Every finding on record at Americus Hospice, Inc.

Observed in Emergency Management Session. the organization failed to analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan as the organization was unable to produce any after action reports to exercises conducted on survey. This observation was reviewed with the Administrator/DPCS and DPCS Designee. Observed in Emergency Management Session. the organization failed to review and evaluate all exercises and actual emergency or disaster incidents. During the emergency management session the leadership was unable to produce documentation of any after action improvement plans or program updates based on the evaluation or review of the exercises conducted nor had they identified gaps in their response procedures or determined plans for improvement. This observation was reviewed with the Administrator/DPCS and DPCS Designee.

Observed in Record Review. In 1 of 3 patient records reviewed, for live discharge, the organization failed to respect the patient's right to participate in decisions about their care, treatment, or services. For example: in RRDC#1 the organization failed to follow their process for presenting the patient with the Notice of Medicare Non-Coverage as required, as there was no documentation of the form noted on the patient's record. This observation was reviewed with the Administrator/DPCS, and DPCS Designee.

Observed in Record Review. In 1 of 9 patient records reviewed, the organization failed to ensure the patient record was complete, promptly and accurately documented. For example: in review of RRNHV#7 the admission orders noted the patient was a Full Code however the record contained a signed POLST indicating the patient was a DNR. This observation was reviewed with the Administrator/DPCS and DPCS Designee.

Observed in Record Review. In 4 of 9 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#1, RRHV#2, RRHV#3, and RRNHV#5 the patient was being seen by the chaplain yet there was no spiritual care plan as part of the plan of care. In RRHV#2, and RRHV#3 the patient was being seen by the social worker yet no psychosocial care was noted on the plan of care. These observations were reviewed with the Administrator/DPCS, and the DPCS Designee.

Observed in Record Review. In 3 of 9 patient records reviewed, The organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions to include medications ad treatments necessary to meet the patient needs. For example: in RRNHV#5, and RRNHV#6 there was an order for thickener as part of the diet, yet the order was incomplete as there were no instructions as to what thickener consistency was to be utilized. In RRNHV#8 there was an order for buspirone where the frequency noted single dose yet there were no specific instruction to indicate when the single dose was to be given. These observations were reviewed with the Administrator/DPCS and DPCS Designee.

Observed in Record Review. In 4 of 9 patient records reviewed, the organization failed to ensure the plan of care was revised based on information from updates to the patient's comprehensive assessment addressing the patient's progress toward goals and outcomes. For example, in RRHV#1 the care plan goals were noted to not be updated based on changes in the patient's assessment as the goals remained un-updated throughout care IDG to IDG. In the most recent July IDG meeting the target resolution dates were beyond the dates set to resolve in June. In RRHV#2, RRNHV#4, and RRNHV#8 similar pattern of goals remaining un-updated throughout care with the current date being well beyond the established target resolution dates. These observations were reviewed with the Administrator/DPCS, and DPCS Designee.

Observed in HR File Review. In 1 of 1 HR files reviewed, for CHHA, the organization failed to ensure an RN evaluate the following areas by observing a home health or hospice aide's performance of the tasks with a patient or pseudo-patient as part of a simulation: - Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other staff - Reading and recording temperature, pulse, and respirations - Appropriate and safe techniques in personal hygiene and grooming that include bed, sponge, tub, or shower bath; sink, tub, or bed shampoo; nail and skin care; oral hygiene; toileting and elimination - Safe transfer techniques and ambulation - Normal range of motion and positioning. On Review of HR#4 for the CHHA the initial competency evaluation was documented that all skills were evaluated verbally and not via direct observation with a patient or pseudo patient as required. This observation was reviewed with the DPCS Designee, and Office Manager.

Observed in Record Review. In 2 of 9 patient records reviewed, the organization failed to ensure the registered nurse prepare written patient care instructions for the hospice aide. On review of RRHV#2 the hospice aide plan of care did not include specific instructions on whether or not the aide was to remove oxygen while preforming care. On home observation the aide was observed to remove the patient's oxygen to transfer and transport to the patient's room to provide care yet there was no instructions on the plan of care to do so. In RRNHV#8 the aide plan of care assigned the aide to perform foley care, yet the patient did not have a foley. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 1 of 3 patient records reviewed, for live discharge, the organization failed to ensure the patient record contain information that reflected the patient's care, treatment and services. For example: on review of RRDC#1 the patient was discharged for extended prognosis yet there was no documentation noted in the record on what led the IDG team to make the decision to discharge the patient. This observation was reviewed with the Administrator/DPCS and the DPCS Designee.

Observed in Record Review. In 1 of 9 patient records reviewed, the organization failed to ensure the patient record contain information that reflected the patient's care, treatment, and services. For example: during medication reconciliation with the RN for RRHV#2 it was noted that the hospice medication profile noted Seroquel 50mg 1 tab daily, yet the patient caregiver and the medication bottle in the patient home noted the med was to be given PRN. Further, there was another order for Seroquel 25 mg 1 tab daily PRN that the caregiver noted was not in use, and an order for Quetiapine Fumarate 25 mg daily at night that the caregiver also noted was not being used in the home. There was also a PRN order for Benzonatate on the hospice medication profile that the caregiver noted was given in the past for a cough but was no longer being used in the home. In Review of RRNHV#8 there were signed physicians orders for comfort medications to include morphine, lorazepam, and ondansetron yet the medications were not included on the patient's medication profile. Discussion with the staff noted that the family had declined delivery of the comfort medications yet this documentation was not noted on the record. These observations were reviewed with the Administrator/DPCS.