Every finding on record at Careline Hmi400 LLC

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene, and safe handling of soiled items in the patient’s care environment. This standard was not met as evidenced by document review, interview and observation. In 1 of 4 (25%) home visit observations it was revealed that the agency did not ensure the staff followed the agency policy. DOCUMENT 1: Agency Policy titled, Hand Hygiene, Policy No. 7-009, revised April 2024, stated in part, "Hand decontamination using an alcohol-based hand rub should be performed: D. After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings, if hands are not visibly contaminated. G. After removing gloves." DOCUMENT 2: Agency Policy titled, Application of Dry Dressing G-100, revised February 2024, stated in part, "1. Wash hands. Refer to the Hand Washing procedure... 4. Don clean gloves. 5. Remove old dressing... 7. Hold soiled dressing in hand and remove glove to wrap inside out and around dressing. Repeat with second glove and discard in disposable bag... 10. Don second pair of gloves... 12. Clean the wound with prescribed solution and gauze pad. 13. Apply ointment as ordered. 14. Apply dry sterile dressings... 16. Remove gloves and dispose of waste according to the Agency Waste Disposal Policy. HOME VISIT 2/CLINICAL RECORD 10: During the home visit on 03/18/2025 with the Registered Nurse (RN) (Personnel Record 4), the RN was observed to don two pairs of gloves, stating that the hands sweat a lot. The RN completed the assessment and obtained vital signs. The RN removed the outer set of gloves and donned another pair. The RN removed the dressing from the wound to the right outer lower leg below the knee. While holding the removed dressing in the hand, the RN also held clean gauze in the same hand and cleaned the wound using wound cleanser. The RN discarded the dressing, gauze, and the outer pair of gloves in the trash. With the initial inner pair of gloves on, the RN applied Medihoney to a clean dressing and applied it to the wound. The RN did not decontaminate the hands after contact with non-intact skin and wound dressings or after removing gloves. The Hand Hygiene policy did not include a process for double gloving. During an interview on 03/19/2025, the Administrator confirmed that the staff did not follow agency policy.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed it was revealed that the organization did not ensure the patient’s record included updated physician’s orders. CLINICAL RECORD 10: The election of benefits form was dated 12/12/2024. The Plan of Care Order dated 12/12/2024 documented, "Hospice nurse to perform wound care to stasis ulcer on right lower leg. Utilizing clean technique - cleanse with wound cleans, apply maxsorb, cover with foam dressing and change every 3-5 days and prn for soiled or dislodged." The RN [Registered Nurse] Hospice Subsequent W/Sup [With Supervisory] Visit note dated 03/18/2025 documented, "Describe other wound type: Ulcer; Describe wound location: R [right] shin... Cleanse with wound cleanser, pat dry, apply medihoney and optifoam; perform twice weekly or more often as needed for soilage or dislodgement." The record lacked evidence of an updated physician's order for the change in wound care orders. CLINICAL RECORD 12: The election of benefits form was dated 09/04/2024. The Hospice Physician Order dated 02/07/2025 documented, "Pressure ulcer stage 2 to sacrum. Utilizing clean technique, SN/Caregiver to cleanse wound with wound cleanser, pat dry gently with gauze, apply bag balm, cover with foam dressing. Change dressing every 2-3 days and prn if soiled/dislodged..." The RN [Registered Nurse] Hospice Recert Assessment note dated 03/04/2025 documented, "Describe other wound type: Decubitus; Describe wound location: Coccyx Sacrum... Cleanse with wound cleanser pat dry apply xeroform gauze and optifoam change 2x [two times] weekly and as needed." The record lacked evidence of an updated physician's order for the change in wound care orders. During a joint review of the record and an interview on 03/20/2025, the Administrator agreed that there was no documented evidence of an updated physician’s order for the changes in the wound care procedure.

It is required that hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed, the agency did not ensure RN services were provided as ordered in the plan of care. Record #37041: The plan of care effective April 5, 2022 included orders for skilled nursing visits once the first week and then 2 times a week for 12 weeks. Clinical record revealed only one of the two skilled nursing visits ordered was completed the week of May 15, 2022. Interview with the Administrator on June 1, 2022 confirmed that only one RN visit was completed the week of May 15, 2022.