Every finding on record at Caring Hands Hospice LLC

Based on interview and record review, the Hospice agency failed to ensure the emergency preparedness plan and training for staff was done on an annual basis. This deficient practice had the potential to result in the staff having a lack of knowledge to respond effectively during an emergency. --- During a record review of the emergency preparedness plan of the Hospice, the Hospice did not have documented evidence of an Emergency Preparedness training/disaster drill for all staffs for 2022 and did not have an evidence of an emergency plan annual review for 2021 and 2022. During an interview on 5/26/2023, at 11:40 a.m., with Director of Patient Care Services (DPCS) the DPCS stated whatever the last emergency preparedness training and drill recorded in the binder was that was the last one done. DPCS stated that means there hasnt been one since 2021. There was no documented evidence the governing body reviewed the policy annually for Emergency Preparedness/Disaster. During a review of the agencys Policy and Procedure titled ";Emergency Operations (EOP) Training Program" revised (March 2019), the policy and procedure indicated, ";2. The training program is reviewed and updated at least annually. 3. Hospice will do the following. Provide emergency preparedness training at least annually."

Based on observation, interview, and record review, the hospice agency failed to ensure the patient's current medications and the medication profiles were reviewed and updated, for two of 13 sample patients (Patient 8 and 9). This deficient practice placed the patient at a potential risk for medication error and side effect which could affect the patient's overall health status. --- a. During a review of Patient 8's (P8) Certification of Terminal Illness (CTI) dated 1/12/2023, the CTI indicated the patient was admitted to the hospice agency on 1/12/2023, with primary diagnosis of senile degeneration of the brain (a decrease in cognitive abilities or mental decline). During a review of P 8's Plan of Care (POC), the "POC Summary" dated 5/18/2023, indicated the Skilled Nurse (SN) visit was twice a week, the Medical Social Worker (MSW) will visit twice a month, and the hospice aid (HA) will visit twice a week. During a review of P 8s ";Client Medication Report" dated 5/24/23, the medication profile listed an order for the following PRN (as needed) medications : Acetaminophen (fever and pain medicine) 500mg dose 1 tablet orally as needed every 4 hours for mild pain 1-3 and fever greater than 100 Fahrenheit, Bisacodyl (stool softener) 10 mg rectal suppository daily as needed for constipation, Bisacodyl (stool softener) 5 mg tablet orally daily as needed for constipation, Calcium Carbonate (anti gas medicine) 500 mg 1 tablet orally twice a day as needed for gas relief, Docusate sodium (stool softener) 100 mg 1 tablet orally twice a day as needed for constipation, Hydralazine Hydrochloride (high blood pressure medication) 25mg 1 tablet orally three times a day as needed for high blood pressure, Lactulose (stool softener) 20g/30ml solution 10g orally daily as needed for constipation, Milk of Magnesia 2400mg/10ml suspension 1200mg orally daily as needed for constipation, Miralax Powder for Solution 17g 1 packet orally as needed for anti-gas, Mylanta Maximum strength suspension 40mg strength 10mg orally as needed for anit-gas, Ondansetron (nausea medication) 4mg 1 tablet sublingually (under tongue) every 6 hours as needed for nausea and vomiting, Sennosides 8.6mg 1 tablet orally at bedtime as needed for constipation, Hydrocodone Bitartrate/Acetaminophen 5mg-325mg 1 tablet orally as needed every 4 hours for moderate pain (4-6/10), Calmoseptine (skin maintenance cream) apply to skin folds, sacrum and other moist areas of the skin daily and diaper changes, and Vitamin A & D apply to skin folds, sacrum and other moist areas of the skin daily and diaper changes. On 5/24/2023 at 11:00 a.m. joint visit was made with Registered Nurse 1 (RN 1) to the Board and Care facility where P 8 resides. During an observation on 5/24/2023 at 12:20 p.m., with Registered Nurse 1 (RN1) at the board and care