reviewed of patients receiving hospice aide services revealed the hospice agency did not ensure that the hospice aide followed the plan of care established by the IDG. Clinical Record 4: The patient elected hospice care on 11/13/2021. The aide plan of care dated 11/13/2021 ordered the aide to visit 2 x per week. There were no visits documented the weeks of 11/15/2021, 11/19/2021 and 11/22/21 and for these visits, the aide documented " omit per caregiver." There was no documented evidence in the clinical record of communication with the Registered Nurse (RN) or physician that the aide did not provide the tasks as assigned and no documentation of missed visits. Clinical Record 7: The patient elected hospice care on 11/10/2022. The aide plan of care dated 11/10/202 assigned the aide to perform bed bath, hair care, transfers, and repositioning. On 11/10/2022 the hospice aide documented that the family had performed the needed tasks and the aide provided companionship for the patient. There was no evidence the assigned tasks had changed to include companionship and no documented evidence of communication with the RN that the assigned tasks had not been provided as ordered. Clinical Record 5: The patient elected hospice care on 03/13/2023. The aide plan of care dated 03/13/2023 ordered the aide to visit 2 x per week. There were no visits documented on 03/14/23, 03/16/23, 03/21/23 and 03/23/23 the aide documented "omit for these days the care giver had performed care." There was no documented evidence of communication with the physician or RN that the assigned tasks had not been provided as ordered. Clinical Record 8: The patient elected hospice care on 10/13/2022. The aide plan of care dated 10/13/2022 ordered the aide to provide bed bath, hair care, transfers, and repositioning, On 10/18/22 the aide documented that the family had performed the tasks and the aide provided companionship for the patient. There was no evidence the assigned tasks had changed to include companionship. There was no documented evidence of communication with the RN that the assigned tasks had not been provided as ordered. Clinical Record 9: The patient elected hospice care on 04/09/2023. The aide plan of care dated 04/09/2023 ordered the aide to provide sponge bath, hair care, transfers, and repositioning, On 04/11/23 the aide documented that the family had performed the tasks and the aide provided companionship for the patient. There was no documented evidence the assigned tasks had changed to include companionship. There was no documented evidence of communication with the physician or RN that the assigned tasks had not been provided as ordered. Clinical Record 12: The patient elected hospice care on 05/18/2023. The aide plan of care dated 05/18/23 ordered oral care, hair care, dressing and shampoo every visit. The aide documented on 05/19/23 that the care was performed by the caregiver. There was no documented evidence of communication with the physician or RN that the assigned tasks had not been provided as ordered. The RN Clinical Manager was interviewed on 06/13/2023 and confirmed the findings and stated the aide did not follow the aide plans of care established by the IDG and there was no evidence the assigned tasks had changed and no evidence of documentation of missed visits or communication with Physician or the registered nurse.