Every finding on record at Achieva Hospice, Inc

Observed in Record Review. In 1 of 2 patient records reviewed, During Live D/C RR#1 it was noted the patient was discharged with an extended prognosis. The Notice of Non Medicare Coverage was signed the day before the discharge date by the pt. representative. This was discussed with the DPCS.

Observed in Record Review. In 3 of 10 patient records reviewed, During RR#2 it was noted the patient comorbidities on the POC included diabetes type II, with glipizide listed on the medication profile. The initial RN assessment lacked an assessment of the patient diabetic status. During RR#6 it was noted during the RN initial evaluation the patient had black stools with episode of rectal bleeding and recent episode of coffee ground emesis. The physician was notified, orders received, however, there was lack of GI assessment and interventions added to the POC. During RR#8 RN initial evaluation the patient had a tracheostomy. There was lack of respiratory interventions added to the POC. This was discussed with the DPCS.

Observed in Record Review. In 3 of 10 patient records reviewed, During RR#1, RR#2 and RR#3 it was noted many goals were generic and/or not individualized. They included in RR#2: pt symptoms will be managed, pt will remain comfortable, achieve optimal nutrition, will express satisfactory control of symptoms. They included in RR#3: pt symptoms will be managed, pt will remain comfortable, pt will achieve optimal nutritional status. During RR#1 it was noted all goals had target dates to be accomplished at 30 days after the SOC. This was discussed with the DPCS.

Observed in Record Review. In 4 of 10 patient records reviewed, During HV#2 record review it was noted an order for wound care every 3 days. The patient had 2 SN visits per week. The order for wound care lacked who would perform the procedure on the days the SN was not scheduled. During RR#5 it was noted an order for wound care to a stage 2 pressure ulcer daily without indication of who will perform the wound care on non SN visit days. During RR#7 it was noted an order to insert a F/C the end of March 2024. There was lack of GU interventions added to the POC. During RR#8 it was noted an order to change the inner cannula of the tracheostomy tube daily, and an order to perform wound care around the G-tube insertion site daily. The orders lacked who would perform the care on non SN visit days with a visit frequency of once a week. In addition the G-tube feeding order at the SOC lacked the water flushing amount and frequency during feedings. This was discussed with the DPCS.

Observed in Record Review. In 4 of 10 patient records reviewed, During HV#1 and #2 record review it was noted lack of instruction on s/s bleeding and bleeding precautions on the POC related to Eliquis order for HV#1 and Plavix order for HV#2. During RR4 and RR#7 it was noted orders for Eliquis. There was lack of instruction on s/s bleeding and bleeding precautions on the POC. This was discussed with the DPCS. Observed in Record Review. In 5 of 10 patient records reviewed, During HV#1, RR#2, RR#4, RR#5, RR#6 it was noted orders for Oxygen therapy 2-5 L/min PRN SOB. The orders lacked the titration parameters to increase the liter flow. Possible aspiration was added to the HV#1 and RR#5 POC as a safety precaution however the POCs lacked interventions to the family on S/S and prevention of aspiration. This was discussed with the DPCS.

Observed in Record Review. In 2 of 10 patient records reviewed, During review of the aide POC for HV#1 record review it was noted lack of instruction on bleeding precautions related to the patient's Eliquis prescription on the medication profile. During RR#3 it was noted the CHHA assignment form lacked direction to the aide if the continuous oxygen therapy should be left on or could be removed during personal care. This was discussed with the DPCS.

Observed in Record Review. In 1 of 2 patient records reviewed, During Live D/C RR#2 it was noted the patient was transferred to the hospital after a fall. The discharge summary was not sent to receiving hospital. This was discussed with the DPCS.

Observed in Document Review. In 1 of 4 contracts reviewed, During review of the organization contract for GIP and respite care it was noted lack of a stipulation of delineation of the responsibilities of the hospice and the SNF to provide bereavement services to SNF staff. This was discussed with the DPCS.

Observed in Document Review. In 1 of 4 contracts reviewed, During review of the therapy contract it was noted lack of a stipulation that the outside agency will complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This was discussed with the DPCS.

Observed in Emergency Management Session. The Emergency Operations Plan did not describe how the organization informs state and local officials of any on-duty staff they are unable to contact, though the DPCS was able to speak to the process. Observed in Emergency Management Session. The Emergency Operations Plan did not describe how the organization will inform state and local emergency preparedness officials before, during, and after emergencies on the following: Patients the organization is unable to contact (to determine service needs) though the DPCS was able to speak to this process.

Observed in Emergency Management Session. The Emergency Operations Plan did not describe how the organization will inform state and local emergency preparedness officials before, during, and after emergencies on the following: Patients in need of evacuation due to their medical or behavioral health condition or home environment, though the DPCS was able to speak to this process.

