Every finding on record at Burch-Garrett Enterprises, Inc

Observed in Record Review. In 1 of 16 patient records reviewed, the organization failed to maintain a complete and accurate record. During record review for RRNHV#6, the Hospice Nurse Surveyor observed the record was inaccurate. For example in RRNHV#6, the record had an order for the physician to make visits 1 x week for 8 weeks, with 1 PRN visit that had been in place for 2 months prior to survey. Per the organization, this was an error as the Physician does not go out that often. In the same record the aide was given 3 bath options and documented all three were completed on at least 3 occasions. This was discussed and reviewed with the Hospice Administrator.

Observed in Record Review. In 10 of 16 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#5, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10, the Hospice Nurse Surveyor observed the goal target dates were not individualized to meet the patients needs. For example in RRHV#1, the patient had a goal of self determined life closure- patient or family will communicate effectively concerns or fears regarding DNR started 5/3 with a target date of By time of death. The patient also had a goal of will verbalize understanding and comfort with the patients management plan and feel confident in providing interventions related to: agitation, anxiety, confusion, restlessness, hallucinations started 5/5 with a goal date of By time of death. In RRHV#3, the patient had a goal of will verbalize understanding and comfort with the patients management plan and feel confident in providing interventions related to : agitation, anxiety, confusion restlessness, hallucinations with a goal of two weeks. goal was started at SOC 5 years previous to survey. In RRHV#4, the patient had a goal of the individual will relate controlled falls or o falls, as evidenced by the following indicators: Patient will not sustain fall. Patient will relate the intent to sue safety measures to prevent falls, Patient will demonstrate selective prevention measures. Patient/ CG will implement strategies to increase safety and prevent falls in the home with a timeframe by time of death. In RRNHV#1, the patient had a goal for acceptable pain level with a target date of by time of death. In RRNHV#2, the patient had a goal of pt/ cg will implement strategies to increase safety and prevent falls in home by time of death. In RRNHV#5, the patient had a goal of will verbalize understanding and comfort with the patient's SOB management plan and feel confident in providing SOB interventions with a goal timeframe of by time of death. In RRNHV#7, the patient had a goal of acceptable level of dyspnea- will verbalize understanding and comfort with the patient's SOB management plan and feel confident in providing SOB interventions with a outcome timeframe of 0-24 hrs.. The goal was initiated 11 months prior to survey and the goal timeframe was not updated. In RRNHV#8, the patient had a goal of patient and caregiver will implement strategies to increase safety and prevent falls in the home with a timeframe of by time of death. In RRNHV#9, the patient had a goal of will verbalize the importance and understanding of bowel regimen with a timeframe to meet that goal being by time of death. In RRNHV#10, the patient had a goal of pt/ family will communicate effectively concerns or fears regarding DNR with a goal time frame of by time of death. This was discussed and reviewed with the Hospice Administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, with wound care orders, the organization failed to plan the patient's care. During record review for RRHV#1, the Hospice Nurse Surveyor observed the plan of care did not contain the most current wound care orders and interventions. After conversation with the Hospice Team, the surveyor noted the Plan of Care contained a goal and intervention for wound management but the specific wound care orders were not entered into the plan of care. This was discussed and reviewed with the Hospice Administrator.

Observed in Patient Home. the organization failed to implement its infection prevention and control activities. During home visits for RRHV#1, RRHV#2, RRHV#3, and RRHV#4, the nursing staff utilized Wet Ones antibacterial hand wipes to clean their blood pressure cuffs, thermometer, pulse oximeter and computer equipment. The active ingredient is Benzalkonium Chloride, and the directions were for wiping hands. The organizational policy states alcohol would be used for stethoscope and pulse oximeter and soap and water or manufacturer guidelines for the blood pressure cuff. During the course of survey the Administrator ordered a new product and set a date for retraining. This was discussed with the Hospice Administrator. Observed in Patient Home. In 4 of 4 home visits conducted, the organization failed to plan for preventing and controlling infections. During home visits for RRHV#1, RRHV#2, RRHV#3, and RRHV#4, the Hospice Nurse Surveyor observed staff utilizing Wet One's wipes to disinfect their equipment after patient use. The policy stated they would use alcohol on stethoscopes and pulse oximeters and soap and water or manufacturer guidelines for blood pressure cuffs. The Wet One's were marketed as hand wipes with no alcohol in the contents. The staff had been instructed by a consultant hired by the organization to use the Wet One's product which was not consistent with their policy. Before end of survey, the new product that was alcohol based was ordered and a time for education was set up. This was discussed and reviewed with the Administrator.

