Every finding on record at Altus Hospice of Georgia, LLC

Based on clinical record review, agency policy, and staff interview, it was determined the agency failed to ensure compliance regarding the destruction of controlled drugs following the patient's death for two patients (P) (P#10 and P#11) of two sampled deceased patients. --- Findings include: Review of the policy titled ";Medication Disposal," revised date 12/01/24, revealed the following: Purpose: To outline the process for disposal of controlled drugs in the home setting.Procedure:3. The nurse will document in the medical record if the patient/caregiver accepts or refuses the hospice agency to assist with the disposal of the controlled substances. 1. The bereavement record for patient P#9 reflected that the patient received hospice services in the home setting from 6/12/24 - 6/15/24 and the patient was prescribed controlled medications which were identified on the medication profile. Documentation of a death pronouncement form reflected the patient died at home on 6/12/24. However, the clinical record failed to reveal documentation of drug destruction at the death visit. 2. The bereavement record for patient P#10 reflected that the patient received hospice services in the home setting from 2/23/24 - 3/1/24 and the patient was prescribed controlled medications which were identified on the medication profile. Documentation of a death pronouncement form reflected the patient died at home on 3/1/24. However, the clinical record failed to reveal documentation of drug destruction at the death visit. During an in-office interview with the Executive Director on 2/11/25 at 1:00 p.m., the Executive Director stated that the registered nurses (RN) completing the death visit are required to document in the clinical record if medication disposal was done or if the family was educated on drug disposal in the home at the time of death. The Executive Director did confirm that the clinical records lacked documentation of drug disposal.

Based on observations, clinical record reviews, and staff interviews, the agency failed to ensure medication profiles for two (2) of nineteen (19) patients (P) (#1 and #2) were updated to reflect current medications at the time of the comprehensive assessments. The Findings include: 1. During a home visit on 2/9/22, at approximately 11:00 a.m., with Registered Nurse (RN) AA, the surveyor observed P#1 while the nurse was performing Foley care. Review of the medical record revealed diagnoses that include Alzheimer's disease, dementia, failure to thrive, anorexia, type 2 diabetes, and hypertension. When reviewing the medications that P#1 was taking at home to the agency's current medication profile, it was determined that P#1's Haldol has expired. Patient #1 was taking Haldol lactate 2milligrams (MG)/milliliters (ML) give 0.5ml sublingual every six hours as needed for agitation. Haldol has expired on 1/25/22. On 2/9/22 at 11:50 a.m., an interview was conducted with a Registered Nurse (RN) AA, who stated that she was not aware that P#1 Haldol was expired. 2. During a home visit on 2/9/22, at approximately 12:00 p.m., with Registered Nurse (RN) BB, the surveyor observed P#2 while the nurse was performing wound care. Review of the medical record revealed diagnoses that include Alzheimer's disease, dementia, anorexia, chronic kidney disease stage3, dysphagia, and hyperlipidemia. When reviewing the medications P#2 was taking at home to the agency's current medication profile, it was determined that P#2's Haldol has expired. Patient #2 was taking Haldol lactate 2mg/ml give 0.5ml sublingual every six hours as needed for agitation, but Haldol has expired on 2/2/22, hyoscyamine 0.125mg sublingual every four hours for secretion, expired on 2/2/22; Lorazepam 0.5mg give one tablet oral every six hours as needed for anxiety or agitation, expired on 2/2/22; Prochlorperazine maleate 10mg give one tablet oral every six hours for nausea and vomiting, expired on 2/2/22; acetaminophen 650mg insert one suppository every eight hours as needed for mild pain or fever, expired on 2/2/22; and bisacodyl 10mg insert one suppository rectal as needed for laxative, expired on 2/2/22. On 2/9/22, at 1:10 p.m., an interview was conducted with a Registered Nurse (RN) BB, who stated that she was not aware that the above medications for P#2 has expired.

Based on observations, clinical record reviews, and staff interviews, the agency failed to ensure plan of care for two (2) of nineteen (19) patients (P) (#1 and #2) were updated to reflect current medications at the time of the comprehensive assessments. The findings include: 1. During a home visit on 2/9/22, at approximately 11:00 a.m., with Registered Nurse (RN) AA, the surveyor observed P#1 while the nurse was performing Foley care. Review of the medical record revealed diagnoses that include Alzheimer's disease, dementia, failure to thrive, anorexia, type 2 diabetes, and hypertension. When reviewing the medications that P#1 was taking at home to the agency's current plan of care, it was determined that P#1's Haldol has expired. Patient #1 was taking Haldol lactate 2 milligrams (MG)/milliliters (ML) give 0.5ml sublingual every six hours as needed for agitation. Haldol has expired on 1/25/22. On 2/9/22 at 11:50 a.m., an interview was conducted with a Registered Nurse (RN) AA, who stated that she was not aware that P#1 Haldol was expired. 2. During a home visit on 2/9/22, at approximately 12:00 p.m., with Registered Nurse (RN) BB, the surveyor observed P#2 while the nurse was performing wound care. Review of the medical record revealed diagnoses that include Alzheimer's disease, dementia, anorexia, chronic kidney disease stage3, dysphagia, and hyperlipidemia. When reviewing the medications P#2 was taking at home to the agency's current medication profile, it was determined that P#2's Haldol has expired. Patient #2 was taking Haldol lactate 2mg/ml give 0.5ml sublingual every six hours as needed for agitation, but Haldol has expired on 2/2/2, hyoscyamine 0.125mg sublingual every four hours for secretion, expired on 2/2/22; Lorazepam 0.5mg give one tablet oral every six hours as needed for anxiety or agitation, expired on 2/2/22; Prochlorperazine maleate 10mg give one tablet oral every six hours for nausea and vomiting, expired on 2/2/22; acetaminophen 650mg insert one suppository every eight hours as needed for mild pain or fever, expired on 2/2/22; and bisacodyl 10mg insert one suppository rectal as needed for laxative, expired on 2/2/22. On 2/9/22, at 1:10 p.m., an interview was conducted with a Registered Nurse (RN) BB, who stated that she was not aware that the above medications for P#2 has expired.

Based on clinical record reviews and staff interviews, it was determined that the hospice agency staff failed to sanitize or perform handwashing before wearing gloves and after the removal of gloves, after completion of the procedures, to prevent spread of infection for one (1) of nineteen (19) sampled patients (P#2). The findings include: On 2/9/22, at 12:55 p.m., surveyor observed Registered Nurse (RN) perform wound care to P#2 right heel. (RN) BB did not wash her hand before she wore the gloves, and after she finished the procedures. (RN) BB removed the hand glove three times, but she did not wash nor sanitize her hand before she touched the clean supplies that she used for heel dressing. On 2/9/22, at 12:58 p.m., an interview was conducted with (RN) BB, stated that she did know better, and would take the blame for not performing handwashing before and after the removal of gloves in between and after completion of procedure.