Every finding on record at Vitas Healthcare Corporation of Illinois

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review, interview, and observation. Agency policy "Hand Hygiene Policy and Procedure" (updated 06/18/2012) stated in part, "decontaminate the hands using an alcohol-based hand rub, or wash hands with an antimicrobial soap and water when hands are not visibly soiled and before having direct contact with patients... after all direct patient care contact." In 1 of 4 (25%) home visits observed, the agency did not ensure that hand hygiene, using the correct technique, was performed when indicated per the agency's policy. Home Visit 4/Clinical Record 4: The patient elected hospice care on 12/04/2021 and resided in a skilled nursing facility (SNF). During the home visit in a large community room at the SNF with the Social Worker (SW) [Personnel Record 3] on 07/23/2024, the SW did not wash their hands or apply hand sanitizer before the visit. The SW stated that they recently washed their hands. The SW met with the patient, touching the patient's shoulder more than once. The SW left the patient and did not wash their hands or use hand sanitizer. The SW touched the visit logbook used by the hospice staff and other common area surfaces within the facility without washing their hands or applying hand sanitizer. The SW did not wash their hands or apply hand sanitizer before the visit or after direct contact with the patient.

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 5 of 18 (28%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the HA care plan included all instructions required to meet the patient's care needs. Clinical Record 8: The patient elected hospice care on 02/18/2023 with a diagnosis of unspecified cirrhosis of the liver. The patient resided in a skilled nursing facility (SNF). On 09/11/2023, the physician ordered the addition of airborne precautions for ten days. The HA care plan dated 08/13/2023 through 02/14/2024 was not updated to include the airborne precautions. The HA visit notes dated 09/11/2023, 09/12/2023, 09/13/2023, 09/14/2023, 09/18/2023, 09/19/2023, and 09/20/2023 did not include documentation or evidence of airborne precautions. The Regional Patient Care Director (RPCD) stated in an interview on 07/24/2024, "In the scheduling system, the aide can see an icon that indicates precautions." The Regional Patient Care Director confirmed that the HA care plan was not updated to include precautions. Clinical Record 12: The patient elected hospice care on 02/27/2024 with a diagnosis of malignant neoplasm of the pharynx. The patient resided in a SNF. The skilled nursing (SN) assessment dated 02/27/2024 documented that the patient had a gastrostomy tube (G-tube). A clinical record review revealed that on 05/01/2024, a new wound was documented on the patient's left hip that required dressing. The HA care plan dated 04/10/2024 through 06/05/2024 did not alert the HA to the presence of a G-tube or provide the HA with instructions related to the G-tube. The HA care plan was not updated with information or instructions regarding the new wound dressing on the left hip. The HA visit notes dated 05/02/2024, 05/07/2024, 05/09/2024, 05/14/2024, 05/16/2024, and 05/21/2024 did not reference the patient's G-tube or a dressing on the left hip. Clinical Record 13: The patient elected hospice care on 07/14/2024 with a diagnosis of cerebral atherosclerosis. The patient resided in a SNF. The HA care plan dated 07/16/2024 assigned the HA the relevant tasks: shower with chair, sponge bath, and tub bath. The HA visit notes dated 07/16/2024 and 07/23/2024 documented: "shower with bath chair was not performed/not required this visit, sponge bath was not performed /not required this visit, and tub bath was not performed/required this visit." The HA visit note dated 07/19/2024 documented: "shower with bath chair" was "performed," and the "sponge bath and tub bath" were "not performed/required this visit." The HA care plan did not specify the bath type the patient would receive. There was no documentation to indicate that the patient decided on the type of bath. Clinical Record 14: The patient elected hospice care on 07/11/2024 with the diagnoses: malignant neoplasm of the lung and chronic renal failure. The patient resided at home. The SN assessment dated 07/11/2024 documented that the patient had wounds on their elbows and buttocks that required dressings. The HA care plan dated 07/12/2024 assigned the HA the relevant task: sponge bath. The HA visit notes dated 07/17/2024 and 07/19/2024 did not document the elbow and buttock dressing management during the bath. The HA care plan provided the HA with no instructions for managing the dressing during the bath. Clinical Record 16: The patient elected hospice care on 01/16/2024 with a diagnosis of cerebral infarction. The patient resided at home. The HA care plan dated 01/17/2024 assigned the HA the relevant tasks: shower with bath chair, bath and inspect feet, and sponge bath. The HA care plan included comments "shower or sponge bath 1X week, wash hair 1X week." The HA visit note dated 01/23/2024 documented that a "sponge bath" was "performed," and the "shower with bath chair" was "not performed/declined." The HA care plan did not specify when to provide a shower versus a sponge bath or clarify who would decide between a shower and a sponge bath. After a joint clinical record review and interview on 07/24/2024, the Regional Patient Care Director confirmed that the five (5) clinical records noted did not include required individualized care needs.

