Every finding on record at St Paul Elder Services

Based on record review and interview, the agency RN (Registered Nurse) failed to supervise the hospice aide for quality of care and services no less frequently than every 14 days in 5 of 12 patients receiving hospice aide services (Patients #2, #4, #7, #8, and #9) in a total of 14 patient records reviewed. --- Findings Include: Review of agency policy titled "Evaluation" (effective 07/07, latest review 2023) revealed "Procedure: Nurse Aide Supervision. 1. An RN Case Manager makes on-site visits to the patients home no less frequently than every 14 days to assess the quality of care and services provided by the nurse aide and to ensure that services ordered by the hospice IDG (Interdisciplinary Group) meet the patients needs." Record review of Patient #2s ";Combined Disciplinary Plan of Care" with start of care date 01/27/2022 revealed ";Musculoskeletal - Issues: Interventions: Hospice Aide to assist with bathing once weekly." Review of RN documentation from 05/21/2023 to 07/22/2023 revealed the RN conducted weekly hospice visits and no evidence of RN supervision of the aide the week of 05/21/2023 and 06/22/2023. Record review of Patient #4s ";Combined Disciplinary Plan of Care" with start of care date 06/21/2023 revealed ";IDG approval: Minimum number of hospice aide visits before next scheduled IDG review: 2." Review of RN documentation from 06/21/2023 to 07/22/2023 revealed the RN conducted weekly hospice visits. There was no evidence of hospice aide supervision from 06/21/2023 to 07/18/2023. Record review of Patient #7s ";Combined Disciplinary Plan of Care" with start of care date 06/22/2023 revealed ";Musculoskeletal - Issues: Interventions: Hospice Aide to provide cares at visit per assignment." Review of RN documentation from 06/22/2023 to 07/22/2023 revealed the RN conducted weekly hospice visits. There was no evidence of hospice aide supervision from 06/22/2023 to 07/19/2023. Record review of Patient #8's "Combined Disciplinary Plan of Care" with a start of care date 03/21/2023 revealed "Musculoskeletal - Issues: Interventions: Hospice Aide provide weekly visit providing care per assignment" Review of RN documentation from 06/19/2023 to 07/18/2023 revealed no evidence of hospice aide supervision from 06/26/2023 - 07/09/2023. Record review of Patient #9's "Combined Disciplinary Plan of Care" with a start of care date 02/13/2023 revealed "Musculoskeletal - Issues: Interventions: Hospice Aide: Provide weekly visit providing care per assignment" Review of RN documentation from 05/21/2023 -07/22/2023 revealed no evidence of hospice aide supervision from 06/13/2023 - 07-09/2023. During an interview with RN Case Manager D on 07/25/2023 at 3:20 PM, the RN visit documentation for aide supervision was reviewed and noted that in Nurse Progress Notes for each RN visit, there is a section that stated, ";Section Summary: The care provided by the Hospice Aides in the last 14 days follow the Hospice Aide assignments: Yes, No, N/A (Non-Applicable)". When asked what the agency process for documentation of RN aide supervision, RN Case Manager D replied, ";Yes, we click on that every visit." The above findings for patients #2, #4, #7, #8 & #9 were confirmed with Hospice Administrator A, Office Manager B, and RN Case Manager D on 07/25/2023 at 3:30 PM. Administrator A, Officer Manager B, and RN Case Manager D were given opportunity to look in the record for missing aide supervision visits. During interview with Administrator A, Office Manager B, and RN Case Manager D on 07/25/2023 at 4:30 PM. RN Case Manager D stated, "I agree Patients #2, #4, #7, #8, and #9 are missing supervisory visits."