Every finding on record at Blue Bonnet Palliative Care, PLLC

Observed in Emergency Management Session. During the Emergency Management session, it was noted that the organizations Emergency Operations Plan did not identify the patient population(s) that it served and the types of services it would have the ability to provide in an emergency. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Emergency Management Session. During the Emergency Management session it was noted that the organizations Emergency Operations Plan did not include methods for contacting off-duty staff. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Record Review. In 1 of 10 patient records reviewed, it was noted that the organization did not ensure that the plan of care goals included outcome measures for specific care activities. For example, during a review of the medical record for RRNHV#4, the following goal statement(s) were noted, “Instructed caregiver to ensure pt take Lasix as prescribed” and Family/caregivers will verbalize safe feeding techniques. The goal statement(s) did not include a method to measure the effectiveness of problem interventions. Example #2: During a review of the medical record for RRNHV#5, the following goal statement was noted, “Patient will be supported with maximum symptom reduction”. The goal statement did not include a method to measure the effectiveness of problem interventions. This observation was reviewed with the Administrator.

Observed in Individual Tracer. In 1 of 10 patient records reviewed, it was noted that the organization did not ensure medication orders were clear and accurate. For example, during individual tracer activities for RRHV#2, it was noted that the patient's medication list included the following information: Acetaminophen 325mg oral tablet - 1 tablet every 8 hours as needed for fever or pain; Morphine O/SYR 10 mg/0.5ml 1 prefilled syringe every 4 hours as needed for pain or shortness of breath; Acetaminophen 325mg / Hydrocodone bitartrate 5mg oral tablet - 1 tablet every 4 hours as needed for pain. The order nor the organization's policy specified which medication to use first. In addition, the following information was noted: Lactulose 667mg/ml - 10g/15ml - 15ml oral solution every night at bedtime as needed for constipation, Docusate sodium 50mg / sennosides, USP 8.6mg - 1 oral capsule daily as needed for constipation. The order nor the organization's policy specified which medication to use first. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Data Session. The organization leaders did not ensure that a quality assessment and performance improvement (QAPI) program was developed that involved all services provided by the organization. For example, the QAPI plan did not include indicators to evaluate the following areas: volunteer services, bereavement services, durable medical equipment, and/or supplies. This observation was reviewed with the Administrator.

Observed in HR File Review. A review of 2 of 2 applicable human resource files, revealed the organization did not fulfill the requirement to directly observe the Hospice Aide demonstrate needed tasks with a patient/psuedo patient. For example, a review of the competence evaluation for hospice aide #1, and hospice aide #2, revealed that the following subject areas were not evaluated via direct observation during patient care activities: 1) Appropriate and safe techniques in personal hygiene and grooming that include bed, sponge, tub, or shower bath; sink, tub, or bed shampoo; nail and skin care; oral hygiene; and toileting and elimination. 2) Safe transfer techniques and ambulation. 3) Normal range of motion and positioning. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Individual Tracer. In 1 of 2 applicable Individual tracers, a review of the medication list for RRHV#3, revealed that the Assisted Living Facility medication list did not include an accurate description of the medication’s the patient was currently taking. For example, the following medications were not listed: Nystatin 100,000 unit/ml topical cream - 1 ml topical cream 3 times a day as needed for peri area rash; Bisacodyl 10mg rectal suppository 10mg - 1 rectal suppository every 3 days as needed for constipation. The Assisted Living Facility medication list did not match the medication list in the hospice agency medical record for this patient. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Emergency Management Session. The Emergency Operations Plan did not describe how the organization will obtain and replenish medical supplies that will be required in response to an emergency. During the emergency systems tracer, the Administrator reported that the emergency plan did not delineate how medical supplies would be replenished. Observed in Emergency Management Session. The Emergency Operations Plan did not describe how the organization will obtain and replenish medications and related supplies that will be required in response to an emergency. During the emergency systems tracer, the Administrator reported that the emergency plan did no delineate how medications would be replenished.

Observed in Record Review. A registered nurse who is a member of the interdisciplinary group and is responsible for hospice aide supervision prepares written patient care instructions for the hospice aide. During review of patient record 7 it was noted that the aide plan of care was blank. This was confirmed by the Administrator.

Observed in Record Review. In 4 of 10 patient records reviewed, The home health aide or hospice aide did not provide services that are ordered by the physician or allowed practitioner in the plan of care, consistent with the ’s training, and that the is permitted to perform under state law. During review of patient records it was noted that in the records associated with home visit 1 and home visit 3, and records 1 and 7 the aide notes did not show that the plan of care created by the RN was being followed. For example, in the record associated with home visit 3 the plan of care ordered that the Foley bag be emptied, bed linens be changed and a bed bath be given. None of these services were documented as provided by the aide. This was confirmed by the Administrator.