It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 18 (11%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that the HA provided services that were included in the patient's plan of care. Clinical Record 2: The patient elected hospice care on 06/12/2024 with the diagnoses: senile degeneration of the brain, lesion to scalp, malignant neoplasm on scalp. The patient resided in a skilled nursing facility (SNF). The HA care plan dated 06/13/2024 assigned the HA the relevant tasks: shower or sponge bath based on patient choice, oral hygiene, and dressing the patient. The HA visit notes dated 07/09/2024 and 07/16/2024 documented that the patient refused the shower or bed bath, oral hygiene, and dressing. In addition, the HA care plan assigned the HA the relevant task: "Update to caregiver or notification/report to the nurse." The HA visit notes dated 07/09/2024 and 07/16/2024 documented the task as "not answered." The HA did not perform the assigned tasks during the visits. Clinical Record 13: The patient elected hospice care on 07/14/2024 with a diagnosis of cerebral atherosclerosis. The patient resided in a SNF. The HA care plan dated 07/16/2024 assigned the HA the relevant tasks: shower with bath chair, sponge bath, perineal care, bath and inspect feet, tub bath, inspect and apply lotion to the skin, shave, apply protective cream. The HA visit notes dated 07/16/2024 and 07/23/2024 documented: perineal care, shower with bath chair, sponge bath, tub bath, lotion applied to skin, shave, apply protective cream were "Not performed/ not required this visit." The HA visit note dated 07/19/2024 documented: "shower with bath chair" was "performed," and the "sponge bath and tub bath" were "not performed/required this visit." The HA did not perform the assigned tasks during the visits.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy "VS Supervision Delegation and Coordination" (updated 07/15/2019) read in part, "Provides care only as designated on the POC...Contacts the RN with all changes in condition or inability to follow the care plan...Documents communication and direction received in the clinical note." In 2 of 18 (11%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA reported changes in the patient's condition or needs related to the plan of care to the Registered Nurse (RN). Clinical Record 2: The patient elected hospice care on 06/12/2024 with the diagnoses: senile degeneration of the brain, lesion to scalp, malignant neoplasm on scalp. The patient resided in a skilled nursing facility (SNF). The HA care plan dated 06/13/2024 assigned the HA the relevant tasks: shower or sponge bath based on patient choice, oral hygiene, and dressing the patient. The HA visit notes dated 07/09/2024 and 07/16/2024 documented that the patient refused the shower or bed bath, oral hygiene, and dressing. There was no documentation that the HA notified the RN of the change in the patient's care needs and care plan. In addition, the HA care plan assigned the HA the relevant task: "Update to caregiver or notification/report to the nurse." The HA visit notes dated 07/09/2024 and 07/16/2024 documented the task as "not answered." A review of the clinical record revealed no documentation that the HA notified the RN that the patient refused care. Clinical Record 13: The patient elected hospice care on 07/14/2024 with a diagnosis of cerebral atherosclerosis. The patient resided in a SNF. The HA care plan dated 07/16/2024 assigned the HA the relevant tasks: shower with bath chair, sponge bath, perineal care, bath and inspect feet, tub bath, inspect and apply lotion to the skin, shave, apply protective cream. The plan of care did not indicate that the assigned tasks should be limited to less than every HA visit. The HA visit notes dated 07/16/2024 and 07/23/2024 documented that perineal care, shower with bath chair, sponge bath, tub bath, lotion applied to skin, shave, apply protective cream were "Not performed/not required this visit." The HA visit note dated 07/19/2024 documented: "shower with bath chair" was "performed," and the "sponge bath and tub bath" were "not performed/required this visit." The HA care plan did not specify the bath type the patient would receive. There was no documentation to indicate that the HA sought clarification from the RN or that the RN was notified related to the care plan not being followed. During an interview and a joint record review on 07/24/2024, the Regional Director of Clinical Services confirmed that the aide did not document any notification to the RN related to the inability to follow 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. 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 was transferred to another hospice, the agency did not ensure that a complete discharge summary was sent to the receiving facility. Clinical Record 15: The patient elected hospice on 02/22/2024 and requested a transfer to an alternate hospice on 03/08/2024. A review of the clinical record revealed no evidence that a discharge summary was sent to the receiving facility, the alternate hospice. In an interview on 07/24/2024,the Regional Patient Care Director confirmed that the branch had looked everywhere for a discharge summary and there was not one for this patient.

