Every finding on record at The Hospice Foundation of Greater Baton Rouge

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: Prescription and over-the-counter (OTC) Supplements; Herbal remedies; Other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: The effectiveness of drug therapy; Drug side effects; Actual or potential drug interactions; Duplicate drug therapy; Drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 1 of 26 (4%) clinical records reviewed revealed that the agency did not ensure the medication profile was updated with a full review of all medications that the patient was taking. CLINICAL RECORD 25: The patient’s election of benefits was 04/21/2025 with diagnosis of Pancreatic CA. The patient was admitted to IPU (inpatient unit) to GIP (general inpatient Care) on 04/21/2025 for pain and nausea with IVP (intravenous push) morphine [pain control], Phenergan [control of restlessness], and Zofran [control of nausea]. The use of a saline flush before and after medications would be required, but saline was not documented on the medication profile during the comprehensive assessment and consequently not reviewed. During the interview with the inpatient manager who jointly reviewed the records stated that the normal saline to flush the line should have been on the medication profile, where all medications are reviewed.

It is required that the hospice designates a registered nurse member of the IDG to: Provide coordination of care; Ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) Clinical records of routine patients were reviewed and revealed that the agency did not ensure that all care was coordinated and that the plan of care was followed as ordered. CLINICAL RECORD 23: The patient’s election of the hospice benefit was 12/27/2024. The initial comprehensive assessment 12/27/2024 included the patient had a tunneled PICC (peripherally inserted central catheter) line. The initial plan of care and updated plans of care documented an intervention, Central Line Dressing change to be performed every 7 days using sterile technique by a hospice nurse or caregiver. The PICC line dressing changes were documented 12/29/2024 and again 01/06/2025, then 01/16/2025 (10 days), then 01/24/2024 to 02/03/2025, this was 10 days, then 2/10/2025, then 02/26/2025, this was 16 days. Interview with the registered nurse, case manager stated that the dressing was changed every week by the nurse or the caregiver but stated that the specific documentation was not in the clinical record. There was no documented evidence that care was coordinated and that the plan of care was followed as ordered. During the joint record review with the Clinical Director and the Director of Compliance and Education, who stated that the coordination of care was not documented by the registered nurse.

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 2 of 23 (9%) clinical records reviewed, for routine hospice patients, it was revealed that the agency did not ensure the plan of care was updated with interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 1: The hospice benefit of election was 05/30/2024. The updated nursing assessment identified sleep as an increasing problem for the patient on 12/31/2024 and noted in the updated nursing assessment as well as the face-to-face documented on 03/04/2025. There was no documented evidence for interventions on the plan of care for the sleep problem as of 04/22/2025. CLINICAL RECORD 3: The hospice benefit of election 12/13/2024 for senile dementia. The initial plan of care, 12/13/2024, and updated plans of care documented an intervention under GI/GU for patients' catheter will be maintained without discomfort or signs or symptoms of infection. This intervention continued as of the last plan update 04/17/2025. Interview with the nurse, the patient does not have a catheter and had not had a catheter during care. During the interview with the Clinical Director, who stated that all interventions were not accurate and completely updated, but this was a current process improvement.

It is required that each patient’s individualized written plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 26 (15%) clinical records reviewed revealed that the agency did not ensure that the plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. CLINICAL RECORD 1: The hospice benefit of election was 05/30/2024. The updated nursing assessment identified pain as an increasing problem on 06/03/2024 and continued with multiple medication changes and instructions. The updated plan of care documented a goal, "Patient/Caregiver goals: pain rating of ( )/10 will be maintained by start date 6/3/2024. All updated plans through 04/22/2025 document the same goal with no clarification, individualization, or measurability. CLINICAL RECORD 11: The hospice benefit of election 01/25/2025. The updated plan of care 04/02/2025 for skin and wound care documented a goal "Patient will exhibit pain related to wound care acceptable to patient ( )/10 by 04/02/2025. The updated plan on 04/07/2025 and 04/16/2025 continued with the same goal, with no clarification, individualization, or measurability. CLINICAL RECORD 14: The hospice benefit of election was 01/10/2025 with an identified patient goal: "patient caregiver goals: pain rating of ( )/10 will be maintained by 01/10/2025. The updated plans 01/23/2025, 02/04/2025, 02/20/2025, 03/04/2025, 03/19/2025, and 04/02/2025 continue to document the same goal with no clarification of individualization or measurability. During the interview with the Director of Compliance and Education and the Clinical Director, who jointly reviewed the records, stated that the goals were not defined.

