Every finding on record at Audubon Hospice of Lafayette, Inc

Based on record review and interview, the agency failed to maintain a system of communication to ensure that coordination of care was provided as evidenced by the SN (skilled nurse) failing to inform the physician of the patients complaint of pain for 1 (#13) out of 14 (#1-#14) sampled patients. --- Patient #13. Review of the patients electronic clinical record revealed the start of care date was 09/22/2024. The patients diagnoses included severe protein calorie malnutrition and repeated falls. The benefit period reviewed was 09/22/2024 to 12/03/2024. Review of the patients POC (plan of care) for benefit period 09/22/2024 to 12/03/2024 revealed an order for SN 2/wk, decreased to 1/wk beginning 09/30/2024 (skilled nurse visits two times a week, decrease to one visit a week beginning 09/30/2024.) Review of the patients RN (Registered Nurse) Initial Assessment visit note dated 09/22/2024 under the pain assessment section revealed, ";...Management...Target pain goal: 2 on a pain scale of 1-10...What pain level warrants further attention: 5 ..." Review of the patients skilled nurse visit note dated 09/26/2024 at 10:29 AM to 11:02 AM revealed the patient complained of pain 8/10 (pain scale 1-10, with 10 being worse) during the visit. There was no evidence the skilled nurse informed the physician of the patients pain. Review of the patients skilled nurse visit note dated 09/30/2024 at 12:07 PM to 12:38 PM revealed the patient complained of pain 8/10 during the visit. There was no evidence the skilled nurse informed the physician of the patients pain. On 02/25/2025 at 10:40 AM, an interview was conducted with S1ADM (Administrator). After S1ADM reviewed Patient #13s initial assessment conducted on admission, she confirmed that the target goal for pain was a level 2 on a pain scale of 1-10. S1ADM stated that pain level of 5 or greater warranted further attention and that the physician should be informed. On 2/25/2025 at 11:50 AM, a telephone interview was conducted with S2RN. S2RN confirmed that she was the nurse that made the SN visits on 09/26/2024 and on 09/30/2024. S2RN reviewed the electronic SN visit notes and confirmed the patient complained of pain that was at a level 8 for both visits and she confirmed that there was no evidence the physician was informed of patients pain. On 02/25/2025 at 12:15 PM, an interview was conducted with S1ADM. She reviewed the SN visit notes dated 09/26/2024 and 09/30/2024. S1ADM confirmed the patient complained of pain that was at a level 8 out of 10. S1ADM confirmed there was no evidence the SN informed the physician of patients pain and confirmed that she should have.

Based on observation and interview, the agencys RN (Registered Nurse) failed to follow accepted standards of practice to prevent the transmission of infections and communicable diseases while performing wound care for Patient #2. --- Review of Patient #2s electronic clinical record revealed the election date for hospice services was 12/12/2023. Her start of care date was 02/07/2025. The patients admitting diagnosis included in part the following diagnoses: senile degeneration of brain, anxiety disorder, unspecified protein-calorie malnutrition, and essential (primary) hypertension. The benefit period reviewed was 02/04/2025 to 04/04/2025. Further review of the patients electronic record revealed a physician order with a start date of 02/24/2025 that read, ";Wound Cleanser External Solution—Dose: 1ml (milliliter); Instructions: apply top wound for 5 days and then prn (as needed); Indication: Wound care." Review of CDCs (Centers for Disease Control) ";Clinical Safety: Hand Hygiene for Healthcare Workers" dated 02/27/2024 (https://www.cdc.gov/clean-hands/hcp/clinical-safety/index.html#cdc_clinical_safety_best_practices_recomm-recommendations) read in part,...CDC provides the following recommendations for hand hygiene in healthcare settings...Know when to clean your hand: ...before moving from work on a soiled body site to a clean body site on the same patient...after contact with blood, body fluids, or contaminated surfaces...Know when to wear (and change) gloves: ...When to change gloves and clean hands...if gloves become soiled with blood and body fluids after a task...if moving from work on a soiled body site to a clean body site on the same patient or if a clinical indication for hand hygiene occurs...if they look dirty or have blood or body fluids on then after completing a task... On 02/24/25 at 12:00 PM, a home visit was conducted with S3RN at a nursing facility. She stated she would be assessing the wound on the patients right leg and performing wound care. She went into the patients bathroom and washed her hands and donned clean gloves. S3RN placed a barrier of the bedside table and placed the wound care supplies on the bedside table. S3RN removed the transparent dressing from the patients right lower leg. Bloody drainage was observed on the dressing. Upon removing the dressing, it cause the patients wound to start bleeding. S3RN reached in her clean wound care supply bag and removed clean gauze with the same gloves that she used to remove the bloody dressing. She sprayed the wound with wound cleanser and cleaned it with the gauze. Blood was observed on the gauze. SN then discarded the blood stained gauze and reached in her clean wound care supply bag with the contaminated gloves and removed a transparent dressing. She applied the dressing on the patients wound. She reached again into her clean wound supply bag with the contaminated gloves and removed her pen to sign and date the patients dressing. S3RN removed her gloves and put on a clean pair of gloves without sanitizing her hands to clean her vital sign equipment and placed in her bag. She also placed the bag with the wound care supplies back in her bag. Then, she removed her gloves and washed her hands. On 02/24/2025 at 12:42 PM, after completing the visit, S3RN was informed that she didnt changed her gloves until after she completed the patients wound care. She was informed that she removed the patients old dressing; cleaned the patients wound; touched the gauze that had blood on it and reached into her clean wound care supply bag twice to get supplies without changing her gloves. She confirmed that she should have changed her gloves, sanitized her hands, and put on a clean pair of gloves after she removed the old dressing from the patients wound. She confirmed that she should have changed her gloves, sanitized her hands, and put on a clean pair of gloves after cleaned the patients wound and touched the gauze with blood on it. She also confirmed that she should not have reached in her clean wound supply bag with the same gloves. On 02/24/2025 at 12:15 PM, an interview was conducted with S1DON. S1DON confirmed that S3RN should have changed her gloves and sanitized her hands after removing the patients old dressing and when she cleaned the wound. She also confirmed that S3RN should not have reached in her clean wound supply bag with changing her gloves.

