Every finding on record at Assist on Call Palliative & Hospice Care, Inc.

Observed in Record Review. In 1 of 6 patient records reviewed, it was noted in record review for home visit #3 that there were no orders or interventions on the plan of care for a treatment provided to the patient. For example, the SN documented on the last visit note that she cleansed an excoriated area on the patient's ear with normal saline and applied a bandaid. There was no physician order for this on the plan of care. This was discussed with the DON.

Observed in Record Review. In 1 of 6 patient records reviewed, it was noted in record review #1 that the order for foley catheter was stated as 16F/10cc balloon however the nursing documentation for the insertion of the foley indicated that a 14 fr. catheter was used. This was discussed with the DON.

Observed in HR File Review. In review of the HR file for a hospice aide it was noted that all of the areas required to be assessed via direct observation were assessed verbally. This was discussed with the DON.

Observed in Patient Home. In 1 of 10 patient records reviewed, it was noted that the hospice aide did not perform services as ordered. For example, the aide plan of care specified bed bath to be given each visit, however the board and care staff member stated that the aide gives the patient a shower once or twice a week and the other time gives a bed bath depending upon how the patient is feeling. This was discussed with the RN present on the visit.

Observed in Record Review. In 1 of 6 patient records reviewed, it was noted that in review of record for home visit #3, the aide documented that a bed bath was given on each visit however the board and care staff stated that the patient receives a shower once or twice a week. This was discussed with the RN present in the home. Observed in Record Review. In 1 of 6 patient records reviewed, it was noted that in record review #1 the nurse did not document a balloon size when inserting a foley catheter. This was discussed with the DON. Observed in Patient Home. In 1 of 3 home visits conducted, it was observed during the medication reconciliation process in home visit #3 that the current hospice medication list did not include a Multivitamin or Aricept which the caregivers are giving. Additionally, the order for Seroquel was stated as 12.5 mg, give one tab at bedtime however what was in the home was 25 mg and they were giving 1/2 tab. This was discussed with the RN present on the visit.

Observed in Record Review. In 1 of 6 patient records reviewed, the hospice did not conduct and document a patient specific comprehensive assessment that identified the need for psychosocial support. For example, the record of RR#4 did not include documentation of a psychosocial assessment as part of the initial comprehensive assessment. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.

Observed in Record Review. In 6 of 6 patient records reviewed, the hospice did not document patient specific comprehensive assessments and re-assessments that identified the need for bereavement services. All initial comprehensive bereavement assessments were completed by a registered nurse not having the knowledge and expertise to do so. Policy 2-010 entitled Bereavement Services requires that the initial assessment is to be completed by a social worker at the time of admission. Also, in the records of RR#2, RR#3, and RR#4 there was no documentation to support that family and caregiver bereavement risks were re-assessed following the patient’s death. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.

Observed in Record Review. In 3 of 3 patient records reviewed, where patients' length of stay was more than two weeks, the interdisciplinary group notes did not document patient/family decline, changes, and progress towards goals since the previous reassessment. In addition, there was no documentation of individualized plans for care and services for the following two weeks. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.

Observed in Record Review. In 6 of 6 patient records reviewed, goals were not measurable and completion target dates were not individualized. For example: The patient`s blood pressure will maintain at its normal level; patient will have optimal bowel elimination and comfort; patient will show improvement of appetite; assist on getting patient resource as needed; have patient achieve a sense of peace. Additionally, every targeted completion date was either the date of the next interdisciplinary meeting or the last day of the benefit period. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.

Observed in Record Review. In 1 of 6 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. For example, in the record of HV#2 the patient did not have a POLST or other advance directive and needed assistance in applying for in home supportive services. These problems and appropriate interventions and goals were not addressed by the social worker in the plan of care. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.

Observed in Record Review. In 6 of 6 patient records reviewed, the hospice did not provide an organized bereavement program for the provision of bereavement services. The initial assessment was documented by a registered nurse; risk was not re-assessed following a patient’s death; an individualized plan of care was not created by the coordinator and approved by the interdisciplinary group; and letters were independently mailed to family members by office staff. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.

Observed in Tracer Activities. Staff were not held accountable for their responsibilities as evidenced by the failure of psychosocial, spiritual, and bereavement disciplines to assess and provide bereavement services. This RFI was reviewed, discussed, and validated with the Administrator and Director of Patient Care Services.