Every finding on record at American Hospice Care, Inc

Observed in Patient Home. In 1 of 3 home visits surveyor observed that the medication profile in patient's home did not indicate the specific dose to administer for liquid Lorazepam. For example, in HV#2 the medication profile listed the medication concentration for liquid Lorazepam as 2mg per ml in the medication dose section. This was reviewed with the organization's Director of Nursing.

Observed in Record Review. In 1 of 10 records reviewed, surveyor observed that the goal for pain relief was not measurable and did not have an appropriate timeframe for achieving the expected outcome. For example, the plan of care goal for pain relief for RRHV#2 stated patient will remain at a comfortable level during care. This was reviewed with the Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits surveyor the clinician did not comply with the current CDC and/or WHO hand hygiene guidelines. For example, in HV#2 the clinician did not wash hands after removing gloves that were used to perform wound care and before applying new gloves to continue wound care. This was verified by the organization's Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits the hospice aide failed to provide services per the aide plan of care. For example, In HV#1 surveyor observed the aide perform vital signs (blood pressure and temperature), however, performing vital signs was not a task ordered in the hospice aide plan of care. This was reviewed with the Director of Nursing.

Observed in Record Review. In 4 of 7 HR records reviewed, surveyor observed that the annual competency evaluations had not been completed per the organization's policy. This was reviewed with the Administrator.

Observed in Record Review. In 7 of 10 records reviewed surveyor observed that the Medical Director did not address how the patients met the criteria for a terminal diagnosis of 6 months or less if the illness runs its normal course based on current subjective and objective findings, medication and treatment orders, and information about the medical management of patients' conditions related to the terminal diagnosis. This was reviewed with the Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits surveyor that the organization did not ensure effective education and training related to oxygen storage was completed. For example, during the home visit HV#2 an oxygen tank was observed standing upright in a small room closet. This was reviewed with the Director of Nursing.

Observed in Individual Tracer. In 2 of 4 patient records reviewed, it was identified that the goals on the POCs were not individualized and had not documented specific time frames. For example, for RR # 2 the goals for the initial POC were , ADL goals- ADL needs are met by the POC and family, Falls - Will have no episodes of falls, Oxygen- PCG will verbalized understanding of safety interventions, Pt will remain free of injury. For RR # 4 ADL- ADLs needs are met by her PCG and family, Impaired thyroid- Pt will remain compliant to medications, Somnolence- promote optimal rest status for patient and family . This was validated by the DPCS.

Observed in Individual Tracer. In 1 of 4 patient records reviewed, it was found that the visits were not made as identified on the POC. For example, for RR # 1 the MSW did not follow the POC which identified monthly visits. The initial POC developed, almost three months ago identified monthly visits , however, no visit were made after that. There was evidence of a phone call made on 5/13 and family asked to reschedule. The IDG on 5/11/22 identified MSW will make contact with pt in May to provide support and assess for any needed . On 5/13 the MSW left message with patient to schedule a visit vs and the family reported they needed to reschedule. . On the IDG 5/25/2022 the MSW had the same note as 5/11/2022. There was no further explanation or communication found that explained the reason for the social worker not following the POC. This was validated by the DPCS.

Observed in Record Review. In 7 of 9 patient records reviewed, It was found on review of 7 of 9 patient records that the frequencies for the MSW and Chaplain did not reflect the patient needs. Frequencies on all records stated visit one time and prn. On review of documentation in the records it was found that the MSW only made visits when the patient or care giver called. The Chaplain made visits again when the family called with no frequencies. This was discussed with the Administrator, DPCS and Nursing supervisor.

Observed in Record Review. In 7 of 9 patient records reviewed, It was found on review of 7of 9 patient records reviewed that the goals on the POC's where not individualized and did not document times frames or time frames were based on the IDG. Examples included: Pt./Care Giver will verbalized understanding of safety measures. Pt. will maintain optimum peripheral circulation. Pt. will have a reduction of discomfort. These issues were discussed with the DPCS and supervisor. Pt. will maintain B/P within normal range.

Observed in Record Review. In 7 of 9 patient records reviewed, It was found on review of 7 of 9 patient records that frequency for skilled nursing, social work and chaplain services included a provision for “PRN” visits. However, the order did not include the specific reason(s) for those visits. This was verified with the DPCS and Nursing Supervisor.

Observed in Record Review. In 7 of 9 patient records reviewed, It was found on review of 7of 9 records that the MSW and Chaplain were not following the frequencies documented on the Plan of Care. The Plan of Care documented monthly visit however the patient was not being seen for weeks and only if the patient requested. This was verified with the DPCS .

Observed in Individual Tracer. In 2 of 3 home visits conducted, It was observed on HV#2 that the nurse did not follow organization policy related to hand washing. The nurse changed her gloves multiple times however she did not wash her hands between glove changes according to policy. The nurse also entered her bag on two occasions without washing her hands. Observed in Individual Tracer. On HV#1 the LVN did not follow organization policy related to hand washing. The LVN changed gloves multiple times during wound care however he did not wash his hands between glove changes. This was also observed by the nursing supervisor.

Observed in Leadership Session. The governing body/leadership did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews: - §418.100 and §418.56

Observed in HR File Review. In 2 of 7 HR files reviewed, It was found on review of the personnel files that 2 of 7 files reviewed did not have documentation of initial orientation. This was verified with the Administrator.