Every finding on record at Rta Hospice, LLC

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable diseases, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review, interview, and observation. Agency policy #IPC.11_A2 "Infection Control: Bag Technique and Standard Precautions" (last reviewed 09/19/2025) stated in part, "Hand hygiene is divided into two (2) aspects: a. Hand washing using soap and water; b. Use of alcohol-based hand gel (sanitizer) when soap and water are not available or feasible for use. When to wash hands with soap and water:... after using gloves. When to use hand gel (sanitizer): before direct patient contact and after direct patient contact; before donning gloves and after removing gloves;... moving between clean and contaminated body surfaces/sites...When washing hands with soap and water. Wet your hands with clean running water (warm or cold), turn off the tap, and apply soap. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails for at least 20 seconds....Rinse your hands well under clean, running water. Dry your hands using a clean paper towel or air-dry them. Faucet to be turned off with paper towel used to dry hands. If the air-dry method is used, turn the faucet off with elbows, hands up, no contact to face or hair. Repeat process 1-5, before and after patient contact, before and after entering your bag, before and after donning and doffing gloves, before and after any patient procedure, or after contact with inanimate objects in the patient environment." In 1 of 4 (25%) home visits observed, the organization did not ensure that hand hygiene was performed correctly when indicated per the agency's hand hygiene policy. HOME VISIT 3: During the home visit (Clinical Record 8) on 03/25/2026 with the Hospice Aide (HA) [Personnel Record 11], the HA removed their gloves after washing the patient’s legs and donned a new pair of gloves. The HA cleaned the patient’s peri area of stool and applied lotion to the back. The HA then finished changing the patient's brief and chux pad and removed their gloves. The HA washed their hands with soap and water, turned off the faucet with their wet hands, and dried their hands with paper towels. The HA selected a shirt for the patient, donned a new pair of gloves, and applied lotion before putting the shirt on. The HA did not perform hand hygiene between glove changes or when moving from a contaminated area to a clean area. Additionally, the HA did not use a paper towel or air-dry their hands, and did not turn off the water with a paper towel or the elbow. During an interview on 03/25/2026, the Area Executive of Clinical Operations agreed that the staff did not follow the hand hygiene policy.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 19 (21%) clinical records reviewed, the agency did not ensure that the individualized plans of care included interventions related to the patient's psychosocial or safety needs, specifically fall prevention and aspiration precaution measures. Clinical Record 1: Election of benefit 1/20/23. RN initial comprehensive assessment, dated 1/20/23, documented a fall risk assessment score of "14" with "a total score of 10 or more indicates high risk." The physician narrative signed on 1/29/23 stated: "He is able to ambulate short distances however is an increasingly high fall risk." On 3/22/23, an RN documented a PRN (as needed) visit for a fall and stated, "patient had a fall this morning with a head strike." That nursing visit assessment included an area for interventions provided, and goals met, neither of these areas addressed safety needs or fall precautions. The plan of care effective from 1/20/23 to current did not include any problems, goals, or interventions related to safety or fall prevention. Clinical Record 3: Election of benefit 3/21/22. Nursing recertification comprehensive assessment, dated 2/28/23, documented, "Pt (patient) is a high fall risk and has had >4 falls in past three months." A nursing visit dated 3/29/23 documented, "son reported that patient fell out of bed on 3/24/23 and the fire department was called to pick her up off the floor." The plan of care effective 3/24/23 to current did not contain any problems, goals, or interventions related to safety or fall prevention. A historical review of the care plan showed that safety and fall precautions had been addressed initially, but those problems, goals, and interventions were discontinued on 11/3/2022. Clinical Record 7: Election of benefit 2/4/22. The initial social worker assessment was documented on 2/7/22, and the following was added to the care plan: "Medical Social Worker (MSW) evaluation performed. No additional visits will be performed for this discipline." There were no additional MSW, per patient request, until 8/3/22 when an order was written: "MSW visit to assess/support psychosocial needs." The recertification plans of care from August 2022 to current ordered an MSW visit frequency of one visit every other month. Recertification plan of care orders for the current benefit period (3/28/23 to 5/29/23) included orders for the MSW visit frequency of one visit for the certification period. An MSW comprehensive assessment visit was documented on 5/3/23, with companionship and psychosocial support documented. In the interdisciplinary team, meeting notes from 5/9/23, the MSW documented, "update this person's care plan to reflect changes discussed and agreed during this meeting," however there were no updates made to the social worker care plan to indicate what problems, goals, or interventions were being addressed. As of 5/16/23, the only problem on the plan of care for the MSW remained "Medical Social Worker evaluation performed. No additional visits will be performed for this discipline." Clinical Record 11: Election of benefit 2/7/23 with relevant diagnoses: dysphagia and repeated falls. RN's initial comprehensive assessment dated 2/7/23 documented the following: severe dysphagia, high aspiration risk, nectar fluids, no longer able to swallow pills, history of repeated falls, and a fall risk score of 18 (over 10 equals a high risk for falls). A nursing visit note dated 2/10/23 documented that the patient "continues to take a small amount of pureed diet and nectar thick liquids." The plan of care is effective 2/7/23 to current did not contain any problems, goals, or interventions related to aspiration precautions, dietary modifications, safety, or fall prevention. The Regional Director of Quality reviewed the clinical records and confirmed, during an interview on 5/18/23, that the plans of care for these patients were not individualized to meet the safety and psychosocial needs identified and did not address all of the interventions that they should have.