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, interview, and observation. In 5 of 21 (24%) clinical records reviewed in which a hospice aide was accepted, the agency did not ensure that the registered nurse prepared a hospice aide plan of care that included clear and specific instructions for the patient's required care. CLINICAL RECORD 2: The hospice aide assignment dated 11/11/2024 and updated 02/28/2025 documented for skin to "apply barrier cream as directed." There were no documented specific instructions for where the cream should be applied. The aide visits 3 times a week and documents that barrier cream was applied but did not document where it was applied. CLINICAL RECORD 5/HOME VISIT 5: The hospice aide assignment dated 12/31/2024 assigned the task to "apply barrier cream as directed 3 times a week." There were no documented specific instructions for where the cream should be applied. During the home visit with the hospice aide (Personnel Record 5) on 04/21/20225, the aide's plan of care continued the assigned "apply barrier cream as directed". Interview with the aide during the visit, she stated that she applies barrier cream to the perineum and coccyx area as the patient is incontinent, and that she had spoken and verified with the nurse. There was no documented evidence of the communication of the aide with the nurse. CLINICAL RECORD 3: The hospice aide assignment documented dated 12/13/2024 with no documented updates as of review 04/23/2025 documented the task for " apply barrier cream as directed 3 times a week. " There was no documented evidence of specific instructions for where the cream should be applied as of review 04/22/2025. CLINICAL RECORD 8: The hospice aide assignment document dated 02/26/2025 and updated 04/17/2025 with the task to "apply barrier cream as directed, “however There were no documented evidence of specific instructions for where the cream should be applied as of the review 04/23/2025. CLINICAL RECORD 14: The patient’s election of benefit was 01/10/2025 with diagnosis of Senile degeneration of the brain. The patient resided with a daughter. The hospice aide assignment updated 04/07/2025 included the tasks of shampoo prn and clean nails prn. The prn was not specific to frequency or who would be the decision maker for these assigned tasks. During the interview with the Director of Compliance and Education and the Clinical Director, who jointly reviewed the records and stated that direction for barrier cream was missing, as well as identified the decision maker.

It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group; Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 21 (19%) Clinical records reviewed in which a hospice aide was accepted for care, the agency did not ensure that the hospice aide provided care according to the ordered plan of care. CLINICAL RECORD 2: The hospice aide assignment dated 11/11/2024 and updated 02/28/2025 with the task of shampooing every Monday. The following dates the shampoo was provided was 03/26/2025 (Wednesday), 03/28/2025 (Friday), 04/02/2025 (Wednesday and 04/04/2025 (Friday). These were not Monday dates, and no documented evidence why it was provided on days other than Monday as ordered. CLINICAL RECORD 15: The hospice aide assignment dated 01/26/2025 with no updates assigned the task of bed bath five times a week and shampoo one time a week. The week of 04/06/2025, with five aide visits documented there was no documented evidence that the shampoo was provided and no documented reason for not providing the shampoo. The week of 04/13/2025, with aide visits documented five times a week, the aide documented that the hair was shampooed on 04/15/2025, 04/17/2025, and 04/18/2025, which was three times that week. There was no documented evidence why the shampoo was provided three times the week of 04/13/2025. CLINICAL RECORD 9: The hospice aide's plan of care assignment dated 01/15/2025, included the task for shampooing one time a week. The week beginning 03/02/2025 the aide documented shampooing on 03/06/2025 (Thursday) and 03/08/2025 (Saturday). This was two times during the week of 03/02/2025, not the one time assigned, and no reason why the plan of care was not followed. CLINICAL RECORD 18: The hospice aide assignment dated 03/07/2025 included the assigned tasks of bed bath, oral care, hair care, peri care to be provided three times a week, with visits ordered three times a week, and shampoo one time a week. For the aide visit notes dated 04/05/2025 and 04/19/2025, none of the care tasks were documented. There was no documented evidence as to why the assigned task were not completed or evidence of notification to the registered nurse. An interview on 04/23/2025 with the aide on 04/23/2025 revealed that the patient refused care on these dates and that the aide did call the hospice nurse and facility nurse, but agreed it was not documented. During the interview on 04/23/2025 with the Director of Compliance and Education, and with the Clinical Director stated that the documentation of the care was not as ordered on the aide assignment.

