Every finding on record at Walker Companion Services, LLC

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 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 document review, interview, and observation. In 2 of 3 (67%) medication profiles for active hospice patients reviewed revealed that the hospice agency did not ensure that the patient's drug profile contained the patient's current prescription and over-the-counter drugs. The hospice agency did not ensure the patient's drug profile was updated per the hospice policy and procedure. Agency Policy HCC, PC.M55 stated in part, that when a patient is admitted to hospice, a medication profile is initiated to document all of the patient's prescription and over-the-counter drugs. the patient's medication is reviewed by the IDG whenever there is a significant change and, at a minimum, every 15 days Home Visit 1: During home visit (Home Visit 1) (Clinical Record 3) on 05/09/2024 with the chaplain (Personnel Record 4) in a skilled nursing facility, the facility medication profile was reviewed. The facility medication profile listed Guaifenesin 600 mg by mouth once daily. The hospice agency medication profile listed guaifenesin 600 mg by mouth twice daily. Home Visit 2: During the home visit observation (Home Visit 2) (Clinical Record 2) on 05/09/2024 with the registered nurse (Personnel Record 3), the facility medication profile review revealed that morphine sulfate (concentrate) solution 20mg/ml, ordered 12/04/2023, administered 0.5ml by mouth every 4 hours as needed for pain. There was no documented evidence of morphine sulfate (concentrate) medication on the hospice agency's medication profile. The Director of Nursing reviewed the facility and hospice agency medication profiles on 05/09/2024 and agreed the medication profiles had not been updated.

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, and consistent with the hospice aide training. This standard was not met as evidenced by interview and observation. In 1 of 2 (50%) home visits observed of patients that accepted and received aide services revealed that the hospice agency did not ensure the hospice aide provided services ordered by the Interdisciplinary Group. Home Visit 3: The aide care plan for the certification period 04/02/2024-05/31/2024 delegates the task of a shower to be provided by the hospice aide. On a joint home visit (Home Visit 3) with the hospice aide (Personnel Record 9) on 05/09/2024, the hospice aide was observed giving the patient a sponge bath in the patient's walker with an attached seat. The hospice aide did not communicate or contact a registered nurse or supervisor before deterring from the aide care plan. During an interview on 05/08/2024, the Director of Nursing agreed that the aide had not followed the aide care plan that had been written by the registered nurse and did not report the changes to a registered nurse.

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 document review, interview, and observation. In 1 of 7 (14%) clinical records reviewed revealed that the hospice agency did not ensure that the hospice aide reported all changes in the patient's plan of care. Agency Policy HCC, PC.H25 stated in part, hospice aides must report changes in the patient's medical, nursing, rehabilitative, and social needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities. Clinical Record 1: The aide care plan written by a registered nurse dated 04/02/2024 delegated the task of a shower to be provided by the hospice aide. On a joint home visit (Home Visit 3) with the hospice aide (Personnel Record 9) on 05/09/2024, the hospice aide was observed giving the patient a sponge bath in the patient's walker with an attached seat. The hospice aide did not communicate or contact a registered nurse or supervisor before deterring from the aide care plan. During an interview on 05/08/2024, the Director of Nursing agreed that the hospice aide did not report the changes of providing a sponge bath in a chair instead of a shower to a registered nurse.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and document review. In 1 of 7 (14%) clinical records reviewed revealed that the hospice agency did not ensure the hospice aides were supervised by a registered nurse no less than every fourteen (14) days. Agency Policy HCC, PC.H40, stated in part, that a registered nurse makes an on-site visit to the patient's home no less frequently than every 14 days to ensure that the services ordered by the IDG and provided by the hospice aide are meeting the patient's need. Clinical Record 10: The hospice aide visit was documented on 01/23/2024. A supervisory visit was not completed and documented until 02/16/2024. This was ten days past the fourteen-day requirement.

It is required that the hospice documents and demonstrates viable and ongoing efforts to recruit and retain volunteers. This standard was not met as evidenced by document review and interview. In 1 of 1 (100%) volunteer program binder reviewed revealed that the hospice agency did not ensure that the Volunteer Coordinator documented viable and ongoing efforts to recruit and retain volunteers. Agency Policy HCC, PC. V20, stated in part that active and ongoing recruitment and retention efforts are sufficient to ensure that the hospice has enough volunteers to meet the needs of patients and families and the requirements of Federal regulations. Documentation is kept regarding these efforts. During an interview on 05/10/2024, the Administrator/Volunteer Coordinator stated that she recruited volunteers at churches and facilities. The Administrator/Volunteer Coordinator stated that agency had bought the volunteers lunch for retention efforts. The Administrator/Volunteer Coordinator agreed that the recruitment and retention efforts had not been documented.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: the hospice election form and any advance directives. This standard was not met as evidenced by document review and observation. In 1 of 2 (50%) Observed visits at a skilled nursing facility revealed that the agency did not ensure that required documents were in the facility binder, specifically the hospice benefit of election. Agency Policy HCC, PC.H50 stated in part, that the hospice will ensure mechanisms are in place to provide for the coordination of all hospice services provided to patients residing in facilities. The hospice will provide the following to the facility: most recent plan of care, hospice election form, physician certification, and recertification of terminal illness specific to the patient. Home Visit 1: During home visit (Home Visit 1) (Clinical Record 3) on 05/09/2024 with the chaplain (Personnel Record 4) in a skilled nursing facility, the hospice agency binder was reviewed and revealed no documented evidence of the patient's hospice election of benefit was in the binder or provided to the facility.