Every finding on record at A-Assure Hospice, Inc

Observed in Patient Home. In 4 of 4 home visits conducted, the organization did not provide the patient with written information about its policies on advance directives. While reviewing a sample home folder the surveyor found that information from the state of Texas was provided, but the policy was not. This RFI was validated during home visits and reviewed with administrative and clinical leaders.

Observed in Record Review. In 2 of 19 patient records reviewed, the organization failed to complete an initial comprehensive assessment no later than five calendar days after the election of the hospice benefit. In record RRHV #2 spiritual, psychosocial, and bereavement assessments were not documented within the required number of days. In RRHV #4 a psychosocial assessment was not documented for the second benefit period. This RFI was reviewed with administrative and clinical leaders.

Observed in Record Review. In 19 of 19 patient records reviewed, most updates to the comprehensive assessment did not document patient decline, changes, and progress towards goals, nor plans for visits until the next meeting. This was true in most nurses and all spiritual care and psychosocial entries. This RFI was reviewed with administrative and clinical leaders.

Observed in Record Review. In 19 of 19 patient records reviewed, the organization did not ensure that patients’ plans of care were based on individualized goals and time frames. Most goals were not specific and measurable. For example: Patient/caregiver will understand reality and need to report changes in LOC to the hospice nurse. Ministry of prayer and pastoral care. Facility staff aware of ongoing POC and available resources and to call hospice first with any change in condition or concerns. Safe and comfortable end of life care. Chaplain will be sure patient is progressing spiritually. Patient's comfort will be maintained. Remain free of moments of forgetting. Remain free of the unknown. Patient will learn to express herself slowly or in another way. Additionally, documented completion dates were “by the time of death/discharge”. This RFI was reviewed with administrative and clinical leaders.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization did not plan the patient’s care, treatment, or services based on identified needs. For example, in the initial comprehensive assessment of RRHV #1 both nursing and social services wrote that the patient stated that she thought about walking out into the street to be hit by a car but did not address the issue in the plan of care. This RFI was reviewed with administrative and clinical leaders.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization did not use standard precautions to reduce the risk of infection. For example, at RRHV #4 the home health aide removed a patient's brief, then donned gloves without performing hand hygiene. This action was not prohibited by policy however it did not conform with CDC guidelines. This RFI was reviewed with administrative and clinical leaders.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization did not ensure that patient record contained all orders. For example, during RRHV #1 an RN stated that eight medications were discontinued when the patient was admitted to a skilled nursing facility for respite care. The nurse documented in the record that she talked with the physician about discontinuing the medications and admitting the patient to respite care. However, orders were not written. This RFI was reviewed and validated by administrative and clinical leaders.

Observed in Patient Home. In 4 of 4 home visits conducted, The organization did not ensure that the patient, the patient’s representative, or the family were educated on the hospice’s policies and procedures for managing the safe use and disposal of controlled medications. While reviewing a copy of the patient handbook the surveyor found that FDA information on drug disposal was provided, but the narcotic use and disposal policy wasnot. This RFI was during home visits and reviewed with administrative and clinical leaders.

Observed in Patient Home. The organization did not implement the infection prevention and control activities it had planned. During HV#2 the RN performed hand hygiene using sanitizer gel but did not continue to rub hands until the gel dried as required, and in compliance with Hand Hygiene policy IC.3. This was reviewed with the VP of Operations. Observed in Patient Home. The organization failed to reduce the risk of infections associated with medical equipment. During HV#2 the RN did not disinfect her medical equipment per the manufacturer’s recommendations for use, which require a wet time of two minutes. This was discussed with the VP of Operations.