Every finding on record at Angel Hospice Providers, Inc.

Observed in Individual Tracer. In 3 of 3 home visits conducted, In 3 of 3 home visits conducted, the surveyor noted that the organization was not following their Hand Hygiene Policy 9-009.1. For example, in HV 1 the RN did not gel his hands after removing his gloves. In HV 2 the LVN used her bare hands to turn off the faucets twice after washing her hands. In HV 2 the CNA used her bare hands to turn off the faucets twice after washing her hands. This was validated in a discussion with and observation by the Oner/Administrator during the visits. Observed in Individual Tracer. Ducting HV 2, the surveyor noted that the LVN did not have her own antibacterial soap and paper towels to perform hand washing which does not follow bag technique Policy 9-014.1 which states the following contents in nursing bag should include washing equipment gel, antibacterial soap, paper towels. This was validated in a discussion with and observation by the Owner/Administrator during the visit.

Observed in Individual Tracer. In 1 of 3 home visits conducted, During HV 1, the surveyor noted that the medications in the home did not match the profile. For example, the wife had Trazadone in the home, after stating that it did not work and was prescribed Temazepam instead. Also the wife stated she was giving a whole pill of Metoprolol (50 mg) when he order was for half a pill (25 mg). This was not in compliance with organization Policy Medication Profile 3-002.1. This was validated in a discussion with and observation by the Owner/Administrator during the visit.

Observed in Individual Tracer. In 1 of 2 patient records reviewed, the agency did not develop measurable goals with reasonable time frames. During record review of RR1 the goals related to pain control and bowel elimination were stated as optimal comfort and optimal elimination and did not specify what was optimal. The time frames on all the goals on the care plan were dated for the end of the certification period. This was validated with the Administrator.

Observed in Individual Tracer. During the joint home visit with the RN the surveyor observed that the nurse changed gloves several times without hand sanitizing between glove changes. The agency's policy on hand hygiene stated that hands needed to be sanitized after removing gloves. This was validated with the Supervising RN.

Observed in Individual Tracer. In 2 of 2 patient records reviewed, the aide's written care plan had not been updated to reflect the patient's needs. For example, HV 1, the patient originally was able to ambulate independently, However, since 9/28 the patient required the use of a walker and assist which was verified during the surveyor's home visit. The aide assignment had not been updated with new instructions for the aide as of 11/2. A second example during record review of RR1 the aide assignment did not specify the patient's diet when the aide was assigned to assist with feeding.

Observed in Individual Tracer. In 1 of 2 patient records reviewed, the aide did not follow the care plan. For example, in RR1, the aide took the patient's vital signs on 10/14 and 10/19. The aide was not assigned to measure vital signs. This was validated with the Administrator.