Every finding on record at Shepherd Care Hospice LLC

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, observation, and interview. 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the patient's plan of care (POC) included the drugs and treatments necessary to meet the needs of the patient. Clinical Record 1/Home Visit 1: The patient elected hospice care on 9/21/2023. During the home visit on 10/4/2023, the patient was observed using oxygen. The initial comprehensive assessment completed by the Registered Nurse (RN) on 9/21/2023 documented the patient was using oxygen at 3 liters per nasal cannula. On 9/22/2023, the physician ordered "Oxygen at 3L per NC." The plan of care dated 9/21/2023 did not include documentation of oxygen as a medication, including the route of administration and the liter flow. The POC was not updated to include the physician's order for oxygen on 9/22/2023. Clinical Record 12: The patient elected hospice care on 3/15/2022. The recertification assessment completed by the RN on 12/21/2023 documented a "stage 3 sacral wound." The POC dated 12/25/2023 ordered "Hospice nurse to perform wound care to sacral pressure wound. Utilizing clean technique- Complete wound care as ordered." The POC dated 1/9/2023 through 1/18/2023 read "wound care as ordered." The POCs did not include the specific wound care. During an interview on 10/4/2023, the Executive Director confirmed that the plan of care dated 1/9/2023 did not include specific wound care orders and the oxygen orders were not included in the plan of care. 2 of 14 (14%) of clinical records reviewed revealed that the agency did not ensure that all individualized care plans included all of the drugs and treatment necessary for the patient's individualized care.

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 13 (15%) clinical records reviewed of patients with a hospice aide, the hospice did not ensure the hospice aide received specific patient care instructions. Clinical Record 4: The patient elected hospice care on 7/1/2023 with the diagnosis of renal cancer with metastasis. The comprehensive assessment completed by the Registered Nurse (RN) on 7/1/2023 documented the patient had a percutaneous endoscopic gastrostomy (PEG) tube in place. The Aide Care Plans initiated on 7/1/2023 and updated on 7/10/2023, 7/19/2023, 9/15/2023, 9/18/2023, and 9/21/2023 did not include documentation of instructions for the hospice aide related to the patient's PEG tube. Clinical Record 12: The patient elected hospice care on 3/15/2022. The comprehensive assessment completed by the RN on 3/15/2022 revealed that the patient had a PEG tube in place. The recertification comprehensive assessment completed by the RN on 12/21/2022 documented the PEG tube remained in place. The Aide Care Plan dated 12/7/2022 did not include documentation of instructions for the hospice aide related to the patient's PEG tube. 2 of 13 (15%) of clinical records reviewed with a home health aide, revealed that the agency did not ensure that home health aide care plans included patient specific information that could impact the personal care of the patient.

It is required that the hospice obtains a criminal background check on all hospice employees who have direct patient contact or access to patient records. Criminal background checks are obtained in accordance with state requirements. In the absence of state requirements, criminal background checks are obtained within three (3) months of the date of employment for all states in which the individual has lived or worked during the past three (3) years. This standard was not met as evidenced by interview and personnel record review. 1 of 9 (11%) of personnel records reviewed revealed that the agency did not ensure that personnel files included evidence of a criminal background check. Personnel Record 1: The Director of Nursing (DON)/Clinical Manager was hired on 01/02/2014. The employee was hired by the previous owner in 2014. The personnel record included documentation from 2022 forward. A review of the personnel record revealed no documented evidence of a criminal background check. During an interview on 10/5/2023, the Executive Director reported that the employee had a background from former employer prior to acquisition but they were unable to find it. 1 of 9 (11%) of personnel records reviewed revealed that the agency did not ensure that personnel files included evidence of a criminal background check.