medication room, all the medication listed above for patient 8 were missing. During an interview on 5/24/2023 at 12:25 p.m., with board and care caregiver 1, she stated she does not know where these medications are, she hasnt seen them and the nurse should know. During a phone interview on 5/24/2023 at 12:30 p.m., with care coordinator 1, care coordinator 1 stated the missing medications were on hand when patient 8 signed on, but they were never refilled. She stated the visiting nurse is supposed to reconcile the meds during each visit. These were missed by P 8s regular visiting LVN 2. b. During a review of Patient 9's (P9) Certification of Terminal Illness (CTI) dated 12/31/2022, the CTI indicated the patient was admitted to the hospice agency on 12/31/2022, with primary diagnosis of heart failure (a chronic condition in which the heart doesnt pump blood as well as it should). During a review of P 9's "POC Summary" dated 5/18/2023, the POC Summary indicated the Skilled Nurse (SN) visit was once a week for 1 week then twice a week, the Medical Social Worker (MSW) will visit twice a month, and the hospice aid (HA) will visit twice a week. During a review of P 9s ";Client Medication Report" dated 5/24/23, the medication profile listed an order for the following medications including: Nitroglycerin 0.4mg (chest pain medication) 1 tablet under the tongue every 5 minutes as needed up to 3 doses for chest pain, Lidocaine 4% topical patch (skin patch for pain) 1 patch on skin daily to effected area for pain relief, and Docusate sodium (stool softener) 100 mg 1 tablet orally twice a day as needed for constipation. On 5/24/2023 at 11:00 a.m. joint visit was made with Registered Nurse 1 to the Board and Care facility where P 9 resides. During an observation on 5/24/2023 at 12:05 p.m. with Registered Nurse 1 (RN1) in the Board and care medication room, all the medication listed above for patient 9 were missing. During an interview on 5/24/2023 at 12:10 p.m., with board and care caregiver 1, she stated she does not know where these medications are. She stated the nurse checks the medications every visit and should know if its missing. During a phone interview on 5/25/2023 at 8:00 a.m. with LVN 2, she stated, ";I saw patient 8 and patient 9 last on 5/22/202. I looked at all the medications they had at the board and care for them but I didnt compare it to the electronic medication profile, I was not aware the PRN medications were missing for both patients. I just looked at the meds that need refill." During an interview on 5/26/2023 at 12:28 p.m. with Director of Patient Care Services (DPCS), DPCS stated, ";all nurses are supposed to compare all patient medications to the electronic medication profile on each visit. I am not sure what happened with patient 8 and 9, but the nurse should have looked at the medication profile." During a review of the agency's policy titled "Medication Profile " (undated), the policy indicated "; 5). During subsequent hospice visits, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver as well as other clinicians, understand the medication regimen. A. Using the medication profile to evaluate the use of the drugs in the home settings".

Based on record review, and interview, the hospice agency failed to ensure their Volunteer Coordinator and volunteers had the required training to provide hospice services. This deficient practice put the patients at risk of not receiving hospice services by a trained and qualified personnel as required. --- During employee file review of the hospice volunteer coordinator and volunteer on 5/26/23, indicated no documented evidence the volunteer coordinator and volunteers received training from the hospice agency. During an interview on 6/26/23 at 11:50 a.m., with the volunteer coordinator and office staff, stated she had the training however the hospice agency could not provide documentation, the volunteer coordinator and volunteer received the required training. During an interview with the director of patient care services (DPCS) in the hospice agency on 5/26/23, DPCS stated proof of training for the volunteer staff needs to be in the employee file.

