Every finding on record at Appalachian Hospice South, LLC

Observed in Patient Home. In 6 of 7 patient records reviewed, The Surveyor noted patient care goals had not been specific to the patient, measurable nor with an appropriate time frame for achievement. Examples include Patient/Caregiver will verbalize understanding of bowel regimen; Patient will have a bowel regimen established within one day of narcotic initiation; Patient/Caregiver will receive optimal teaching and support as cardiac and pulmonary functions change during care; Patient will achieve optimal breathing patterns, airway patency, and comfort; Patient will maintain optimal urinary elimination patterns and comfort; Fall prevention will be maintained during care; Patient will achieve and maintain optimal skin integrity as disease progresses. Optimal hygiene will be maintained during care. This was validated with the RN Administrator.

Observed in Record Review. In 3 of 7 patient records reviewed, The Surveyor noted the patient Plan of Care (POC) had been missing issues identified either by the patient or the RN who completed the comprehensive assessment. For example, RRHV #1, the patient reported that she had been complaining of “itching all the time” and had been self-medicating to relieve this; however, this had not been included on the POC. RRHV #2, the RN had identified dysphagia and a high risk for skin breakdown on the initial assessment, but this had not been added to the POC with interventions and goals. RRNHV #5 the patient had documented issues with medication compliance, yet this had not been included on the POC. This was validated with the RN Administrator.

Observed in Tracer Activities. The HCO had not completed an Infection Risk Assessment to identify risks based on the geographic location, community, and population served. This was validated with the RN Administrator.

Observed in HR File Review. In 2 of 2 HR files reviewed, of the Certified Nursing Assistant files, a Licensed Practical Nurse conducted the initial field evaluation not a Registered Nurse. The document was co-signed by the Clinical Manager; however, the Clinical Manager had not been present in the patient home. This was validated with the Clinical Manager.

Observed in Patient Home. In 1 of 3 patient records reviewed, where the patient had a Hospice Aide (HA) ordered, the Surveyor noted the HA plan of care (POC) had been incomplete. For example, in RRHV #2, the HA had order to Apply barrier cream to ________. Where the area of application had been blank. This was validated with the HA performing the care.

Observed in HR File Review. In 3 of 9 HR files reviewed, the Surveyor noted the initial orientation competency had not been signed as validated by the Preceptor/Supervisor. This had been evident in HR #6, HR #7 and HR #9. This was validated with the Clinical Manager.

Observed in Patient Home. In 3 of 3 home visits conducted, The Surveyor noted discrepancies between the medication list in the EMR and what the patient was being administered. For example, In RRHV #1 the patient EMR medication list had been missing: Ondansetron 8 mg, 1/2-1 tab every 8 hours (script date: 10/04/23) and Hydrocodone 5/325, 1 tab every 6 hours (script date: 12/13/23), as well as over the counter medications: Tylenol Arthritis 2 tabs 3 times per day, Magnesium 500 mg, Potassium 99mg, Melatonin 5 mg, Benadryl 25 mg, Flonase nasal spray and Mucinex. In RRHV #2, the patient had been taking multiple medications different that listed in the EMR. For example, the Cyclobenzaprene 10 mg had been prescribed for 3 times per day, but the patient had been taking 1 time per day for ‘over 2 months’ and taking 3 tabs of Carbidopa-Levodopa 3 times per day, not 1 tab 3 times per day and then Carbidopa-Levodopa ER, 2 tabs 2 times per day, not 1 tab 2 times per day. The patient had also been taking CoQ10 3 times daily, not daily; Oxycodone 5 mg tab, taking 1/2 tab every 6 hours, not 1 tab, and Lorazepam 0.5 taking ‘several times a day’ and not once a day at bedtime. The patient also had Magnesium citrate gummies daily, Aspercream with Lidocaine, ibuprofen 200 mg, and Flonase nasal spray. In RRHV #3 the patient had been taking B-12 3000mg q am and Bio-Cleanse 2 caps q hs “for months”; however, these had not been on the EMR. The patient also had D3 2000 international units (on med profile D2 1.25mil); Metoprolol 100mg tab, taking ½ tab 2 time per day (on the EMR as 1 tab 2 times per day); Morphine 10 mg 1 tab daily, but on EMR as taking 2 times daily. Nortriptyline 10 mg stopped 2 weeks ago, Oxygen had been listed on the EMR medication list, but the patient had not used Oxygen. This was validated with the Clinicians present during the visit.