Observed in Regulatory Review. In 3 of 7 patient records reviewed, with aide services ordered, the organization failed to plan the patients care. During record review for RRHV#2, RRHV#3, and RRNHV#1, the Hospice Nurse Surveyor observed not all elements were included in the aide plan of care. For example in RRHV#2, the patient had PRN oxygen in place but directions were not included in the aide plan of care. Fall precautions were also not on the aide plan of care but the patient was high risk for fall and had a history of falls. The patient was also on Aspirin but bleeding precautions were not on the plan of care. In RRHV#3, the aide care plan did not contain precautions for fall risk. In RRNHV#1, the patient had a history of falls but the aide care plan did not contain precautions for fall risk. This was discussed and reviewed with the Hospice Administrator.

Observed in Record Review. In 1 of 3 patient records reviewed, the organization failed to provide care, treatment or services in accordance with orders and the aide plan of care. During record review for RRHV#3, the Hospice Nurse Surveyor observed the aide was not following the plan of care. For example in RRHV#3, the aide care plan listed complete shower but the aide had been completing a bed bath for the two months prior to survey. This was discussed and reviewed with the Hospice Administrator.

Observed in Record Review. In discussion with the Volunteer Coordinator and organization CEO, the surveyor noted that the percentage of volunteer hours for calendar year 2024 through November was less than 2%. While this is below the required 5%, it is increased in the most recent months and reflects renewed volunteer recruitment efforts post-Covid pandemic which were recently initiated.

Observed in Record Review. In 1 of 2 patient records reviewed, with wound care orders, the organization failed to record information that reflected the patient's care, treatment, or services. During record review for RRHV#1, the Hospice Nurse Surveyor observed the wound care documentation stated per wound orders but did not include what wound care was completed. This was discussed and reviewed with the Hospice Administrator.

Observed in Record Review. In 7 of 13 patient records reviewed, the agency failed to document the recognition and resolution of duplicate drug therapy. In HV#2 Tramadol and Morphine were both ordered as needed for pain with no differentiation as to when to take which medication. In HV#3 Mucinex and Tessalon were both ordered prn for cough; morphine. Tramadol and Tylenol ES were ordered prn for pain with no differentiation as to when to take which medication. HV#1, RR#3, RR#4, RR#6, and RR#10 also had duplicate medication orders. This was validated with the Clinical Director.

Observed in Record Review. In 1 of 13 patient records reviewed, the interdisciplinary group failed to plan and coordinate all necessary services to meet the patient needs. In RR#3 the nurse documented that the patient sometimes did not have enough money to buy food while the MSW documented that there were no financial concerns. There was no documentation in the record to resolve this discrepancy in the record and there was no notation in the plan of care to offer assistance regarding the patient's financial situation. This was validated with the Clinical Director.

Observed in Record Review. In 6 of 13 patient records reviewed, the plan of care did not include all drugs and treatments necessary to meet the needs of the patient. In HV#2, HV#3 and RR#1 the assessment indicated that the patient was using oxygen but there were no oxygen orders on the plan of care that would include flow rate, delivery mechanism and whether the oxygen was consistent or intermittent. In RR#4 the nursing notes indicated that the patient was using Polysporin on facial wounds but the plan of care did not include this treatment. RR#6 did not include orders for a Foley catheter that was placed during a GIP episode to include size and maintenance. This patient was placed in GIP for the management of uncontrolled pain but there was no mention of pain in the plan of care. In RR#9 Spiritual Care established a visit frequency but there the plan of care did not include any spiritual care components. This was validated with the Clinical Director. Observed in Record Review. In 1 of 13 patient records reviewed, the agency failed to clarify unclear orders before providing care. In RR#5 wound care orders were unclear. The initial wound care orders on the plan of care called for the wounds to be covered by bordered foam in one section of the order and by a dry dressing in another part of the order. The wound care documented utilized the dry dressing but there was no documented clarification of the order to account for the bordered foam that was also part of the order. This was validated with the Clinical Director.

Observed in Record Review. In 2 of 13 patient records reviewed, the medical record failed to document care provided in accordance with the plan of care. In HV#1 nursing documentation of wound care provided did not follow current wound care orders in the plan of care. In RR#4 the initial plan of care in October called for PT twice a week for 4 weeks but no therapy was delivered until December after a fall. This was validated with the Clinical Director.

Observed in Tracer Activities. The governing body/leadership did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews: 418.56, 418.100.