Every finding on record at Carepartners HHA, LLLP

Observed in Tracer Activities. In 10 of 10 patient records reviewed, Upon review of the patient admission packet and signed admission paperwork for active records reviewed, it was noted that the organization failed to ensure that the patient/caregiver was provided in writing an approximate dollar amount they will be responsible for, even if that amount is zero, as the consent and financial agreement reviewed failed to indicate a dollar amount for financial liability. This observation was reviewed with the Clinical Manager and Corporate Hospice Director.

Observed in Record Review. In 2 of 10 patient records reviewed, for active hospice patients, the organization failed to conduct and document a patient specific comprehensive assessment and reassessment that identified the patient's need for hospice care and services. For example: On review of the record for HOSRRHV#3 the documentation noted on 7/18/23 that the patient had a stage 2 wound on the buttocks with a dressing change, yet the patient's wound was not assessed on the next visit 7/20, nor during home observation on 7/25, as the RN did not complete an assessment of the patient's bottom. On HOSRRNHV#6 the patient had wounds to bilateral heels with treatment orders, yet the documentation failed to include assessment and measurement of the wounds weekly as required by policy. Policy noted an exception for hospice patients who are imminent, or performing the task would cause or intensify they pain or discomfort, yet there was no documentation in the record that either of the situations applied to the patient. These observations were reviewed with the Clinical Manager.

Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to ensure the patient-specific comprehensive assessment and reassessment identify the patient's need for hospice care and services. For example: on all active records reviewed there the comprehensive assessment did not include the need for volunteer services to offer support or respite to the patient, family, or other caregivers as required. This observation was reviewed with the Hospice Director and Clinical Manager.

Observed in Record Review. In 6 of 10 patient records reviewed, for hospice, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. For example: in review of HOSRRHV#1 the patient was diabetic with orders for blood glucose monitoring and insulin yet this was not reflected in the care plans. In HOSRRHV#3, HOSRRNHV#5, and HOSRRNHV#10 the patient was being seen by the Chaplain however there was no spiritual care reflected in the plan of care. In HOSRRNHV#4 the patient has a fall documented and was noted to be a fall risk, yet fall safety was not reflected in the care plans. In review of HOSRRNHV#8 the documentation noted issues with poor appetite, yet nutrition was not reflected in the plan of care. These observations were reviewed with the Clinical Manager, and the Corporate Hospice Director.

Observed in Record Review. In 6 of 10 patient records reviewed, for hospice, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions to include all drugs and treatments necessary to meet the needs of the patient. For example: on review of HOSRRHV#2 the patient had a foley catheter yet the physician's order lacked the size of the balloon and the frequency for catheter change as required. On home observation there was a Cpap machine noted on the patient's bedside that the patient's wife verified the patient was using at night up until a week prior to survey. There were no physicians for the cpap, nor was its use reflected in the plan of care. Further, documentation in the record noted the patient utilized supplemental oxygen but no O2 orders were noted on the med profile or reflected in the plan of care. In HOSRRHV#3 the documentation noted a stage 2 wound to the buttocks on 7/18/23 with wound care performed yet there were no orders for the wound care provided, nor were the changes in skin integrity reflected in the plan of care. In review of HOSRRNHV#5 there were orders for hydrocodone, Tylenol, and Morphine listed on the med profile for pain yet there were no specific instructions to guide the patient/caregiver to know which pain medication to chose for which type and severity of pain listed on the medication profile. HOSRRNHV#8 also had multiple pain meds ordered in Oxycodone and Morphine but no specific instructions to guide the patient/caregiver which med to choose noted on the medication profile. In review of HOSRRNHV#9 the patient was in GIP level of care for pain control and the medication orders were incomplete on the medication profile. The order read Dilaudid (PF) 0.2mg/ml injection syringe 1 mg hourly injection - severe pain management. May increase hourly up to 5mg per hour. The order was incomplete and lacked the route of IV continuous drip, nor did it specify what fluid it was to be administered with nor instructions of how to increase. Further, documentation from nursing notes stated the patient was changed to a fentanyl drip with dilaudid IVP but the orders were not noted in the record. There was documentation of oxygen, and Bipap and GIP order set and facility protocols in hospital system yet these orders were not noted on the patient record. In HOSRRNHV#10 the order for wound care lacked a frequency as required. These observations were reviewed with the Clinical Manager.

Observed in Record Review. In 7 of 10 patient records reviewed, the hospice organization failed to ensure the revised plan of care include information from the patient's updated comprehensive assessment and note the patient's progress toward outcomes and goals specified in the plan of care. For example: on review of HOSRRNHV#7 the care plans remained similar IDG to IDG such as patient/caregiver verbalize current understanding of medication schedule/set up and how to dispense and patient/caregiver verbalize/demonstrate understanding of the importance of medication compliance. The goals were established on admission in November 2022 and remain unrevised to date of survey. Similar lack of revision to the care plans can be seen in HOSRRHV#1, HOSRRHV#2, HOSRRHV#3, HOSRRNHV#4, HOSRRNHV#5, and HOSRRNHV#6. Further, on attending the organizations IDG meeting there was no discussion of updates to the plan of care and progress toward goals. These observations were reviewed with the Clinical Manager.

Observed in Record Review. In 2 of 10 patient records reviewed, for Hospice active patients, the organization failed to ensure the care and services were provided in accordance with the plan of care. For example: in HOSRRHV#1 the aide was assigned a shower or bed bath yet a sponge bath was provided. In HOSRRNHV#10 the aide was assigned a shower but documented that a sponge bath was provided. These observations were reviewed with the Clinical Manager.

Observed in Patient Home. In 2 of 10 patient records reviewed, the organization failed to ensure the registered nurse prepare accurate and complete written patient care instructions for the hospice aide. For example: on review of RRHV#1 the aide assignment plan of care noted both a shower and bed bath with a frequency of per patient request. There was no documentation that shower was primary nor a frequency beyond per request. The aide and PCG noted the patient was no longer getting a shower. Further, it was noted that the patient was assigned shampoo each visit yet the aide and PCG noted that shampoo was not necessary as the patient hair is done by a hairdresser. On review of HOSRRNHV#4 the aide assignment also included a shower and bed bath assigned per request. These observations were reviewed with the Clinical Manager.

Observed in Tracer Activities. The organization failed to ensure documentation of cost savings achieved through the use of volunteers as the organization has not had an active volunteer since 2020. This observation was reviewed with the Corporate Hospice Director and the Corporate Volunteer Manager.

Observed in Tracer Activities. The organization failed to provide volunteer service that meets the patient needs. The volunteer program failed to provide day-to-day administrative and/or direct patient care services in an amount, at a minimum, that equals 5% of the total patient care hours as there have been no active volunteers at the hospice since 2020. This observation was reviewed with the Corporate Hospice Director and Volunteer Manager.

Observed in Tracer Activities. Upon review of all tracer activities it was noted that there was a pattern of staff failing to follow established organization policy and the governing body/Leadership did not ensure the Conditions of Participation for 418.100, and 418.56 were met as determined through observations,, documentation, and staff interviews.