Based on record review and interview, the agency failed to ensure the patient's written individualized POC (plan of care) was followed as evidenced by the agency failing to ensure HA (hospice aide) visits were made as ordered per the POC for 2 (#5, #10) patients out of a sample of 11 patients. Findings: 1. Patient #5. Review of the patient's electronic clinical record revealed a start of care date of 5/20/2022. The patient's admitting diagnoses included Heart Failure and Age-related Physical Debility. The benefit period reviewed was 5/20/2022 to 8/17/2022. Review of the patient's POC for the benefit period 5/20/2022 to 8/17/2022 revealed an order for HA visits 2wk (hospice aide visits two times a week). Review of the patient's HA visit notes revealed that there was no documented evidence that HA visits were made for the week of 5/20/2022. On 6/21/2022 at 10:15 A.M., S1Admin (Administrator) reviewed the patient's electronic clinical records and confirmed that there was no evidence that HA visits were made as ordered for the week of 5/20/2022. 2. Patient #10. Review of the patient's electronic clinical record revealed a start of care date of 1/13/2022. The patient's admitting diagnoses included Chronic Obstructive Pulmonary Disease and Cachexia. The benefit period reviewed was 1/13/2022 to 4/12/2022. Review of the patient's POC for the benefit period 1/13/2022 to 4/12/2022 revealed an order for HA visits 3wk (hospice aide visits three times a week). Review of the patient's HA visit notes revealed that there was no documented evidence that HA visits were made for the week of 1/13/2022. On 6/21/2022 at 3:05 P.M., S1Admin (Administrator) reviewed the patient's electronic clinical records and confirmed that there was no evidence that HA visits were made as ordered for the week of 1/13/2022.

Based on record review, observation and interview, the agency failed to ensure the agency's staff follow accepted standards of practice to prevent the transmission of infections and communicable diseases, including the use of standard precautions as evidenced by staff failing to use appropriate PPE (Personal Protective Equipment) for 1 (patient #3) out of 3 (#1, #2, and #3) patients that home visits were conducted with, out of a total sample of 11 (#1-#11) patients. Findings: Patient #3. Review of the agency's Coronavirus (COVID-19) Policy revealed, " ...Wear face mask when in contact/presence of others ..." Review of the patient's electronic clinical record revealed a start of care date 3/12/2022. The patient's admitting diagnosis included Acute Systolic Congestive Heart Failure. The benefit period reviewed was 6/12/2022 to 8/10/2022. Review of the patient's POC (plan of care) for the benefit period 6/12/2022 to 8/10/2022 revealed an order for MSW visits 1 mo (Medical Social Worker visits one time a month). On 6/20/2022 at 12:00 P.M., a home visit was conducted in the patient's home with S3MSW. S3MSW was observed entering Patient #3's home without wearing a mask, and conducted the entire visit without wearing a mask. On 6/22/2022 at 11:20 A.M., an interview was conducted with S1Admin (Administrator). She stated that all staff making home visits should wear a mask during the home visits.

Based on record review and interview, the agency failed to ensure that the RN (registered nurse) made an on-site supervisory visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide as evidenced by no documentation of an RN conducting a supervisory visit every 14 days for 1 (Patient #5) patient, out of a sample of 11 (#1-11) patients. Findings: Patient #5. Review of the patient's electronic clinical record revealed a start of care date 5/20/2022. The patient's admitting diagnoses included Heart Failure and Age-related Physical Debility. The benefit period reviewed was 5/20/2022 to 8/17/2022. Review of the patient's POC (Plan of Care) for the benefit period 5/20/2022 to 8/17/2022 revealed an order for HA visits 2wk (hospice aide visits two times a week). The patient's HA visit notes were reviewed and revealed that the HA visits started on 5/24/2022. There was no documented evidence found from 5/25/2022 to 6/8/2022, (16 days) that the RN made a supervisory visit of the hospice aide between this time frame. On 6/21/2022 at 10:15 A.M., an interview was conducted with S1Admin (Administrator). S1Admin reviewed the patient's electronic clinical records and she confirmed that the RN did not make a supervisory visit of the HA no less than every 14 days.

Based on record review and interview, the facility failed to develop a COVID-19 policy and procedure for ensuring that all staff provide evidence that they were fully vaccinated for COVID-19 or have religious or medical exemptions for COVID-19 vaccination and that the medical exemptions identify which COVID-19 vaccine is contraindicated for staff. Finding: Review of the facility's policy and procedure for COVID 19 revealed that the policy did not address COVID-19 vaccinations and exemptions for staff. Review of the facility's COVID-19 Staff Vaccination Status Roster that was completed by the agency revealed that S4VC (Volunteer Coordinator) had a medical exemption. Review of S4VC's medical exemption revealed that it did not identify which COVID-19 vaccine was contraindicated for her. On 6/22/2022 at 3:20 PM, S1Admin (Administrator) stated that the agency does not have a policy and procedure on COVID-19 vaccinations for the staff. On 6/22/2022 at 4:15 PM, S1Admin confirmed that the medical exemption did not identify which COVID-19 vaccine was contraindicated for S4VC.