Every finding on record at Rta Hospice, LLC

It is required that 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 15 (13%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure the registered nurse provided specific written instructions for the hospice aide. CLINICAL RECORD 15: The patient elected the Hospice benefit on 10/16/2025 with documented diagnosis of Senile degeneration of the brain. The hospice aide care plan dated 11/12/2025 included the following relevant tasks: "Bathing (bed); bathing (shower); dressing; hair care; HOB (head of bed) elevated; nail care-file or trim fingernails or toenails, oral care; position for comfort; shampoo; skin care; change linens; RN communication for incomplete tasks; fall precautions." All tasks were to be completed every visit. Aide frequency of three times weekly. The aide care plan did not provide the aide(s) with specific instructions for which type of bath to provide for the patient during the visit(s). CLINICAL RECORD 17: The hospice aide care plan dated 05/01/2025 included the following relevant tasks: "Bathing (bed); OR bathing (shower); routine ostomy care, stand by assistance with ambulation; fall precautions." All tasks were to be completed every visit. Aide visit frequency of twice weekly. The aide care plan did not provide the aide(s) with specific instructions for which type of bath to provide for the patient during the visit(s). A joint clinical record review and interview was conducted with the Director of Clinical Services on 02/11/2026 during which time she advised "they had been conducting audits of the aide care plans to modify the ones that had two types of baths, adding oxygen and fall precautions and clarifying other instructions for the aides."

It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 15 (7%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure hospice aide provided services included in the plan of care. CLINICAL RECORD 3: The hospice aide care plan dated 02/06/2026 included the following relevant tasks: "Assist to bedside commode; bathing (shower); dressing; hair care; perineal care; shampoo; skin care; transfer to/from bed/chair; empty trash; RN communication for incomplete tasks." All tasks were to be completed every visit. The aide visit dated 02/09/2026 noted the following: "Bathing (shower) No. Gave bed bath." The aide did not follow the plan of care and documented they gave a bed bath instead of a shower. A joint clinical record review and interview was conducted with the Director of Clinical Services on 02/11/2026 during which time she advised "the aides should call a registered nurse to have the care plan adjusted if they are not providing the type of bath listed."

It is required that Hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. This standard was not met as evidenced by clinical record review and interview. In 1 of 15 (7%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure that the hospice aide reported changes to a registered nurse (RN). CLINICAL RECORD 3: The hospice aide care plan dated 02/06/2026 included the following relevant tasks: "Assist to bedside commode; bathing (shower); dressing; hair care; perineal care; shampoo; skin care; transfer to/from bed/chair; empty trash; RN communication for incomplete tasks." All tasks were to be completed every visit. The aide visit dated 02/09/2026 documented: "Bathing (shower) No. Gave bed bath." The clinical record did not provide evidence that the Hospice Aide reported the changes to the care plan to the RN. A joint clinical record review and interview was conducted with the Director of Clinical Services on 02/11/2026, who stated, "The aides should call a registered nurse to have the care plan adjusted if they are not providing the type of bath listed."