Every finding on record at Stairways Hospice, Inc

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 must be prepared by a registered nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of this section. This standard was not met as evidenced by clinical record review and interview. In 3 of 7 (43%) clinical records reviewed of patients who received hospice aide services revealed the agency did not ensure the hospice aide received specific and accurate written patient care instructions. Clinical Record 1: The patient elected hospice care on 11/28/23. The aide plan of care dated 11/28/2023 assigned the aide visit frequency 5 times a week. The start of care was on a Tuesday. The aide could not have visited the patient 5 times that week. There were only 4 days left in the week. The aide did not receive specific accurate instructions for the visit frequency. Clinical Record 4: The patient elected hospice care on 02/23/23 The aide plan of care dated 02/23/2023 assigned the aide visit frequency 5 times a week. The start of care was on a Thursday. The aide could not have visited the patient 5 times that week because there were only 2 days left in the week. The aide did not receive specific accurate instructions for the visit frequency. Clinical Record 9: The patient elected hospice care on 10/12/23 The aide plan of care dated 10/12/2023 assigned the aide visit frequency 5 times a week. The start of care was on a Thursday. The aide could not have visited the patient 5 times that week because there were only 2 days left in the week. The aide did not receive specific accurate instructions for the visit frequency.. During a joint review of clinical records and interview on 04/03/24, the DON confirmed that the aide frequencies were not specific and accurate.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 5 of 10 (50%) records reviewed revealed the agency did not ensure that the hospice aide provided services that were ordered by the interdisciplinary group and included in the plan of care. Clinical Record 1: The aide care plan dated 11/28/2023 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 12/03/2023 through 12/09/2023, the aide documented completion of shampoo at every visit. Clinical Record 4: The aide care plan dated 02/23/2023 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 02/26/2023 through 03/04/2023, the aide documented completion of shampoo at every visit. Clinical Record 5: The aide care plan dated 03/15/24 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 03/17/2024 through 03/23/2024, the aide documented completion of shampoo at every visit. Clinical Record 6: The aide care plan dated 03/28/24 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 04/10/2024 through 04/06/2024, the aide documented completion of shampoo at every visit. Clinical Record 9: The aide care plan dated 10/12/23 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 10/15/2023 through 10/21/2023, the aide documented completion of shampoo at every visit. During an interview on 04/03/2024, the DON confirmed the finding and stated the aide had not followed the plan of care.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I; and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed, in which the patient revoked their hospice benefit and was admitted to a Medicare/Medicaid Certified hospital, revealed that the agency did not ensure that a discharge summary was forwarded to the receiving facility. Clinical Record 12: The patient elected hospice care on 11/16/2023 with a diagnosis of CHF. The discharge summary dated 12/26/2023, the RN documented that the patient was admitted at a hospital to seek aggressive treatment. There was no documented evidence that the discharge summary was sent to the receiving hospital for continuity of care. On 04/03/2024 a joint clinical record review and an interview was conducted with the DON who confirmed that a discharge summary was completed but was not forwarded to the receiving hospital.