Every finding on record at Angel Hospice Inc

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 5 of 14 (36%) clinical records reviewed the agency did not ensure that the written plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The patient elected the hospice benefit on 9/4/23. In review of the benefit period #1 (BP#1) dated 9/4/23 to 12/2/23, the initial comprehensive assessment conducted by the registered nurse (RN) on 9/4/23 documented, “Patient with Colostomy on right lower abdominal quadrant. The stoma is moist, it’s above skin level, and pink in color, and no irritation on peristomal skin noted.” A subsequent RN visit note on 9/16 documented “Patient has colostomy, Peristomal area; no signs or symptoms of infection”. The plan of care for BP#1 dated, 9/4/23 to 12/2/23 did not include problems, goals or interventions to address the care of the patient's colostomy. Clinical Record 2: The patient elected the hospice benefit on 10/9/23. In review of the benefit period #1 (BP#1) dated, 10/9/23 to 1/6/24, the initial comprehensive assessment conducted by the registered nurse (RN) on 10/9/23 documented “The patient has moisture - associated dermatitis on her breast folds, otherwise skin intact” and that the patient had an order dated 10/9/23 for Levetiracem oral tablet, 250 mg 1 tab twice daily for seizures. The plan of care for BP#1 dated, 10/9/23 to 1/6/24 did not include problems, goals or interventions to address the patient's dermatitis or seizure issues. Clinical Record 3: The patient elected the hospice benefit on 8/17/23. In review of the benefit period #1 (BP#1) dated, 8/17/23 to 1/6/24, the initial comprehensive assessment conducted by the registered nurse (RN) on 8/17/23 documented that the patient had sustained an injury prior to admission to hospice. The RN documented “the patient has a small, dried laceration on the right temporal area with 3 stiches open to the air." In subsequent RN visits conducted on 8/23/23 and 8/30/23 it was documented, “noted with dried sutures on forehead”. The plan of care for BP#1 dated, 8/17/23 to 1/6/24 did not include problems, goals or interventions to address care of the patient's wound. Clinical Record 4: The patient elected the hospice benefit on 8/8/23. In review of the benefit period #1 (BP#1) dated, 8/8/23 to 11/5/23, the initial comprehensive assessment conducted by the registered nurse (RN) on 8/8/23 documented, "Indwelling foley 16fr 10cc/ patent and intact". On 8/15/23 the RN conducted a nursing visit and documented, "Foley intact and patent with good urine output”, and on 9/6/23, the RN conducted a nursing visit and documented, "Foley last changed 8/18/23 16fr/10cc, catheter patent with good urine output”. The plan of care for BP#1 dated, 8/8/23 to 11/5/23 did not include problems, goals or interventions to address care of the patient's urinary catheter. Clinical Record 5: The patient elected the hospice benefit on 8/8/23. In review of the benefit period #1 (BP#1) dated, 8/8/23 to 11/5/23, the initial comprehensive assessment conducted by the registered nurse (RN) on 8/8/23 included a medication order for Keppra 1000mg 1 tablet 2X daily, for seizures. The plan of care for BP#1 dated, 8/8/23 to 11/5/23 did not include problems goals or interventions to address seizures issues. In an interview conducted with the clinical director on 10/19/23 they did verify that in record 1 the plan of care did not include problems, goals or interventions to address the care of the patient's colostomy. In record 2 they did verify that the plan of care did not include problems, goals or interventions to address the patient's dermatitis or seizure issues. In record 3 they did verify that the plan of care did not include problems, goals or interventions to address care of the patient's wound. In record 4 they did verify that the plan of care did not include problems goals or interventions to address care of the patient's urinary catheter. In record 5 they did verify that the plan of care did not include problems, goals or interventions to address seizures issues.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene and safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids. This standard was not met as evidenced by document review, interview and observation. In 1 of 3 (33%) home visit observations it was revealed that the agency did not ensure that the staff member used standard precautions such hand hygiene that followed accepted standards of practice and agency policy. Document 1: The agency's policy titled; Hand Hygiene, dated November 2022 stated in relevant parts; "Policy: when hands are not visibly soiled, they should be washed using an alcohol-based hand rub for routinely decontaminating hands." "Procedure: 3. Hand decontamination using an alcohol-based hand rub should be performed: D. After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings if hands are not visibly contaminated." Home Visit 3: A home visit was conducted with staff 3, the registered nurse (RN), on 10/19/23. The RN was observed to remove soiled wound dressings from the patient's right leg and left buttock. The RN then proceeded to access clean wound care supplies and apply new dressings without first performing hand hygiene and donning clean gloves. In an interview conducted on 10/19/23 with the Clinical Director they did verify that staff 3 did not follow standard precautions and established policy for hand hygiene as defined in agency policy.