Every finding on record at Calm Care, Inc.

Observed in Emergency Management Session. The organization’s hazard vulnerability analysis did not include technological hazards. This was confirmed by the QA Manager.

Observed in Emergency Management Session. The organization reviews and makes necessary updates based on after-action reports or opportunities for improvement every two years, or more frequently if necessary. Example: The HVA was not updated to include Hospice MD EMR outages, which had occurred twice in the last 12 months and resulted in the activation of the Emergency Plan. This was confirmed by the QA Manager.

Observed in Record Review. In 4 out of 5 wound record reviews, hospice did not conduct and document patient-specific reassessments that identified the patient’s need for hospice care and services. Example: In 3 out of 4 wound records, reassessments did not accurately reflect the patient’s wound status and were not updated per agency Ongoing Assessment Policy. Example: In RRHV#2 benefit period 8, RRHV#3 benefit period 4, RRNHV#4 benefit period 1, and RRHV#6 wound measurements were not obtained during bi-weekly RN Supervisory visits per policy. This was confirmed by the DCPS.

Observed in Tracer Visit. In 3 out of 4 wound record reviews, the hospice did not ensure that the primary care giver(s) received education ad training as appropriate to their responsibilities for care and services identified in the plan of care. Examples: In RRHV#1: There was no documentation that the primary care giver was educated and trained on how to provide the ordered G-Tube dressing changes on the non-SN visit days. There was also no documentation that the primary care giver was educated and trained on how to provide the ordered G-Tube flushes 3 times per day. In RRHV#3, there was no documentation that the primary care giver(s) were educated and trained on how to provide the ordered L-side facial wound care on non-SN visit days per the plan of care. In RRNHV#3, there was no documentation that the primary care giver(s) were educated and trained on how to provide the ordered wound care to the patient's multiple wound sites. This was confirmed with the DCPS.

Observed in Record Review. In 5 out of 5 record reviews, the hospice did not create individualized plans of care for each patient related to identified needs assessed on initial and updated comprehensive assessments for Spiritual Care and Psychosocial services. Examples: Visit frequencies for Spiritual Care and Psychosocial Services for the current benefit period for RRHV#1, RRHV#2, RRHV#3, RRNHV#1, and RRNHV#2 were all for 1 eval visit and x1 every recertification until end of benefit period. In RRHV#1, identified patient distress/concerns during initial comprehensive assessment were anxiety; anticipatory grief, disease progression, and loss of independence. In RRHV#2, identified distress/concerns were anxiety; loneliness, anticipatory grief, and disease progression. In RRHV#3, identified patient distress/concerns included anxiety and loss of independence. In RRNHV#1, identified patient/pcg distress/concerns included lost of legal documents and arrangements related to long term living arrangements. No mortuary plans were in place at initial assessment. In RRNHV#2, patient distress/concerns included anxiety, loneliness, and anticipatory grief. This was confirmed by the DCPS. Observed in Tracer Visit. In 2 out of 2 records, some of the plan of care goals were not individualized and measurable. Examples, In RRHV#1 the following goals were not individualized and measurable: A. For Cardiovascular: Pt will remain comfortable. For Endocrine: Pt will remain comfortable. Blood sugar management for pt. comfort. For GI: Pt/Family/PCG will verbalize having elimination needs met at an acceptable level. For Pain: Pain will remain in comfortable level during care. For Spiritual: That patient/family may receive needed spiritual and emotional support.In RRHV#2, the following goals were not measurable: For Cardiovascular: Pt will remain comfortable within certification period For Skin: Patient will be free of pain and discomfort related to skin issue pain Pain will be controlled by current pain medication as prescribed. Pain will remain in comfortable level during care.This was confirmed with the DCPS.

Observed in Tracer Visit. In 2 out of 5 records, oxygen range did not have defined parameters and indications for adjusting and/or changing the settings. Example: In RRHV#1 and RRNHV#1, oxygen order was for 2 LPM with ability to titrate to 5 LPM for SOB/comfort. However, there were no defined parameters and indications for adjusting and/or changing the settings. This was confirmed by the DCPS.

Observed in Tracer Visit. In 3 out of 3 home visit record reviews, medical supplies and appliances necessary to meet the patient’s needs were not included in the plan of care. Examples: In RRHV#1, NS and gauze wound supplies were not included in the plan of care. In RRHV#2, sacral wound supplies were not included int he plan of care. In RRHV#3, facial wound care supplies (wound cleanser and gauze) were not included in the plan of care. This was confirmed by the DCPS.

Observed in Tracer Visit. In 1 out of 1 observed hospice aide visits, staff were unable to verbally demonstrate competency related to aide care plan safety precautions. Example: During the RRHV#3 staff interview, the hospice aide was unable to identify safety precautions (bleeding precautions) identified on the aide plan of care. When informed by the Surveyor of the bleeding precautions listed, the hospice aide lacked knowledge related to what the precautions meant and how the precautions should be incorporated in the care they provide. This was confirmed by the DCPS.

