Every finding on record at Agape Hospice Care, Inc.

Observed in Patient Home. The organization failed to demonstrate a process for medication reconciliation to assess potential medication-related problems as defined in policy No 3-002.01 Medication Profile. The surveyor observed a failed medication reconciliation procedure on HV#2. Examples 1) the clinician could not verbalize a defined process ; 2) the observed process only included a double check of the Fentanyl patch she was scheduled to change during the visit; 3) when asked what the organization defined to be the official and current medication profile had no answer and 4) she did not have a tablet or any source in which to look up or reference current medications, dosages, route of administration etc. Reviewed with Director of Nursing.

Observed in Record Review. The hospice did not conduct or document a patient-specific comprehensive assessment or reassessment in response to a patient’s suicidal ideation. The surveyor noted in record review for HV#2 a chaplain note stating the patient's grand daughter (present at the visit) stated that the patient was in distress and had suicidal ideation due to wanting to get out of her facility but was unable too. The patient had expressed that her twice daily discussions with her second grand daughter is necessary for her to function and to cope with her situation. The record failed to indicate any further assessment, reassessment or follow-up to this issue as defined by organization policy Suicide No. 2-067.1. The policy required the member of the IDT to identify the follow up plan and to contact the attending physician to make any necessary referrals. Reviewed with the Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted, The surveyor noted during HV#1 that the ALF facility had not been provided with the essential documentation as defined by organization policy to adequately coordinate care. The surveyor noted that the patient's record available to both the facility and the hospice staff did not include: 1) the patient’s most recent hospice plan of care; 2) medication list and 3) advance directives. The facility administrator stated she had requested the information on several occasions. Reviewed with the Director of Nursing. Observed in Patient Home. The organization failed to coordinate the patient’s care, treatment, or services based on the patient’s needs. The surveyor noted during HV#2 that the caregiver staff had not been provided with the essential documentation per organization policy to adequately coordinate care. The patient's record available to both the group home caregivers and the hospice did not include: 1) the hospice plan of care; 2) a medication list or 3) advanced directives. Reviewed with the Director of Nursing.

Observed in Patient Home. The hospice did not follow accepted standards of practice to prevent the transmission of infections including the use of standard precautions. HV#2 involved an observed coccyx wound care procedure. The open, non-healing wound (over eight months)was in close proximity to her rectum and high risk for contamination. The nurse multiple times did not follow the organization's hand hygiene and bag technique policy.  Examples: 1) throughout the entire procedure (initiation through completion) hand sanitizer was never utilized; 2) the same gloves that were donned to initially turn the patient were never removed while performing the wound care (dressing removal, cleansing, application of sterile covering) and 3) during the necessary personal care to remove feces very near the coccyx dressing before removing the old dressing; 4: the same donned gloves were used to enter and reenter the bag as needed during the visit. The organization's handwashing policy and bag technique policies were not followed. Reviewed with Director of Nursing.

Observed in Record Review. In 1 of 5 patient records reviewed, the hospice did not implement the pain policy . Policy #2-032.2 titled Pain Assessment reflected that if pain is assessed descriptors of the pain such as the quality, character, aggregating factors should be documented. RR#3 had back pain that was being managed by daily narcotics. The pain assessment by the RN did not include a description of the quality, character, or aggregating factors. This observation was discussed with the designee.

Observed in Individual Tracer. In 3 of 5 patient records reviewed, the comprehensive care plans were not individualized. The target dates for the goals on the care plans either had the same target dates for all the goals or had no target dates. RR#1 and RR#3 had issues with falls, skin, and pain and the target dates identified on the care plans had xx/xx/xxxx or the end of the certification period. RR#2 had no target dates identified for any of the goals. These observations were discussed with the designee.

Observed in Individual Tracer. In 1 of 5 patient records reviewed, the hospice comprehensive care plan did not include all of the services required to care for the patient based on the assessment. RR#5 was on continuous gastrostomy tube feedings and had a sacral decubiti that required care. The patient resided in a board and care and the comprehensive care plan did not delineate the orders for the feeding or wound care. Nor did the care plan stipulate who would be providing the care. This observation was discussed with the designee.

Observed in Record Review. In 2 of 3 patient records reviewed, the hospice RN did not provide written instruction regarding required precautions. Both RR#1 and RR#2 were assessed as having dysphagia. Based on home visits made to these patients both required the assistance of a Hoyer lift to transfer. The HHA Care plans of these patients did not identify aspiration precautions nor did the care plans reflect the need for a Hoyer lift to transfer. These observations were discussed with the designee.