Every finding on record at Arc Therapy Services, LLC

Observed in Record Review. In 1 of 1 patient records reviewed, it was noted by the nurse surveyor that for RRDC#1, a discharge for extended prognosis, the Notice of Medicare Non-coverage (NOMNC) was signed by the patient’s representative on the day before discharge, not five days in advance of the discharge as required by Texas regulation. Findings were verified by the Corporate Vice President for Clinical Support/Administrator, the Director of Clinical Operations, and the Director of Clinical Services/Clinical Services Manager.

Observed in Record Review. In 1 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that for RRHV#2, the initial bereavement risk assessment was not completed as part of the comprehensive assessment. Finding was verified by the Corporate Vice President for Clinical Support/Administrator, the Director of Clinical Operations, and the Director of Clinical Services/Clinical Services Manager.

Observed in Record Review. In 3 of 10 patient records reviewed, it was noted by the nurse surveyor that treatment orders were missing. For RRHV#2, RRNHV#1-P, and RRNHV#3-A, the patients all had wounds, that were being cleaned and dressed, however, there were no orders for the specific wound care being provided for any of the patients on the plan of care. Findings were verified by the Corporate Vice President for Clinical Support/Administrator, the Director of Clinical Operations, and the Director of Clinical Services/Clinical Services Manager.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During RRHV#3, the registered nurse placed her nurse bag on a barrier, then laid her clean equipment on the barrier next to the bag. She performed hand hygiene with hand sanitizer before going in and out of her bag at the beginning of the visit. The skilled nurse then took the patients vital signs and performed the patient assessment. After use, she placed her dirty equipment, along with two cell phones on the barrier next to the nursing bag. After assessment was complete, she did not complete hand hygiene, however she immediately began cleaning her equipment placing it right back where it had been on the now dirty barrier to dry, next to the phones and the nurses bag. Findings were verified by the Director of Clinical Services/Clinical Services Manager who was present on the visit.

Observed in Record Review. In 1 of 8 patient records reviewed, with the hospice aide, it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. For RRHV#2, the patient has a suprapubic catheter, there were no instructions on the hospice aide care plan regarding what the hospice aide should do it the catheter leaked or if there were any noted problems related to the site. For RRNHV#1, the patient had wounds with dressings, however there were no specific instructions on the hospice aide care plan related to the dressings. Findings were verified by the Corporate Vice President for Clinical Support/Administrator, the Director of Clinical Operations, and the Director of Clinical Services/Clinical Services Manager.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#1the patient’s folder did not contain any educational materials provided to a patient when admitted to hospice and used for ongoing education. The patient had moved from her home to a Board and Care, new materials had not been provided to the new caregivers, nor was there documentation to support specific education provided upon the patient’s move, such as equipment use, infection control, safety measures, or emergency preparedness. Finding was verified by the Director of Clinical Services/Clinical Services Manager who was present on the visit.

Observed in Record Review. In 1 of 1 patient records reviewed, in RR#1, the nurse surveyor noted the organization did not treats it's patient’s pain or refers the patient for treatment. For example Social worker documented that the patient reported a pain level that was above her stated goal, but the case manager was not notified. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 2 of 5 patient records reviewed, the hospice nurse surveyor noted that the organization assesses potential medication-related problems, for example, In RR# 8 patient was noted with order of Acetaminophen 1-2 tablet every 8 hrs prn they were no direction on when to take the different tablet. In RR# 4 patient was noted with order of Lorazepam 1-2 tab every 4 hrs. There no qualifier identity when to take the 1 tab or 2 tab. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 13 of 13 patient records reviewed, the organizations interdisciplinary group failed to document the patient's progress toward goals. It was noted that the plan of care did not contain revisions based upon the updated comprehensive assessment, progress toward established goals, or new issues identified. For example: in RR #4 the plan of care was established and dated at the start of care. No progress toward goals to include no revisions, resolutions, or new additions were noted to most recent IDG in benefit period #4. Similar findings of no progress toward goals with no revisions, resolutions, or new additions from admission were noted in HV1-3 and RR#1-10. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 13 of 13 home visits conducted, The record review associated with HOSV#1-3, RR#1-13 had multiple goals but none were measurable nor had any time frame defined as to when the goals were expected to be achieved. For example RR #1 patient will be comfortable and remain free of injury. RR# 2 patient ADL needs are met to an optimal level , RR# 3 Patient/Family/PCG will express feeling of grief/loss , RR # 4 patient will Establish trusting relationship with Patient and family. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 4 of 13 patient records reviewed, the plan of care did not include interventions to manage pain and symptom in HV#1, RR#1, RR#3, RR#6, RR#10. for example in RR #3, the Surveyor noted the patient was identified as having anxiety and pitting edema ; however, the plan of care did not include interventions to address these issues. In RR #6, the Surveyor noted the patient was identified as having suprapubic catheter ; however, the plan of care did not include interventions to address the catheter care. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 2 of 13 patient records reviewed, It was noted that the plan of care did not contain orders for drugs and treatments to meet the patient needs. For example, in record review #2 the nurse documented that the patient had a foley catheter in place but there were no orders for the Foley, In record review #4 nurse documented that the patient that the patient had a PICC LINE, 4 stage 4 wounds and a Peg tube, no orders were noted in the plan of care. This was confirmed by the the Regional Director of Survey Readiness

Observed in Record Review. In 13 of 13 patient records reviewed, it was noted that the plan of care was not updated and did not note the patient's progress towards goals. For example, in HV#1-3 RR# 1-13 the plan of care was developed at the start of care and there was no indication that any goals had been met or revised. Additionally at each recertification period the same problems, goals and interventions were identified. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 1 of 13 patient records reviewed, the nurse surveyor noted that Medical social services assessment were not based on the patient’s psychosocial assessment, the patient’s and family’s needs. for example in RR# 8 the medical social worker assessment did note include financial resources or constraints and did not identifying family support systems to help facilitate coping with end of life issues. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 2 of 7 home visits conducted, the surveyor noted that the hospice aide plan of care did not specify any safety precaution. For example, in HV#2 it was noted that the patient is on oxygen but it was not noted on aide plan of care. In RR # 4 the patient was noted with a Foley and peg tube none were noted on the aide plan of care. This was confirm by the Regional Surveyor Readiness.