Every finding on record at Angel of Joy Hospice, Inc.

Observed in Record Review. In 4 of 4 live discharge records due to extended prognosis, it was noted the organization failed to ensure that the patient was informed in advance about the expected outcomes of care and services. The Notice of Medicare-Non Coverage (NOMC) was not provided to patient at least two days in advance. For example, in RRDC#1, RRDC#2, RRDC#6, and RRDC#8, the patient received the NOMNC on the same day the episode ended. This finding was discussed and validated by the Hospice management team.

Observed in Record Review. In 14 of 14 patient records reviewed, it was noted that the organization failed to ensure that the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including treatments required to meet the patient's specific needs. For example in records reviewed RRHV#1,RRHV#2,RRHV#3,RRNHV#1,RRDC#1,RRDC#2,RRDC#3,RRDC#4,RRDC#5,RRDC#6,RRDC#7,RRBRV#1, and RRBRV#2, the patient was receiving oxygen therapy at 2-5 LPM via nasal cannula as needed, however, the plan of care did not specify the appropriate oxygen flow rate adjustments for varying levels of shortness of breath, such as during mild versus sever episodes. This find was discussed and validated by the hospice management team.

Observed in Record Review. In 5 of 5 patients receiving hospice aide services, the organization failed to ensure that the written patient care instructions for a hospice aide were developed by a registered nurse responsible for the supervision of hospice aide services. For example in RRHV#1, RRHV#3, RRDC#5, RRDC#7 and RRBRB#1, the patient was on oxygen at 2-5 LPM via nasal cannula as needed for shortness of breath; however, the aide care plan did not specify the appropriate oxygen flow rate adjustments based on the severity of the patient's shortness of breath, such as during mild versus severe episodes. This finding was discussed and validated by the hospice management team.

Observed in Record Review. In 14 of 14 patient records reviewed, it was noted that the organization failed to ensure that all documentation entries were appropriately authenticated and dated. During the review of clinical records of RRHV#1,RRHV#2,RRHV#3,RRNHV#1,RRDC#1,RRDC#2,RRDC#3,RRDC#4,RRDC#5,RRDC#6,RRDC#7RRDC#8,RRBRB#1,RRBRB#2, the following paper clinical records such as Emergency Plan, Safety Guidelines for Hospice, Patient Identification, Certification of Terminal Illness, Prognosis Documentation Summary, Fall Risk Assessment, Pain Assessment, and skilled nursing visit note; Hospice Social Worker Assessment; Spiritual Assessment, Volunteer Assessment, and Hospice Aide visit notes and supervisory visit notes were found to be missing required time stamp as per agency policy no. 5-006.1 Entries Into The Clinical Record: a clinical record will be initiated and maintained for each patient receiving care or services, according to organization policies and will include at a minimum, the dates, times, and type of interventions, assessment, and coordination of care. This findings were discussed and validated by the hospice management team.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not implement the infection prevention and control activities it had planned. According to organizational policy Hand Hygiene No. 9-009, hand hygiene is required after removing gloves and prior to entering the nursing bag. During HV#1, the clinician was observed removing gloves after performing patient care and entering the nursing bag without performing hand hygiene. This was discussed with the Chief Operating Officer following the visits.

Observed in Record Review. In 2 of 11 patient records reviewed, with aide services, the written patient care instructions did not specify the duties of the home health aide. Upon review of HV#2 and HV #3 it was noted the patients were on anticoagulant therapy; however, on review of the aide plan of care, there were no specific instructions provided to the aide regarding bleeding precautions. This was discussed with the Administrator/Director of Patient Care Services.