Every finding on record at Beacon Hospice of Central Texas LP

Observed in Record Review. In 8 of 10 patient records reviewed, the nurse surveyor noted that the goals were not measurable. For example, Patient will maintain optimal coping with hospice care. Patient will express satisfactory control of symptoms. In addition, there were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Finding was verified by the Administrator and Regional Director.

Observed in Patient Home. In 1 of 3 home visits conducted, for active records, it was noted by the nurse surveyor that medication orders were not clear or accurate. In RRHV#3, the order in the medical record for Losartan was unclear and did not include an indication or symptoms or parameters for when the medication was to be taken: Losartan 100mg tablet, take 1 tablet by mouth everyday as needed for hypertension. Findings were verified with the Administrator and Regional Director.

Observed in Patient Home. In 1 of 3 home visits conducted, it was observed the organization had not ensured the clinician followed the organizations Hand Hygiene Policy and Compliance Program which included performing hand hygiene before entering the bag. The clinician was observed entering her bag a couple of times without performing hand hygiene after assessing a dressing to the patient's left leg. Findings were discussed with the Administrator and the Regional Director.

Observed in Patient Home. In 2 of 3 home visits conducted, the nurse surveyor noted that for RRHV#1 the current medication profile was inaccurate or not present. Several medications that were on the nursing home medication profile and being given by the nursing staff, but were not on the agency's medication profile in the EMR. These medications included, Tylenol 500mg po 1 every 6hrs as needed for pain, escitalopram 10mg one po in am for mood, Zofran 4 mg po every 8 hours for nausea and vomiting, hyoscyamine 0.125mg disintegrating tablet give 1 by mouth sublingual every 2 hours for secretions. For RRHV#3, the following medications were being taken by the patient but not reflected in the EMR; B-12 methyldopa, 2500mg one every other day, Guaifenesin ER 1200mg every 12 hours, Losarten/Hctz 50/12.5mg, Centrum 50+ one a day, Vitamin D3 one a day.The findings were discussed with the Administrator and the Regional Director.

Observed in Patient Home. In 1 of 1 home visits conducted, in a skilled nursing facility, the nurse surveyor observed that the agency did not collaborate with the nursing home in which the patient resides per policy (2-059.1), Provision of Care to Residents of SNF/NF or ICF/IID). For RRHV#1, the nursing home did not have a copy of the following; the plan of care, the patient's hospice election form or any advance directives, the physician certification and recertification of the patient's terminal illness, the name and contact information of hospice staff involved in the care of the patient, instructions on how to access the hospice's 24-hour on-call system, information on the hospice medications for the patient, orders from the hospice physician and attending physician, if any for the patient. In addition, coordination of care between nursing home staff was not evident based on discussion with staff who were not aware of hospice plan of care. This was further evidenced by hospice RN not being aware of the hospice policy to provide the required documents to the nursing home. Finding discussed with Administrator and the Regional Clinical Director.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not assess/reassess the patient according to defined time frames. In HV#1 the hospice psychosocial assessment was not completed by the MSW five calendar days from the election of hospice care (completed on day 6). In RR#4, the psychosocial assessment by the MSW and the spiritual care assessment by the Chaplin were not completed until six (6) days from the hospice admission. These findings were reviewed/verified by the Administrator.

Observed in Record Review. In 4 of 11 patient records reviewed, the organization did not assess/reassess its patients by conducting and documenting a patient-specific comprehensive assessment that identifies hospice care and service needs, including survivor risk factors. In HV#1, RR#2, RR#5 and RR#9, the initial bereavement assessment was not completed/documented. This was reviewed/verified by the Administrator.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization did not plan the patient's care by including all services/treatment needed for the palliation and management of the patient's illness and related conditions. In RR#4, RR#5, and RR#9, the hospice plan of care did not include the patient's home oxygen and orders related to the patient's indwelling urinary catheter. This was reviewed and verified by the Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization did not provide care, treatment, or services according to the patient's individualized plan of care. In review of the record for HV#1, the visit note completed by the hospice aide indicated only a bed bath was provided. No other personal care tasks outlined on the plan of care were provided/documented. This was reviewed and verified with the Administrator.

Observed in Record Review. In 2 of 11 patient records reviewed, the record did not contain information that reflected the patient's care, treatment, or services. In RR#4 and RR#6, the patient's death assessment/visit note was not documented by the hospice RN. The Administrator verified the visit was made by the skilled nurse at the time of the patient's death, and confirmed the RN did not complete the visit note documentation.

Observed in Record Review. In 1 of 4 patient records reviewed, the organization did not plan the hospice care for a resident of a skilled nursing facility. The hospice plan of care did not identify the care and services needed, and which provider was responsible for performing the functions/services agreed upon and included in the plan of care. In RR#8, it was documented by the hospice RN that the patient was admitted to hospice with multiple decubitus/pressure wounds, with one visit note indicating wound care nurse providing wound care. The hospice plan of care did not clearly identify the wound care treatment, with no documentation of collaboration or/or coordination with the skilled nursing facility staff regarding the assessments, status, and/or management of the wounds and wound care. This was reviewed and confirmed by the Administrator.