Every finding on record at Transitions Ohio II LLC

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. In 1 of 19 (5%) clinical records reviewed in which hospice aide services were provided, the agency did not ensure that written patient care instructions for the hospice aide were clear and complete. CLINICAL RECORD 12: This patient elected the hospice benefit on 01/30/2025 with a diagnosis of Alzheimer's disease. The RN comprehensive assessment completed on 01/30/2025 included the following list of issues for the patient: several hospital visits for vasovagal syncope and edema requiring elevation when seated in recliner, and a requirement of max assist of two for safe transfers. The hospice plan of care for the dates of 01/30/2025-04/29/2025 included orders for hospice aide visits 3XW. The hospice aide care plan was reviewed for the dates of 01/30/2025-04/29/2025 and did not include directions for max assist x2 for transfers or instructions to keep the patient legs elevated when in a Broda chair. In joint clinical review and interview conducted with Alternate Director of Nursing on 04/01/2026, it was stated that the hospice aide care plans reviewed were not complete. The agency leadership team had identified this deficiency and were providing training for the RNs to improve the hospice aide care plans.

It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that volunteer services were provided to the patient/family. CLINICAL RECORD 6: This patient elected the hospice benefit on 07/29/2024 with a terminal diagnosis of malignant neoplasm of the soft tissue. The MSW visit dated 08/02/2024 stated that volunteer services were reviewed with the patient and family but no documentation if volunteer services were accepted. During a joint review and interview with the Regional Vice President of Operations on 04/01/2026, it was stated that a written initial plan of care IPOC) was the place the agency documented the need of the patient for volunteer services, and there was no documentation present of the patient's need for volunteer services.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview which revealed the agency did not ensure the amount of volunteer services provided equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The report to the Governing Body dated 03/18/2026 was reviewed and revealed that the volunteer utilization for the year of 2025 was 0.87%. An interview was conducted with the Regional Vice President, Administrator and the Volunteer Coordinator (VC) on 03/31/2026 and confirmed the finding. The agency recently hired an assistant to the VC to focus on improvement of the volunteer program. An interview was conducted with the Regional Vice President, Administrator and the Volunteer Coordinator (VC) on 03/31/2026 and the report to the Governing Body dated 03/18/2026 was reviewed and revealed that the volunteer utilization for the year of 2025 was 0.87% and did not meet the requirement of five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The agency recently hired an assistant to the VC to focus on improvement of the volunteer program.

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 registered nurse who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 10 of 11 (91%) clinical records reviewed it was revealed that the agency did not ensure that all care and services required to meet the patient needs were included in the aide plan of care, specifically safety and fall precautions. Clinical Record 1: The date of election of benefits (EOB) was 2/14/23. The patient had a primary diagnosis of Cerebral Atherosclerosis. It was documented in the Comprehensive Assessment performed by the Registered Nurse (RN) on 2/14/23 that the patient was assessed for falls using the Missouri Alliance for Home Care (MAHC) 10 fall risk assessment tool. The patient scored an "8" which the electronic medical record (EMR) stated was a risk for falls. There were no safety or fall precautions included in the aide plans of care dated 2/14/23 and 2/15/23. Clinical Record 2: The date of election of benefits (EOB) was 5/1/23. The patient had a primary diagnosis of Post COVID. It was documented in the Comprehensive Assessment performed by the RN on 5/1/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored an "8" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plan of care dated 5/1/23. Clinical Record 3: The date of election of benefits (EOB) was 4/24/23. The patient had a primary diagnosis of Neoplasm of the Prostate. It was documented in the Comprehensive Assessment performed by the RN on 4/24/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored a "4" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plans of care dated 4/24/23, 4/26/23 and 5/2/23. Clinical Record 4: The date of election of benefits (EOB) was 4/5/23. The patient had a primary diagnosis of Neurocognitive Disorder with Lewy Bodies. It was documented in the Comprehensive Assessment performed by the RN on 4/5/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored an "8" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plans of care dated 2/3/23, 2/4/23, 3/11/23 and 3/23/23. Clinical Record 6: The date of election of benefits (EOB) was 4/19/23. The patient had a primary diagnosis of Alzheimer's disease. It was documented in the Comprehensive Assessment performed by the RN on 4/19/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored an "8" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plans of care dated 4/19/23, 4/20/23 and 4/21/23. Clinical Record 7: The date of election of benefits (EOB) was: 5/2/23. The patient had a primary diagnosis of Liver Failure. It was documented in the Comprehensive Assessment performed by the RN on 5/2/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored a "9" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plan of care 5/2/23. Clinical Record 8: The date of election of benefits (EOB) was 2/2/23. The patient had a primary diagnosis of pelvic fractures. It was documented in the Comprehensive Assessment performed by the RN on 2/2/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored a "9" which the EMR stated was a risk for falls. In addition, the clinical note stated prior to admission, "After a fall in which she sustained bilateral pelvic fractures." There were no safety or fall precautions included in the aide plans of care dated 2/2/23, 2/3/23, 2/14/23 and 2/28/23. Clinical Record 9: The date of election of benefits (EOB) was 2/4/23. The patient had a primary diagnosis of COVID-19 condition. It was documented in the Comprehensive Assessment performed by the RN on 2/4/23 that the patient was assessed for falls using the MAHC-10 fall risk assessment tool. The patient scored a "7" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plans of care dated 2/4/23, 2/14/23 and 3/17/23. Clinical Record 10: The date of election of benefits (EOB) was 4/20/23. The patient had a primary diagnosis of Alzheimer's Disease. It was documented in the Comprehensive Assessment performed by the RN on 4/20/23 that the patient was assessed using the MAHC-10 fall risk assessment tool. The patient scored an "8" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plan of care dated 4/20/23. Clinical Record 12: The date of election of benefits (EOB) was 1/19/23. The patient had a primary diagnosis of Renal Disease. It was documented in the Comprehensive Assessment performed by the RN on 1/19/23 that the patient was assessed using the MAHC-10 fall risk assessment tool. The patient scored a "9" which the EMR stated was a risk for falls. There were no safety or fall precautions included in the aide plans of care dated 1/29/23 or 1/24/23. On 5/3/23 during an interview, the VP of Growth and Development and Staff 5 stated that the aide plans of care did not have fall precautions or safety measures included and agreed they should have that information.