Based on observation, interview, and record review, the hospice agency staff failed to ensure coordination of care with the assisted living facility and updating Interdisciplinary group (IDG) on the patient current medication and patient's home visit for two of 13 sample patients (Patient 9 and 3). The hospice agency Skilled Nurses (SN) failed to coordinate with the office their visit time for Patients 9. For Patient 3, the IDG did not coordinate with the board and care regarding the supplement brought by the family for the patient. . This deficient practice had a potential to for the patients to received lack of care and services that could affect the patients' overall health status. --- During a review of Patient 9's (P9) Certification of Terminal Illness (CTI) dated 12/31/2022, the CTI indicated the patient was admitted to the hospice agency on 12/31/2022, with primary diagnosis of heart failure (a chronic condition in which the heart doesnt pump blood as well as it should). During a review of P 9's "POC Summary" dated 5/18/2023, the POC Summary indicated the Skilled Nurse (SN) visit was once a week for 1 week then twice a week, the Medical Social Worker (MSW) will visit twice a month, and the hospice aid (HA) will visit twice a week. During a review of P 9s ";Client Medication Report" dated 5/24/23, the medication profile listed an order for the following medication Ferrous Sulfate (iron pills for iron deficiency) 65mg 1 tablet orally daily for supplement. On 5/24/2023 at 11:00 a.m. joint visit was made with Registered Nurse 1 to the Board and Care facility where P 9 resides. During an observation on 5/24/2023 at 12:00 p.m. with Registered Nurse 1 (RN1) at the board and care medication room, there were two Iron 65mg bottles found. One was over the counter and the other one dispensed by the pharmacy. During an interview on 5/24/2023 at 12:03 p.m. with board and care caregiver 1, she stated she gives patient 9 both medications, one from each bottle. She stated LVN 2 did not tell her its the same and that she should only give one. During an interview on 5/25/2023 at 8:00 a.m., with LVN 2, LVN 2 stated, she noticed that P 9s family member bought the Iron supplement bottle. LVN 2 stated she told the board and care caregiver to keep it as extra, not sure what happened." During an interview on 5/26/2023 at 12:28 p.m. with Director of Patient Care Services (DPCS), DPCS stated, ";all nurses are supposed to compare all patient medications to the electronic medication profile on each visit. I am not sure what happened, but the nurse should have looked at the medication profile." During a review of the agencys policy and procedure titled ";Safe/Effective Use of Medications" undated, the policy and procedure indicated, ";as a part of the comprehensive assessment, the patient and family/caregiver will be assessed as to their knowledge and skill required for safe and effective use of medications. 2. The components of the medication assessment used to determine patient and family/caregiver knowledge or skill related to medication administration will include, but not limited to: A. Name, dosage, route, duration, time, and usage of medication, intended use as well as expected action of drug therapy." The policy and procedure further indicated, "; using the written information, the clinician will review the key points required, based on patient knowledge and skill, as well as identified needs. This may include: A. teaching the patient the purpose and side effects of medication and the patient 's role in identifying and preventing medication errors." A review of Patient 3's (P3) Certification of Terminal Illness (CTI) dated 2/1/2023, the CTI indicated the patient was admitted to the hospice agency on 2/1/2023, with primary diagnosis of Alzheimer's disease ( a progressive disease that destroys memory and other important mental functions). During a review of P 3's "POC Summary" dated 5/18/2023, the POC Summary indicated the Skilled Nurse (SN) visit was once a week for 1 week then twice a week, the Medical Social Worker (MSW) will visit twice a month, and the hospice aid (HA) will visit twice a week. On 5/23/23, while trying to make arrangement with a home visit to Patient 3 with the agency staff, LVN 1 could not visit Patient 9 on 5/24/23, due to having school that day. RN 1 was not available. The home visit was schedule with LVN 1 to visit Patient 3, at the board and care (B& C) where she resides on 5/25/23, at 10:00 a.m. Review of Patient 3's electronic visit note RN, on 5/25/23, at 8:30 a.m., indicated RN 1 visited Patient 3 on 5/24/2023, from 10:00 a.m. to 11:00 a.m. On 5/25/23, conducted a joint home visit with the Director of Nursing Services (DPCS) conducted a joint visit and due to LVN 1 could not conduct a home visit. During the joint home visit with the DON, at the B & C staff stated LVN 1 visited with Patient 3 in the afternoon of 5/24/23. During an interview with the DPCS on 5/25/23, she stated that she was informed by both LVN1 and RN1 that they could not conduct home visit , however, she was unaware they both visited Patient 3 on 5/24/23, and was not aware of it. During an interview at the hospice agency on 5/25/23, with office staff, they stated they were informed both the LVN and RN could not visit with patient 3 and was unaware of the home visit conducted on 5/24/23.