Observed in HR File Review. In 2 of 6 HR files reviewed, the organization had not documented provision of emergency preparedness training to staff, volunteers, and individuals providing on-site services under arrangement at least every two years. There was no documentation of emergency training since hire in the HR files for the Medical Director and DPCS as confirmed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization had not assessed the patient's pain according to its defined criteria. In the chart for RR#5, the patient had routine Gabapentin and prn Ibuprofen ordered for pain. During the comprehensive assessment, the RN obtained an order to increase the dose of Ibuprofen based on comments from the patient and caregiver, however did not complete a comprehensive pain assessment, rather indicating that the patient had no pain. The organization's Management of Pain policy required that Initial assessment will be documented on the Initial Assessment and Screening form and will include: Location, Frequency of pain occurrence...Goals for pain control.... This was confirmed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization had not provided interdisciplinary care including all core disciplines. In the chart for HV#1, in the two most recent IDG meeting documentations there was not input from the Chaplain. This was confirmed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, the hospice had not provided education and training to the primary caregiver as appropriate to the responsibilities assigned to the caregiver in the plan of care. In the chart for RR#5, the RN obtained daily new wound care orders during the visit. There was no documentation that the caregiver was instructed on the new wound care order. The nurse was not seeing the patient daily. This was confirmed with the DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the written plan of care (POC) was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for RR#1, the goals had not been individualized to the patient; all goals were the end of the benefit period and/or not measurable. Patient will maintain optimum level of functioning appropriate for stage of disease process. The pain goal did not have a measurable score - this area was blank. Patient will maintain a pain score of ___ of less per patient/family preference on a scale of 10. In the chart for RR#2, the majority of goal target dates were the last date of the current BP including safety related goals and medication administration competency.

Observed in Record Review. In 4 of 11 patient records reviewed, the plan of care (POC) did not include all services needed for the palliation and management of the terminal illness and related conditions. In the chart for RR#1, the oxygen order was written as 2-4 milliliters per minute and not clarified with the physician as confirmed with the DPCS. Additionally, this patient was at risk for falls and had oxygen in use, yet the POC did not include any interventions related to these safety risks. In the chart for RR#2, the POC indicated that the SN was to administer medications and failed to include instruction of the primary caregiver as the primary person administering medications to the patient. In the chart for RR#3, the patient's medication order was incomplete for the implanted insulin pump utilizing Humalog and did not include the unit of measurement, simply stated basal rates of 0.8 from 12 am- 9am..... In the chart for RR#6, the SN noted that the patient was utilizing compression socks. This treatment was not included on the hospice POC. This was confirmed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, all disciplines that provide care, treatment or services to the patient had not collaborated in the care of the patient and coordinate their efforts to support the goals outlined in the plan of care. In the chart for RR#5, the hospice physician saw the patient and determined that the patient did not require hospice treatment. This information was not communicated to the rest of the hospice team. The RN found out from the patient's family during the next home visit. This was confirmed with the DPCS.

Observed in Data Session. The organization's written infection prevention and control goals did not include the following: Limiting the spread of infections associated with procedures. This was confirmed with the DPCS. Observed in Data Session. The organization's written infection prevention and control goals did not include the following: Limiting the spread of infections associated with the use of medical equipment, devices, and supplies. This was confirmed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, the care plan for the aide, prepared by the RN was not based on the patient's assessment. In the chart for RR#2, the patient was diabetic. The aide assignment included that the aide may file or trim any long or uneven finger or toe nails. In discussion with the DPCS, it is not organizational practice to allow aides to trim nails of diabetic patients.

Observed in Record Review. In 3 of 3 patient records reviewed, in which the record spanned two documentation systems, the patient record was not accurately documented. In the charts for RR#1, RR#2 and HV#1 the patient records had been transcribed from a previous electronic medical record (EMR) to a new EMR inaccurately. The transcribed order for Morphine failed to include the original indication of SOB and only included the indication for pain. Additionally, the oxygen orders stated the route was via mask and not via nasal canula which was the original order in the previous EMR. This was confirmed with the DPCS. Observed in Record Review. In 1 of 11 patient records reviewed, the record did not include correct clinical information. In the chart for RR#8, one aide visit was dated as performed on the day prior to the patient's admission to hospice. This was a date error as confirmed with the DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the patient record did not contain the following clinical information: any medications administered including dose. In the chart for HV#1, the nurse documented Administered enema and did not include the actual medication administered as confirmed with the DPCS. In the chart for RR#5, during the admission visit, it was unclear as to whether or not the RN actually provided wound care to the patient. In the chart for RR#10, the nurse did not fully document the details of medications administered routine lorazepam given, assisted with suppository with results. This was discussed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, at the time when controlled medications were first ordered, the hospice had not educated the patient, or the patient’s representative, and the family on the hospice’s policies and procedures for managing the safe use and disposal of controlled medications. In the chart for RR#6, this education was not documented as confirmed with the DPCS.

Observed in HR File Review. In 1 of 6 HR files reviewed, the organization had not verified credentials of care providers using the primary source. In the file for the Hospice Physician, there were copies of the license, however there was no primary source verification. This was not a process for the organization in regard to physician licenses as discussed with the DPCS.