Every finding on record at Appling Hospice Care

Observed in Individual Tracer. In 3 of 10 patient records reviewed, did not have a update of the comprehensive assessment by all members of the interdisciplinary group. The update for the physician on at least 1 IDT for RR#1 reflected the following- continue to monitor. At least 1 IDT in RR#2, RR#7, and RR#4 were signed by the physician however the section for the physician update was left blank. A new order in RR#1 was obtained for fluticasone inhaler and the subsequent IDT did not reflect the status or patient response to this medication. This observation was discussed with the RN.

Observed in Individual Tracer. In 5 of 10 patient records reviewed, did not have measurable or individualized goals. The target dates to achieve goals were either by the end of the certification period or within 2 weeks for RR#1, RR#2, RR#4, and RR#3. Some of the goals included safety, bowel management, and wound care. RR#6 had pain and the goal for pain management did not include any numeric value. This observation was discussed with the director.

Observed in Individual Tracer. In 2 of 10 patient records reviewed, the comprehensive care plan did not include specific interventions to manage patients' symptoms. RR#3 & RR#4 had a Foley that was being managed by the hospice and the care plans did not include the specific orders related to the Foley size, balloon size, or how frequently it was to be changed.

Observed in Leadership Session. Based on a review of the available data, the Quality Assessment and Performance Improvement (QAPI) did not address the complexity of the services provided. The Hospice provided routine, continuous, respite, and GIP levels of care. These services were not addressed in the 2024 QAPI minutes. Additionally, the hospice provided services under contract and these services (ie pharmacy, DME, and SNF) were not addressed in the 2024 QAPI minutes. This observation was discussed with the administrator.

Observed in Data Session. Based on the review of available data, the hospice did not collect/analyze hand hygiene data in the field and or collect compliance data on all discipline types that provide care in the field in 2024. This observation was discussed with the Director.

Observed in Individual Tracer. In 3 of 5 patient records reviewed, the hospice aide care plan did not include comprehensive written instruction based on the assessed needs of the patients. RR#1 was oxygen dependent and on aspiration precautions and the aide care plan did not reflect these precautions. RR#2 had seizures and a gastrostomy tube and these precautions were not reflected on the care plan. RR#6 had a colostomy and this was not indicated on hospice aide care plan. This observation was discussed with the director.

Observed in Leadership Session. Based on a review of the available data which included the QAPI minutes, the Hospice did not provide administrative or direct patient care volunteer hours equally 5%. Per the QAPI minutes they have not provided volunteer hours due to the pandemic. This observation was discussed with the administrator.

Observed in Record Review. In 5 of 5 patient records reviewed, During HV# 1, HV# 2, HV# 3, RR# 1, and RR# 2's patient records review and the Admission Packet, it was noted the organization had not informed the patients of the Patient's Rights in writing prior to beginning care. For example: review of the Patient's Rights and Responsibilities revealed no documentation that the patient had the right to choose their attending physician. This was reviewed, discussed, and validated with the Director of Patient Care Services and the Administrator designee.

Observed in Record Review. In 2 of 5 patient records reviewed, During HV# 2 and HV# 3's patient records review it was noted the organization had not ensured the patient's goals were measurable. For example: review of HV# 2 and HV# 3's plan of care revealed the following goal Pain less than ___ on scale 0-10 x 15 day. This was reviewed, discussed, and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 5 patient records reviewed, during HV# 2's patient record review it was noted the organization had not ensured the plan of care included all the services needed for the palliation and management of the terminal illness and related conditions. For example: the patient's terminal diagnosis was end stage renal disease; but the plan of care did not address the central venous line that hemodialysis was being performed thru three days a week. In addition, further review of HV# 2's plan of care revealed no documentation of a suprapubic catheter or interventions/assessments related to the suprapubic catheter. This was reviewed, discussed, and validated by the Director of Patient Care Services.

Observed in HR File Review. In 2 of 2 HR records reviewed for Home Health Aide, During review of the HR#5 and HR#6's personnel records (Home Health Aide (HHA)) it was noted the organization had not ensured the HHA completed the initial aide competencies evaluation with a patient or pseudo-patient as part of a simulation For example: review of HR# 5's initial aide competency assessment skills checklist revealed all the required tasks were evaluated verbally except the transfer from bed to chair and hand washing. Review of HR# 6's initial aide competency assessment skills checklist revealed all the required tasks were evaluated verbally. This was reviewed, discussed, and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 3 patient records reviewed with Home Health Aide services, During HV# 2's patient record review it was noted the registered nurse had not prepared complete written patient care instructions for the hospice aide. For example: the Home Health Aide written assignment revealed the task of a shower two times weekly. During the home observation HV# 2's was observed with a central line dressing on the right chest wall and a suprapubic catheter but the Home Health Aide written assignment did not provide directions regarding the dressing or the catheter. This was reviewed, discussed, and validated with the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, During HV# 2's patient record review it was noted the organization had not ensured the patient's record contained information that reflected the patient's care, treatment, or services. For example: during HV# 2's home observation the patient was observed with a right wall central line. HV# 2 shared that he/she had hemodialysis three days a week for the last year through the line. Review of HV# 2's patient record revealed no documentation that HV# 2 was receiving hemodialysis or that the patient had a central line on the right chest wall. In addition, further review of the record revealed 18 Home Health Aide Visit Notes documented prior to the start of care. This was observed, reviewed, discussed, and validated with the Director or Patient Care Services that was present at the home visit and assisted with the review of the patient's record.