It is required that a hospice-operated inpatient care facility complies with all applicable federal, state, and local health and safety codes, including: The applicable provisions of the Life Safety Code (LSC) of the National Fire Protection Association NFPA 101, Life Safety Code 2012 edition; and, (L827-418.110(d)) Tentative Interim Amendments (TIA) 12-1, TIA 12–2, TIA 12–3, and TIA 12–4; and, The Health Care Facilities Code NFPA 99, 2012 edition and Tentative Interim Amendments TIA 12–2, TIA 12–3, TIA 12–4, TIA 12–5, TIA 12–6 – except Chapters 7, 8, 12, and 13 that do not apply to hospice. (L828-418.110(e)) This standard was not met as evidenced by document review, interview, and observation. An observation of the stored oxygen cylinders revealed that the agency did not ensure they were stored and labeled as required per regulation. Full, partial or empty cylinders. A critical aspect of oxygen uses, and storage is related to identifying each cylinder as full or empty. In an emergency, it is critical for staff to easily identify which cylinders are full. NFPA 99 section 11.6.5.3 specifically requires that empty cylinders be “marked to avoid confusion and delay if a full cylinder is needed in a rapid manner.” Tour of IPU (inpatient unit) on 4/23/2025 revealed that the agency had not maintained the storage room containing oxygen cylinders. There were 13 oxygen e-tanks total, 4 were empty, and 9 were full tanks. The Facility Clinical Manager was aware of which e-tanks were full, and which were empty, however, none of them were marked. 1 empty cylinder was secured in a cart, and 3 empty cylinders were standing with no security holding them up or securing them from falling. There were 5 full cylinders secured in carts, and 4 full cylinders were standing unsecured. During an interview with the Facility Clinical Manager on 4/23/2025, she agreed with the observation of unsecured cylinders in storage and the lack of labeling of oxygen cylinders. By the end of that day, full and empty cylinders were separated and labeled, and all cylinders were secure in racks or in carts. Tour of IPU (inpatient unit) on 4/23/2025 revealed that the agency had not maintained the storage room containing oxygen cylinders.. There were 13 oxygen e-tanks total, 4 were empty, and 9 were full tanks. The Facility Clinical Manager was aware of which e-tanks were full and which were empty, however, none of them were marked. 1 empty cylinder was secured in a cart, and 4 empty cylinders were standing with no security holding them up or securing them from falling. There were 5 full cylinders secured in carts, and 4 full cylinders were standing unsecured. During an interview with the Facility Clinical Manager on 4/23/2025, she agreed with the observation of unsecured cylinders in storage and the lack of labeling of oxygen cylinders. By the end of that day, full and empty cylinders were separated and labeled, and all cylinders were secure in racks or in carts.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over the counter (OTC) drugs. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions and duplicate drug therapy. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records and interview. 2 of 20 (10%) records reviewed revealed the hospice did not ensure the documented comprehensive assessment includes a drug profile that contains the patient's current prescriptions, and allergies. Record #33375: For the certification dated 5/5/2022, the patient's diagnoses included COPD and Cardiomyopathy. The patient's history and physical dated 4/06/2021 documented medication allergies as Codeine and Sodium Bicarbonate. The medication profile dated 5/05/2021, documented, "Client Allergies... NKA." In addition, Oxygen 3 Liters per nasal cannula was not listed on the medication profile. Record #91070: For the certification dated 3/11/2022 through 4/10/2022, the patient's diagnoses included Dementia, Paroxysmal Atrial Fibrillation, Hypertension. Unstageable Sacral Decubitus, Nausea, and Vomiting. The medication profile did not include Oxygen 2 Liters per nasal cannula. In addition, a completed skilled nursing visit note dated 2/7/2022, indicated that the patient had been using” Bio-freeze” for pain. The medication profile did not include the medication Bio-freeze. An interview was conducted on 7/6/2022 and 7/7/2022 with the Administrator who confirmed that the medication profile should be updated.