Observed in Tracer Activities. In 1 of 3 home visit records, the medication profile within the medical record was inaccurate. Example: In RRHV#1, the patient's primary caregiver reported using albuterol and Benadryl as needed. Both medications were in the home but were not on the medical record medication profile. This was confirmed with the DCPS.

Observed in Leadership Session. In 1 out of 5 reviewed contracts, the written agreement with an outside agency providing contracted services for the hospice did not have a stipulation that the outside agency would complete criminal background checks on contracted employees who provided direct patient care or have access to patient records. Example: The written agreement with an outside agency for therapy services did not include the stipulation that the outside agency would complete criminal background checks. This was confirmed with the Business Office Manager.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not ensure that the patient and primary caregiver receive education and training by the hospice as appropriate to their responsibilities for the care and services identified in the plan of care. For example: on review of HV#3 the patient was receiving antihypertensive medication with specific parameters of give medication for systolic BP greater than 160 mm/hg, and another of do not take 2nd tab if systolic BP is under 100mm/hg. There was no documentation noted in the record that the patient was educated on blood pressure monitoring, and the specifics of the parameters, nor was there indication that the patient was proficient in the BP monitoring. In RR#5 the patient was prescribed an oral diabetic medication with a parameter of hold if blood glucose is less than 110 mg/dl. There was no indication in the documentation that the patient was educated on blood glucose monitoring and the ordered parameters. These observations were reviewed with the Administrator/DPCS and the Care Coordinator.

Observed in Record Review. In 11 of 11 patient records reviewed, the organization failed to ensure the written plan of care reflected patient and family goals and interventions that were individualized, specific, measurable, achievable, realistic, and time bound. For example: all records reviewed noted goals that were not individualized, specific, measurable, and time bound. Examples in HV#2 as goal for gastrointestinal was constipation will be managed by current prescribed medication within this certification period another for sleep was patient with adequate sleep and rest at night. In RR#4 the goal for neurological was Patient needs will be met on a day to day basis as communicated this certification period. A goal for respiratory was symptoms will be relieved by intervention. In RR#5 the endocrine goal noted optimal blood sugar management for patient comfort and Prevent disease exacerbation. In RR#6 the goals noted for psychosocial read more like an intervention as LCSW will provide ongoing support and education about death and dying process.... Similar goals that were not measurable, specific, and time bound were noted throughout all records reviewed. These observations were reviewed with the Administrator/DPCS and Care Coordinator.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. For example: Upon review of RR#5 the SN was ordered two times per week yet there were no visits documented for the week of 11/13/22. This observation was reviewed with the Administrator/DPCS and the Care Coordinator.

Observed in Record Review. In 1 of 11 patient records reviewed, The organization failed to ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care was provided directly or under arrangement. For example: Upon review of HV#1 the patient was ordered physical therapy for strength training, however there was no documentation of sharing of information between the physical therapist and the interdisciplinary team. This observation was reviewed with the Administrator/DPCS and the Care Coordinator.

Observed in Record Review. Upon review of the personnel file for the CHHA the organization failed to ensure that a registered nurse evaluate the hospice aide in: communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other staff - Reading and recording temperature, pulse, and respirations - 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; toileting and elimination - Safe transfer techniques and ambulation - Normal range of motion and positioning, by observing the aide's performance of the tasks with a patient or pseudo-patient. On the aide's competency all tasks were evaluated verbally without observation of the tasks. This observation was reviewed with the Administrator/DPCS.

Observed in Record Review. In 9 of 9 patient records reviewed, the organization failed to ensure the physician's written certification, that the patient’s life expectancy is six months or less if the illness runs its normal course, contain all of the required elements. For example: in all patient records reviewed where the patient was recertified the physician's written certification appeared to be very similar from certification to certification and lacked all of the required elements. The narrative lacked current subjective and objective medical findings to show changes since the previous benefit period. This observation was reviewed with the Administrator/DPCS, and the Care Coordinator.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to ensure the patient record contain information to reflect the patient's care, treatment, and services. For example: upon review of RR#9 and RR#10 consents, it was noted that the patient right to choose the attending physician was left blank. The section noting the patient's right to elect the Patient Notification of Hospice Non-Covered Items, Drugs, and Services was also left blank. In RR#10 the advance directives section was left blank. These observations were reviewed with the Administrator/DPCS and the Care Coordinator.

Observed in Competency Session. In 2 of 3 contracts reviewed, Upon review of the organization's DME and SNF contract, it was noted there was not any verbiage to ensure that all contracted entities obtain criminal background checks on contracted employees who have direct patient contact or access to patient records. This observation was reviewed with the Office Manager.