Every finding on record at St Croix 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: medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 24 (8%) clinical records reviewed, the agency did not ensure that all medical supplies and appliances necessary to meet the patient's needs were included in the patient's plan of care. Clinical Record 1: The patient elected the hospice benefit on 12/16/2024 with a diagnosis of malignant neoplasm of the lower lobe of the right lung. The plan of care dated 12/16/2024 through 03/15/2025 ordered "Oxygen 2 liters via nasal cannula continuously." The plan of care did not include documentation of the oxygen concentrator and oxygen supplies. Clinical Record 18: The patient elected the hospice benefit on 10/07/2024 with a diagnosis of end-stage renal disease. The patient resided in an assisted living facility (ALF). The plan of care dated 10/07/2024 through 01/04/2025 ordered "Oxygen 1 liter via nasal cannula at bedtime." The plan of care did not include documentation of the oxygen concentrator and oxygen supplies. In an interview on 03/26/2025, the Regional Director of Clinical Operations reviewed the records and stated, "The oxygen concentrator and oxygen supplies are not on the plan of care."

It is required that the hospice provides nursing care under the supervision of a registered nurse. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #1-031 "Responsibilities/Supervision of Clinical Services" (dated 12/2018) read in part, "A monthly patient visit will be completed by a registered nurse to supervise licensed practical/vocational nursing services." In 5 of 11 (45%) clinical records reviewed of patients that received Licensed Practical Nurse (LPN) visits, the agency did not ensure that nursing care and services were provided by or under the supervision of a Registered Nurse (RN). Clinical Record 8: The patient elected the hospice benefit on 02/14/2025 with a diagnosis of congestive heart failure (CHF). The patient resided in an assisted living facility (ALF). The plan of care dated 02/14/2025 through 04/14/2025 ordered "SN 2 times per week." A clinical record review revealed LPN visits dated 02/17/2025, 02/26/2025, and 03/12/2025. The RN documented no LPN supervisory visits. Clinical Record 10: The patient elected the hospice benefit on 10/05/2024 with a diagnosis of renal cell carcinoma. The plan of care dated 01/03/2025 through 04/02/2025 ordered "SN 2 times per week." A clinical record review revealed a LPN visit dated 02/10/2025. The RN documented no LPN supervisory visits. Clinical Record 15: The patient elected the hospice benefit on 12/03/2024 with a diagnosis of severe protein calorie malnutrition. The plan of care dated 12/03/2024 through 01/31/2025 ordered "SN 2 times per week." A clinical record review revealed a LPN visit dated 12/13/2024. The RN documented a LPN supervisory visit on 01/31/2025, 49 days outstanding. Clinical Record 16: The patient elected the hospice benefit on 09/13/2024 with a diagnosis of neurocognitive disorder with Lewy bodies. The plan of care dated 09/13/2024 through 12/11/2024 ordered "SN 1 time per week." A clinical record review revealed a LPN visit dated 09/16/2024. The RN documented no LPN supervisory visits. Clinical Record 22: The patient elected the hospice benefit on 07/29/2024 with a diagnosis of malignant neoplasm of the lower lobe of the right lung. The plan of care dated 07/29/2024 through 10/26/2024 ordered "SN 2 times per week." A clinical record review revealed a LPN visit dated 08/28/2024. The RN documented no LPN supervisory visits. During a joint record review on 03/27/2025, the Regional Director of Clinical Operations and Manager of Accreditation confirmed that LPN supervisory visits were not completed monthly per agency policy.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide; and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 4 of 23 (17%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that a Registered Nurse (RN) completed HA supervisory visits no less frequently than every 14 days. Clinical Record 4: The patient elected the hospice benefit on 02/21/2025 with a diagnosis of Parkinson's Disease. The patient resided in a skilled nursing facility (SNF). The plan of care dated 02/21/2025 through 04/21/2025 ordered "Hospice Aide 2 times per week. A clinical record review revealed no documentation of HA supervisory visits. Clinical Record 6: The patient elected the hospice benefit on 03/04/2025 with a diagnosis of congestive heart failure (CHF). The patient resided in an assisted living facility (ALF). The plan of care dated 03/04/2025 through 05/02/2025 ordered "Hospice Aide 2 times per week." A clinical record review revealed no documentation of HA supervisory visits. Clinical Record 8: The patient elected the hospice benefit on 02/14/2025 with a diagnosis of CHF. The patient resided in an ALF. The plan of care dated 02/14/2025 through 04/14/2025 ordered "Hospice Aide 2 times per week." The first HA visit was on 02/17/2025. A clinical record review revealed the first HA supervisory visit dated 03/20/2025, with 31 days outstanding. Clinical Record 23: The patient elected the hospice benefit on 09/13/2024 with a diagnosis of Alzheimer's Disease. The patient resided in a SNF. The plan of care dated 09/13/2024 through 11/06/2024 ordered "Hospice Aide 2 times per week." A clinical record review revealed no documentation of HA supervisory visits. During a joint record review on 03/27/2025, the Regional Director of Clinical Operations and Manager of Accreditation confirmed that Hospice Aide supervisory visits were completed less frequently than every 14 days.

It is required that bags used to carry medical equipment (e.g., BP cuff) or supplies into or out of the care environment are transported and used in a manner consistent with organizational policy to prevent the spread of infections and communicable diseases. This standard was not met as evidenced by observation, document review and interview. 1 of 2 (50%) home visit observations with clinicians who brought a bag into the home revealed the hospice did not ensure adherence to bag technique, as defined in hospice policy, was performed. Organizational Policy No. 7-016 titled “Bag Technique” states, in relevant part, "...wash your hands again if you need to re-enter the bag for additional supplies during patient care.” Record #45600: the patient elected the hospice benefit on 5/9/22. An observed home visit was conducted on 6/14/22. During this visit the nurse assessed the patient’s blood pressure (BP), sat the BP cuff aside and re-entered the visit bag without performing hand hygiene. In an interview conducted with the Administrator (#17730) on 6/14/2022, she confirmed that the nurse did not follow the organizational policy.