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 a review of clinical records and interview. 5 of 11 (45%) records reviewed of patients receiving aide services revealed the hospice did not ensure the aide was assigned specific written instructions. Record #82780: For the recertification dated 6/23/2022 through 8/21/2022, the patient's diagnoses included Senile Degeneration, Bipolar Disorder, Toxic Encephalopathy, and Alcohol Abuse. The aide care plan dated 8/21/2022 documented, "Chair, Shower, Tub Bath, Complete Bath." The aide care plan did not provide the aide with specific instructions as to the type of bath the patient was to receive. Record #29042: For the recertification dated 6/25/2022 through 8/23/2022, the patient's diagnoses included Senile Degeneration, Heart Failure, Atrial Fibrillation, and Increased Weakness. The aide care plan dated 6/22/2022 documented, "Chair, Tub, Complete Bath and Shower Chair." The aide care plan did not provide the aide with specific instructions as to the type of bath to be completed. Record #46015: For the certification beginning on 6/8/2022, the patient's diagnoses included Alzheimer's disease, Vascular Dementia, and Parkinson's Disease. The aide care plan documented, "Chair Bath, Bed Bath, Shave Per Request, Passive ROM Left and Right As Requested." The patient's decline in mental acuity and functional status rendered the patient unable to make decisions safely. The aide care plan did not provide the aide with specific instructions as to the type of bath, when to shave the patient and when to provide the passive ROM.. Record #30625: For the certification 4/21/2022 through 5/08/2022, the patient's diagnoses included Alzheimer's, and Hypothyroidism. The aide care plan dated 4/21/2022 documented, "Complete Bath." The aide care plan did not provide the aide with specific instructions as to the type of bath to be completed. Record #64806: For the certification beginning on 6/16/2022, the patient's diagnoses included Senile Degeneration of the Brain, and Benign Prostatic Hyperplasia. The aide care plan dated 6/16/2022 documented, "Personal Care Bed Bath and Shower." In addition, the aide care plan documented, "Catheter Care to Urethra." The aide care plan did not provide the aide with specific instructions to perform the male catheter care and did not specify the type of bath to be completed. An interview was conducted on 7/6/2022 and 7/7/2022 with the Administrator who confirmed the findings and stated that the aide care plan should be specific.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: a copy of the hospice discharge summary and the patient's record, if requested. This standard was not met as evidenced by review of clinical records and interview. 2 of 4 (50%) applicable records reviewed of patients that were discharged, revealed the hospice did not ensure that the patient's attending physician was sent a copy of the hospice discharge summary. Record #30625: For the certification dated 4/21/2022 through 5/08/2022, the patient's diagnoses included Alzheimer's and Hypothyroidism. On 5/8/2022 revocation was requested by the family. The patient had fallen, the family opted for surgery, and the patient was sent to the emergency room. The discharge summary documented, "patient had severe pain … hip was fractured... transferred to the ER.” There was no documented evidence that a discharge summary and/or hospice records were forwarded to the patient's attending physician for continuity of care and services. Record #91070: For the certification dated 3/11/2022 through 4/10/2022, the patient's diagnoses included Dementia, Paroxysmal Atrial Fibrillation, Hypertension, Unstageable Sacral Decubitus, Nausea, and Vomiting. On 2/21/2022 the clinical record documented, “Stage Two to sacrum...debrided by wound care practitioner last week... Wound now has foul odor, red and edematous, purulent, and looks to be tunneling." After speaking with the Nurse Practitioner (NP), the caregiver made the decision to take the patient to the hospital for "aggressive treatment and IV antibiotics." The revocation was signed. There was no documented evidence that a discharge summary and/or hospice records were forwarded to the patient's attending physician for continuity of care and services. The Administrator confirmed the finding and stated during an interview on 7/8/2022, the attending physician should always be notified to ensure continuity of services.

It is required that the Interdisciplinary Group ensures instruction of the patient, as appropriate, and the family and/or other caregivers on the proper handling, storage, and safe utilization of durable medical equipment and/or supplies. Instruction is documented in the patient record. The patient, family and/or other caregivers must be able to demonstrate the appropriate use of the DME to the satisfaction of the IDG. The IDG documents that the patient, family, and/or caregivers can demonstrate appropriate use of the delivered DME. This standard was not met as evidenced by observation, clinical record reviews, and interviews. 1 of 1 (100%) home visits observed of patients utilizing oxygen revealed the hospice did not ensure that the patient received instruction in the safe use of oxygen. Record #40252: During the observed visit on 7/6/2022, with the hospice aide, the patient was noted to have oxygen for as needed use. There was no oxygen safety sign posted in the patient's home. During an interview on 07/08/2022 the Administrator stated that the agency will follow up with DME provider to provide oxygen safety signs for posting in the home.