Every finding on record at Atena Hospice, Inc.

Observed in Record Review. In 1 of 1 patient records reviewed, for extended prognosis, the organization failed to ensure the patient was able to exercise their rights as a patient of the hospice as evidenced by in review of RRDC#1 the hospice presented the Notice of Medicare Non-Coverage but the form was signed by the patient representative on the day of discharge and not 2 days prior to discharge as required. This observation was reviewed with the DPCS.

Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to conducts and documents a patient-specific comprehensive assessment and reassessment that identifies the patient’s need for hospice care and services. For example: on review of RRNHV#7 the patient was receiving IV fluids through a peripheral IV yet there was no documentation noted in the record of an assessment of the IV site. In RRNHV#6 and RRNHV#9 the patient's had wounds and documentation of wound treatment yet no comprehensive wound assessment to include size, color, drainage, odor, and surrounding skin as required. These observations were reviewed with the DPCS.

Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to update the comprehensive assessment to consider changes that have taken place since the initial assessment as frequently as the patient condition requires but no less frequently than every 15 days, On review of RRHV#1 there was a 27 day gap in RN visits for comprehensive assessment and a 20 day gap in February. In RRNHV#4 there were also greater than 15 day gaps in RN comprehensive assessment noted in as there was a 28 day gap December to January and a 27 day gap from January to February. On discussion with the DPCS the organization had identified issues with comprehensive assessment greater than 15 days in February and have been working toward correcting the issue.

Observed in Record Review. In 9 of 10 patient records reviewed, the organization failed to ensure the individualized written plan of care included goals that were specific, measurable, and time-bound. On review of all clinical records reviewed there were examples of goals as part of the plan of care that failed to be specific, measurable, and realistically time-bound. For example in RRHV#1 example of goals were: Patient’s ADL needs will be met/anticipated daily until next review and Minimize complications due to bedbound status within the next IDT meeting and review every IDG date and revise if needed. In RRHV#2 examples were Minimize complications due to impaired mobility and Patient will drink adequate fluid and water and skin will be maintained good moisture during care. In RRHV#3 patient will remain free of preventable discomfort and/or complication due to impaired mobility within the next 2 weeks. revise if needed. In RRNHV#5 an example was Will minimize episode of anxiety and nervous daily and feels comfort during care. In RRNHV#8 examples were Patient able to express feeling and meet on a day to day basis as communicated during care and Patient will achieve optimum level of comfort thru pharmacological and nonpharmacological intervention daily until next review. Further examples can be seen throughout the records reviewed. These observations were reviewed with the DPCS.

Observed in Record Review. In 4 of 10 patient records reviewed, The organization failed to ensure the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRNHV#4 the patient was being seen monthly by the social worker (MSW) yet there was no psychosocial care plan established to guide the care being provided by the MSW. In review of RRNHV#5 the documentation noted a rash on the patient's leg requiring Triamcinolone cream as treatment yet there was no care plan to reflect the care being provided. In RRNHV#9 there was documentation of the patient with diarrhea and adding Imodium to the medication profile yet the issue was not reflected in the care plan. In RRNHV#10 the patient was being seen by the MSW monthly yet no psychosocial care plan open to guide the care. These observations were reviewed with the DPCS.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to ensure care was provided according to the patient's individualized plan of care. For example: on review of RRNHV#4 the patient had a wound documented to the finger with orders to cleanse with wound cleanser, pat dry, apply antibiotic ointment and leave open to air, however the SN documented on multiple occasions that the wound was covered with an oil immersion dressing inconsistent with the patient's plan of care. This observation was reviewed with the DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to implement its infection prevention and control activities when cleaning and performing disinfection of medical supplies and devices. For example: on home observation of RRHV#1 the RN was observed to utilize equipment for the comprehensive assessment such as blood pressure cuff, stethoscope, pulse oximeter, and thermometer yet did not disinfect the equipment prior to returning them to the nursing bag as required by policy. This observation was reviewed with the RN and organization leadership. Observed in Patient Home. In 1 of 3 patient records reviewed, the organization failed to follow accepted standards of practice to prevent the transmission of infections and communicable diseases. For example: on home observation of RRHV#1 the RN was observed to access the nursing bag after direct contact with the patient on multiple occasions without sanitizing hands prior to bag entry as required. This observation was reviewed with the RN and Organization Leadership.

Observed in Record Review. In 4 of 8 patient records reviewed, where aide services were elected, the organization to ensure the RN provide written patient care instructions for the hospice aide. For example: on review of RRNHV#6 and RRNHV#9 the patient had documentation of wounds with dressing treatments, however there were no specific instruction to the aide on how to handle the wound sites and dressings while providing care. In RRNHV#7 the patient had a peripheral IV with continuous fluids yet there were no instructions to the aide on how to handle the IV site while bathing the patient. In RRNHV#9 the patient had a foley catheter but there was no foley care assigned to the aide in the aide plan of care. In RRNHV#10 the patient's plan of care noted that the patient's oxygen was increased to 10 liters/minute continuous yet there was no update to the aide plan of care to note the change and whether or not oxygen shoud be removed or left in place for bathing. These observations were reviewed with the DPCS.

Observed in Record Review. In 3 of 8 patient records reviewed, where aide services were elected, the organization failed to ensure provided care in accordance with the orders on the plan of care. For example: on RRNHV#6 the aide care plan specified shower for the type of bath to be given yet the aide documented over the last month that a bed bath was provided instead of a shower. In RRNHV#8 the aide plan of care also specified a shower be given yet the aide documented on 3 occasions in March that a bed bath was given to the patient. In RRNHV#9 the aide documented that foley care was provided yet foley care was not assigned on the aide plan of care These observations were reviewed with the DPCS.

Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to ensure complete and accurate records. For example: on review of RRHV#1 there was documentation in the RN's assessment that the patient's pain was controlled with tramadol every 12 hours as needed yet on home observation discussion and discussion with the DPCS the patient was on gabapentin and Tylenol and was not taking Tramadol and the documentation was inaccurate and confused with another patient. In RRNHV#9 the patient had a stage 4 wound to the buttocks and another wound to the toe yet on documentation in a narrative by an LVN in April the LVN documented that the skin was intact. In RRNHV#10 the medication profile contained an order for oxygen at 2-5 liters yet the order conflicted with another updated order in the plan of care and also documented by the physician in the Certificate of Terminal Illness of 10 liters oxygen continuous. These observations were reviewed with the DPCS.