Every finding on record at Aadvantage Health & Hospice Care Systems, Inc.

Observed in Record Review. In 1 of 14 patient records reviewed, the hospice admission RN did not complete the initial assessment within 48 hours after the election of hospice care. The initial assessment was completed five days after signed election of benefits and there was no explanation found in the medical record. This was discussed with the Administrator.

Observed in Record Review. In 1 of 13 patient records reviewed, the nurse did not obtain an order for oxygen in RRLiveDC#1. For example in RRLiveDC#1 the nurse documented on admission patient smokes and oxygen would not be ordered due to safety reasons. Two weeks after the admission nursing documentation shows evidence of patient receiving 2L of oxygen via NC, however during record review there was no evidence of a physician order being obtained for the administration of oxygen. This was discussed with the administrator.

Observed in Record Review. In 1 of 14 patient records reviewed, the agency did not follow the plan of care in providing nursing services. For RRHV#2, the plan of care was for once a week. From the date of the initial admission a nursing visit was not conducted for two weeks and there was no documentation as to the reason for the missed visits. This was discussed with the Administrator.

Observed in Record Review. In 1 of 7 patient records reviewed, there was no evidence the agency provided the physician with a discharge summary. In RRNHV#2, the patient revoked hospice and was discharged to the community. After record review there no evidence the discharge summary was provided or sent to the physician. This was discussed with the administrator.

Observed in Record Review. In 9 of 10 patient records reviewed, the organization had not ensured that the plan of care written was individualized and included measurable goals and time frames. For example, while reviewing 9 of 10 records reviewed there was widespread absence of individualized goals and measurable timed goals. This was reviewed by the Administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization had not ensured the care was provided in accordance with the plan of care. For the first example, during the RR 3 the Surveyor identified that the Aide assignment identified personal care that was planned to be completed every visit was not documented as provided without notation by the Aide or report to the Nurse as why these items were omitted. This was confirmed by the Administrator.

Observed in Individual Tracer. In 1 of 2 home visits conducted, the organization had not ensured cleaning and performing disinfection of medical supplies to prevent transmission-based precautions. For example during HV1 the Surveyor observed the Nurse returned her equipment to the storage bag without cleaning it first. This was confirmed by the organizations policy on equipment management and confirmed by the Administrator. Observed in Individual Tracer. In 1 of 2 home visits conducted, the organization had not ensured accepted practice of standards to prevent infections including the use of standard precautions were implemented in patient care. For example, during HVI the Surveyor observed the nurse failed to sanitize her hands between all glove changes or in compliance with their own hand hygiene competency guidelines i.e. using Benzakonium chloride instead of the indicated sanitizer that has between 60-95% alcohol content. This was confirmed with the nurse/Administrator.

Observed in Record Review. In 7 of 10 patient records reviewed, the organization had not ensured the Attending Physician signed the initial Certification of Terminal Illness (CTI) was corroborated by the Attending Physician. For example, in RR1, RR2, RR6, RR7 and RR8 and the initial CTI was signed and dated by the Attending Physician but not other Physician involved in the patients care as well as the printed name identifying the Attending Physician designation was not noted. In the fourth, fifth and 6th examples (RR3, RR4) the Attending Physician was printed but not signed on the Initial Certification form. This was confirmed by the Administrator. Observed in Record Review. In 7 of 10 patient records reviewed, the organization had not ensured the Attending Physician signed the initial Certification of Terminal Illness (CTI) was corroborated by the Attending Physician. For example, in RR1,RR2, RR6, RR7 and the initial CTI was signed and dated by the Attending Physician but not other Physician involved in the patients care as well as the printed name identifying the Attending Physician designation was not noted. In the fourth, fifth and 6th examples (RR3, RR4, RR5) the Attending Physician was printed but not signed on the Initial Certification form. This was confirmed by the Administrator.