Every finding on record at Appl Orchard Hospice of Kansas Inc

Observed in Record Review. In 2 of 15 patient records reviewed, the organization had not conducted and documented a patient-specific comprehensive assessment in accordance with their policy no. 2-030 Comprehensive Assessment which states that a comprehensive assessment will be performed by the hospice IDG no later than 5 calendar days after the election of hospice care. In review of the medical record for RRNHV#6 the surveyor noted that the psychosocial assessment had been completed on the 6th day following the election of the hospice benefit. Also, in review of the medical record for RRNHV#8 the spiritual care assessment had been completed on the 6th day following the election of the hospice benefit. This was validated with the Director of Nursing.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization had not reassessed the hospice patient in accordance with their policy no. 2-031.1 On Going Comprehensive Assessments which states, the nurse will assess the patient on each visit for: Pain, Secondary symptoms related to the terminal illness (nausea, resp distress, response to medications), vital signs, breath sounds, skin integrity, bowel sounds, elimination, mental status, appetite/diet, functional status, safety/home environment, patient/family support. For RRHV #4 the RN did not do a complete skin integrity assessment even though there is documentation in the clinical record of excoriation on patient's right buttock. The patient was not turned for assessment of skin condition on the back of her legs, back and buttocks. This was validated with the Director of Nursing.

Observed in Patient Home. In 1 of 4 home visits conducted, the hospice nurse failed to conduct a medication assessment in accordance with the organizations policy no. 3-002.1 Medication Profile Policy which states, during subsequent hospice visits the medication profile will be used to evaluate the use of the drugs in the home setting. For RRHV #4 the RN had completed the home visit without assessing or reconciling the medications. This was validated with the Director of Nursing who had stated the expectation is that medications in the home will be reconciled using the medication bottles/containers and the medication list.

Observed in Record Review. In 2 of 15 patient records reviewed, the organization failed to revise the plan of care and goals for care, treatment, or services based on the patient’s needs. In review of the medical record for RRNHV#1 the RN documented that the patient had severe left anterior rib pain when moving following a fall and increased the frequency of the patient's Tramadol to four times a day however there was no evidence that the care plan had been revised to include a plan for pain management. Also, in review of the medical record for RRNHV#4 there was documentation and orders for a skin tear /left leg and a skin tear/right foot with physician orders to clean with wound cleanser, pat dry and apply xerofoam dressing however the plan of care had not been revised to include the skin integrity problem. This was validated with the Director of Nursing. This was validated with the Director of Nursing.

Observed in Record Review. In 11 of 15 patient records reviewed, the plan of care did not include measurable outcomes anticipated from implementing and coordinating the plan of care. In review of the medical record for RRHV#1, RRHV#4 and RRNHV#3 the surveyor noted there was a problem for Pain with a goal; patient will be pain free or verbalize an acceptable pain level with current pain management regimen and did not include the patient's goal for acceptable pain management such as 4 out 10. Also, for RRHV#3 there was a problem of Heart Failure with the goal: patient's symptoms will be consistent with stage of disease process and problems managed as well as disease process will allow and did not include goals for specific symptoms such as shortness of breath, edema or weight gain. Additionally, for RRNHV#2 there was a documented problem of heart failure and the goal: optimal cardiac status within disease limitations, as evidenced by ability to resume and maintain adapted lifestyle without distress or complications, however the goal failures to specify what optimal cardiac status is for the patient and what lifestyle activities the patient would like to resume. This also occurred in review of RRNHV#5, RRNHV#6, RRNHV#7This was validated with the Director of Nursing.

Observed in Patient Home. In 1 of 4 home visits conducted, staff failed to follow standard precautions and organizational policy for infection control practices. The surveyor noted that during the bed bath for RRHV #3 the hospice aide was observed to cleanse the patient's perineum and then continued the bath without a glove change and hand hygiene. This was validated with the Director of Nursing.

Observed in Patient Home. In 1 of 1 home visits conducted, with hospice aides, staff did not follow the plan of care. The Aide plan of care for RRHV #3 included shave each visit and oral care each visit however the hospice aide completed the visit and did not offer or provide that care to the patient. This was validated with the Director of Nursing.

Observed in Document Review. the organization had not achieved volunteer savings in an amount that equals 5% of the total patient care hours of all paid hospice employees and contract staff. The hospice demonstrated volunteer utilization and cost savings of 5.5% for 2024 and 2.575% for 2025. This was validated with the Volunteer Coordinator.

Observed in HR File Review. In 1 of 8 HR files reviewed, the organization had not assessed staff competence in accordance with their policy which requires annual competency assessments. In review of the personnel file for the Hospice Medical Director, HR#1 there was no evidence that competency had been assessed in 2024 or 2025. This was validated with the Assistant Administrator.

Observed in Document Review. In 1 of 3 contracts reviewed, the written agreement did not include a stipulation that the outside agency will complete criminal background checks on contracted employees. In review of the Durable Medical Equipment contract there was no language that included the requirement for criminal background checks. This was validated with the Director of Nursing.

Observed in Record Review. In 5 of 13 patient records reviewed, the initial bereavement assessment was not completed. In HV#2, RR#4, RR#8, RR #9, and RR#10, the surveyor noted the bereavement risk assessment was not completed as part of the comprehensive assessment. This was confirmed by the Administrator.

Observed in Record Review. In 3 of 3 patient records reviewed, an assessment at death was not done to determine family's ability to cope and potential for pathological grief reactions. In RR#11, RR#12, and RR#13, the surveyor noted that a post-bereavement assessment was not completed. This was confirmed by the Administrator and Director of Nursing.

Observed in Record Review. In 3 of 13 patient records reviewed, the organization did not reassess the patient based on their desire for care, treatment, or services. In HV#3, the patient declined aide services in August 2022, but the aide plan of care remains active. In RR#5, the patient declined aide services in February 2023, but the aide plan of care remains active. In RR#7, the patient declined aide services in March 2023, but the aide plan of care remains active. This was confirmed by the Director of Nursing.

Observed in Infection Control System Tracer. The organization was collecting data, but there was no written infection prevention and control goals to minimize the possibility of spreading infections. This was confirmed by the Administrator. Observed in Infection Control System Tracer. The organization's written infection prevention and control goals did not include improving compliance with hand hygiene guidelines. This was confirmed by the Administrator. Observed in Infection Control System Tracer. The organization's written infection prevention and control goals did not include limiting the spread of infections associated with the use of medical equipment, devices, and supplies. This was confirmed by the Administrator. Observed in Infection Control System Tracer. The organization's written infection prevention and control goals did not include limiting unprotected exposure to pathogens. This was confirmed by the Administrator. Observed in Infection Control System Tracer. The organization's written infection prevention and control goals did not include limiting the spread of infections associated with procedures.

Observed in Record Review. In 3 of 3 patient records reviewed, the organization had not developed a bereavement plan of care that specifies the type of bereavement services to be offered and the frequency of service delivery. In RR#11, RR#12, and RR#13, the surveyor noted that a post-bereavement assessment and bereavement plan of care was not developed to address family members' grief and bereavement needs. This was confirmed by the Administrator and Director of Nursing.

Observed in Record Review. In 13 of 13 patient records reviewed, the need for volunteer services was not assessed. This was confirmed by the Volunteer Coordinator.

Observed in Tracer Activities. In 1 of 4 contracts reviewed, the DME contract did not stipulate that the outside agency completes criminal background checks on contracted employees who provide direct patient care or have access to patient records. An addendum was obtained during survey. This was confirmed by the Administrator.