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders, and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed of patients with a live discharge, the agency did not ensure that a discharge summary that contained all the required elements was completed. Clinical Record 15: The patient elected hospice on 02/22/2024 and requested a transfer to an alternate hospice on 03/08/2024. A review of the clinical record revealed no evidence of a documented discharge summary. There was no documented evidence of care coordination or communication with the alternate facility or physician related to the patient's discharge. The Regional Patient Care Director stated in an interview on 07/24/2024, "We have looked everywhere and confirmed there is no documentation, and discharge summary does not exist for this patient."

Based on clinical records review, document review and staff interview, it was determined the Hospice failed to complete the bereavement plan of care for 2 of 3 (Pts. # 17 and 19) bereavement records reviewed. --- Findings include: 1. Patient (Pt.) #17 was admitted to Hospice on 03/02/2023 with a terminal diagnosis of Vascular Dementia. As of 08/31/2023, the clinical record lacked an initial bereavement plan of care. 2. Pt. #19 was admitted to Hospice on 08/09/2022 with a terminal diagnosis of Brain Stem Stroke. The clinical record included an initial bereavement plan of care dated 08/10/2022. The bereavement plan of care lacked completed documentation for the post death bereavement interventions. 3. The Hospice procedure document titled, ";Bereavement Plan of Care" included, ";...(iv) Develop a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery... Post Death Interventions... For each intervention: Check off the discipline(s) who will be responsible for carrying out the intervention..." 4. During an interview with the National Patient Care Administrator and the Patient Care Administrator at 12:30 PM the above findings were confirmed.

Based on clinical records review and interviews, the Hospice failed to incorporate patient history in the clinical record. This was found in 5 of 19 (Pts. #2, #10, #4, #5 and #6) clinical records reviewed. --- Findings include: 1. Patient (Pt.) #2 was admitted on 2/20/23 for Hospice services with a terminal diagnosis of Cerebral Atherosclerosis. As of 8/30/23, the clinical record lacked documentation of Pt.'s medical history. 2. Pt. #10 was admitted on 8/2/23 for Hospice services with a terminal diagnosis of Malignant Neoplasm of Ovary. As of 8/20/23, the clinical record lacked documentation of Pt.'s medical history. 3. Pt. #4 was admitted on 4/10/23 for Hospice services with a terminal diagnosis of Alzheimer's Disease. As of 8/30/2023, the clinical record lacked documentation of Pt.'s medical history. 4. Pt. #5 was admitted on 6/22/23 for Hospice services with a terminal diagnosis of Moderate Protein Calorie Malnutrition. As of 8/30/2023, the clinical record lacked documentation of Pt.'s medical history . 5. Pt. #6 was admitted on 11/19/23 for Hospice services with a terminal diagnosis of Senile Degeneration of Brain. As of 8/30/23, the clinical record lacked documentation of Pt.'s medical history. 6. During interviews with the National Patient Care Administrator and the Patient Care Administrator on 8/31/23 between 11:15 AM and 1:00 PM, the above findings were confirmed.

