Every finding on record at Arc Therapy Services, LLC

Observed in Record Review. In 3 of 8 active patient records reviewed, During HV# 1, HV# 2, and RR# 1's patient records review it was noted the organization had not ensured it assessed potential medication problems to include duplicate drug therapy. For example: review of HV# 2's medication profile revealed HV# 2 was ordered more than one medication for constipation without direction on when to take the different constipation medications. HV# 2 was ordered Senna as needed for constipation and MiraLAX prn for constipation. Review of RR# 1's medication profile revealed RR# 1 was ordered more than one medication for pain control without direction on when to take the different pain medications. RR# 1 was ordered Tramadol prn for pain and Morphine Concentrate prn for pain. Review of HV# 1's medication profile revealed HV# 1 was order more than one medication for pain control without direction on when to take the different pain medications. HV# 1 was ordered Acetaminophen 325mg two tablets as needed for pain and Acetaminophen 650 mg rectal suppository as needed for pain. This was reviewed, discussed, and validated with the Hospice Director.

Observed in Record Review. In 2 of 8 active patient records reviewed, During HV# 3 and RR# 5's patient records review it was noted the organization had not ensured it assessed and reassessed it's patient's to include progress toward desired outcomes and a reassessment of the patient's response to care. For example: review of HV# 's patient record revealed HV# 3 had a PRN Skilled Nurse visit for pain of 8/10 and two subsequent Skilled Nurse visits with pain of 8/10. Review of the IDG/POC update revealed new pain medication. However, further review of the IDG/POC update revealed no documentation of the patient's increase in pain or an evaluation of the effectiveness of the new pain medication. Review of RR# 5's plan of care revealed the goal Patient yeast rash under breasts will be revolved in 10 days [date] which the revolve date was 11 days prior to the IDG/POC update. Review of the IDG/POC update revealed no documentation of the progress toward the desired goal. This was reviewed, discussed, and validated with the Hospice Director.

Observed in Record Review. In 2 of 8 active patient records reviewed, During HV# 1 and HV# 2's patient records review it was noted the organization had not ensured the plan of care was based on the patient's goals and the time frames, settings, and services required to meet those goals. For example: review of HV# 1's IDG/POC update revealed new wound care orders for an unstageable pressure ulcer to the left heel. Further review of the IDG/POC update and two subsequent IDG/POC updates revealed no documentation of a goal for the wound. Review of HV# 2’s plan of care revealed the goal “Ongoing assessment of neurological status/signs and symptoms of altered metal status related to possible infection AEB [as evidenced by] increased confusion”. However, this goal was an assessment and not a goal. Further review of HV# 2's patient record revealed and IDG/POC update with a new order for wound care for a skin tear to the left elbow. Further review of the IDG/POC revealed no documentation of a goal for the skin tear. This was reviewed, discussed, and validated with the Hospice Director.

Observed in HR File Review. In 1 of 1 Contracted home health aide HR files reviewed, During HR# 9 (contracted home health aide)'s HR file review it was noted the organization had not ensured the contracted home health aide completed an initial competency evaluation. For example: review of HR# 9's HR file revealed a computer printed document listing the tasks required for an initial home health aide competency evaluation from the contracted staffing organization that had no additional documentation, such as when was it completed and if an RN completed the evaluation. This was reviewed, discussed, and validated with the Hospice Director.

Observed in Patient Home. In 1 of 8 active patient records reviewed with hospice aide, During HV# 2's home observation it was noted the organization had not ensured the registered nurse prepared completed written patient care instructions for the hospice aide. For example: during the home observation the hospice aide was observed removing the bilateral hearing aides prior to completing the shower. Observed in the home were multiple notes taped to the wall instructing the caregivers to remove the hearing aides prior to the shower. However, review of the hospice aide written instructions revealed no documentation HV# 2 had hearing aides or instructions to remove the hearing aides during the shower. This was observed, discussed, validated with the Hospice Director.

Observed in Patient Home. In 4 of 8 home visits conducted with medication review, During HV# 3's home observation and HV# 1, RR# 1, and RR# 2's patient record review it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: during HV# 3's home observation the registered nurse (RN) was observed completing a medication review. During the medication review it was noted the patient had acetaminophen 650 mg rectal suppositories in the home with the comfort kit. However, review of the organization's medication profile revealed no documentation of acetaminophen 650 mg rectal suppositories. For example: review of HV# 1's patient record revealed a RN Supervisory visit with documentation the home health aide (hospice aide) was supervised to include following the hospice aide plan of care and infection control prior to the first hospice aide visit. Further review of HV# 1's patient record revealed an RN start of care comprehensive assessment with documentation No, under Oxygen started or initiated. However, HV# 1 was admitted with oxygen 2-5 lpm as needed. Review of RR# 2’s start of care RN comprehensive assessment revealed documentation of “No”, under “Oxygen started or initiated. Further review of the start of care RN comprehensive assessment revealed documentation that oxygen was stored safely. Review of RR# 1’s plan of care revealed documentation of four goals with a documented dates 17 days prior to when the goal was electronically added to the IDG/POC update. Review of the previous IDG/POC update revealed no documentation of the four goals. This was reviewed, discussed, validate with the Administrator.This was observed, discussed, and validated with the Hospice Director.