Based on document review and interview, it was determined for 2 of 4 (Pt #1, Pt #2) patients record reviewed, the hospice failed to ensure medications were available per the Plan of Care. This has the potential to affect all patients who receive treatment by the hospice. Findings include: --- 1. Pt #1 was admitted to the hospice on 1/28/23 with a diagnosis of malignant neoplasm of appendix. The Plan of Care dated 1/28/23 noted orders for the following medications: Tylenol 650 mg suppository for fever; Zofran 4 mg IV for nausea; Roxanol (Morphine) 5 ml for pain; and Lasix 5 ml for swelling. The Tylenol and Zofran were ordered 1/29/23 (1 day after admission) and Roxanol and Lasix were ordered 1/30/23 (2 days after admission). The record lacked documentation the medications were ordered the day of admission. 2. During an interview with on 4/19/23, E#1 verbally agreed the medications were not ordered on the day of admission. 3. Pt #2 was admitted to the hospice on 3/24/23 with a diagnosis of acute myeloblastic leukemia. The Initial Comprehensive Assessment dated 3/24/23 noted Pt #2 had shortness of breath, treatment for shortness of breath included opioids, other medications and oxygen and opioids were scheduled and on an as needed basis. The record noted Roxanol (opioid for shortness of breath) was prescribed on 3/26/23 and brought to the home at 6:00 PM. 4. During an interview on 4/19/23 at approximately 2:00 PM, E#1 (Registered Nurse, Patient Care Administrator) reviewed Pt #2's record and verbally a agreed Pt #2 did have difficulty breathing although did not have a scheduled or an as needed order for an opioid until 3/26/23.

A. Based on document review and interview, it was determined for 2 of 4 (Pt #1, Pt #2) patients record reviewed, the hospice failed to ensure medications were available per the Plan of Care. This has the potential to affect all patients who receive treatment by the hospice. Findings include: --- 4. Pt #1 was admitted to the hospice on 1/28/23 with a diagnosis of malignant neoplasm of appendix. The Plan of Care dated 1/28/23 noted orders for the following medications: Tylenol 650 mg suppository for fever Zofran 4 mg IV for nausea Roxanol (Morphine) 5 ml for pain Lasix 5 ml for swelling Tylenol and Zofran was ordered 1/29/23 (1 day after admission) Roxanol and Lasix was ordered 1/30/23 (2 days after admission) The record lacked documentation the medications were ordered the day of admission. 5. During an interview with E#1 on 4/19/23 it was verbally confirmed the medications wasn't ordered on the day of admission. 1. Pt #2 was admitted to the hospice on 3/24/23 with a diagnosis of acute myeloblastic leukemia. The Initial Comprehensive Assessment dated 3/24/23 noted Pt #2 had shortness of breath, treatment for shortness of breath included opioids, other medications and oxygen and opioids were scheduled and on an as needed basis. The record noted Roxanol (opioid for shortness of breath) was prescribed on 3/26/23 and brought to the home at 6:00 PM. 2. During an interview on 4/19/23 at approximately 2:00 PM, E#1 (Registered Nurse, Patient Care Administrator) reviewed Pt #2's record and verbally a agreed Pt #2 did have difficulty breathing although did not have a scheduled or an as needed order for an opioid until 3/26/23. B. Based on document review and interview, it was determined for 1 of 4 (Pt #2) patients records reviewed, the hospice failed to ensure death visits were conducted per policy. This has the potential to affect all patient who receive treatment by the hospice. Findings include: 1. The VS Death Attendance policy noted ";Death attendance is not an optional... service but rather a regular and expected service that we provide to our patients and their families... Instead of asking the family to call when the patient dies, you may want to schedule a visit ○ If the death appears imminent you may want to consider a visit 2. The Death Visit... ■ Assess the patient ○ Determine (pronounce) death... ■ Provide post-mortem care... ■ clean the body ■ Fresh linens ■ Clean neat clothes ■ Clean/comb hair ■ Oral care ■ Dentures in ■ Hands neatly folded or overlapped on abdomen ■ Position body straight if possible ■ Place top sheet... Bathe the body... Facilitate transporting patient to facility morgue or hold area if funeral home has not already picked up the body." 2. Pt #2 was admitted to the hospice on 3/24/23 with a diagnosis of acute myeloblastic leukemia. E#4 noted on 3/27/23 at 12:40 AM ";Phone call made to... re new onset fever. It sounds like pt actively dying... declined Tylenol suppositories for now... aware that pt may not make it through the night.... aware to notify hospice when pt does eventually pass." The Report of Death noted dated 3/27/23 noted by E#4 ";Visit start time: 0340 (3:40 PM) Visit end time: 0500 (5:00 AM) Time of pronouncement: 0412 (4:12 AM) Post Mortem Care Performed by: Caregiver... Mortuary Time Called: 0420 (4:20 AM) Time Arrived 0455 (4:55 AM)". 3. During an interview on 4/19/23 at approximately 2:00 PM, E#1 reviewed Pt #2's chart and verbally agreed E#4 should have made a nurse visit on 3/26/23 prior to the death, provided post mortem care and facilitated the mortuary with transport."