Every finding on record at Caring Hands Palliative and Hospice Care Inc

Observed in Record Review. On 1 of 2 patient records reviewed, the nurse surveyor noted that the goals were not measurable or individualized to the patient. On RRNHV #1, it was noted that the goals were not measurable and specific to the patient. For example, “being free of fall injury” and “maintaining dignity and support through patient's final hours”. Finding was verified by the RN Administrator and the Director of Patient Care Services.

Observed in Record Review. In 1 of 2 patient records reviewed, the organization did not have detail on the scope of services needed to provide care. On RRNHV #1, it was noted on review of the assessment that the patient was using 5 L of oxygen but this was not reflected on the plan of care. This finding was reviewed and verified with the administrator.

Observed in Tracer Activities. During the review of the Bereavement Program, it was noted by the nurse surveyor that post death bereavement risk assessments had not been completed and documented for patients who had passed away during the last ten months. Finding was verified by the Administrator who had been managing the program and stated that post death risk assessments had not been completed for the bereaved.

Observed in Record Review. In 10 of 10 patient records reviewed, it was noted by the nurse surveyor that patient orders were not individualized. All patients had the same order for oxygen 2-4 liters as needed for shortness of breath and may insert #14 to #18 FR foley catheter for urinary problems. Findings were discussed with the RN Administrator and the Director of Patient Care Services.

Observed in Record Review. In 10 of 10 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, “Facilitating and creating sense of support for adaptation” and “Identifying contributing factors related to altered mental functioning.” There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Additionally time frames for completion were either at the end of the certification period or none at all. Finding was verified by the RN Administrator and the Director of Patient Care Services.

Observed in Record Review. In 2 of 10 patient records reviewed, it was noted by the nurse surveyor that the plan of care was not complete. For RRHV#2, the patient had a drain with a dressing for a necrotizing tumor, there were no orders or information regarding the care that was being provided by the nurses and the significant other. For RRHV#3, the patient had a non-healing ulcer on his heal that the nurses were dressing per orders of a Wound Care Company, however, this was not included in the plan of care. Findings were validated with the RN Administrator and the Director of Patient Care Services Observed in Record Review. In 2 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that medication orders were not clear or complete. For RRHV#2 and RRHV#3, the order for Morphine concentrate 0.25ml every two hours as needed, did not give specific clear instructions or indications as to when to take it. The patients were on other pain medications so it was hard to determine when to take what. Findings were verified with the Administrator, and the DPCS.

Observed in Tracer Activities. During the review of the Bereavement Program, it was noted by the nurse surveyor that bereavement plans of care had not been developed and documented for patients who had passed away during the last ten months. Finding was verified by the Administrator who had been managing the program and stated that care plans had not been developed for the bereaved.

Observed in HR File Review. In 1 of 1 HR files reviewed, for the Hospice Aide, t was noted by the nurse surveyor that for HR#5 (Hospice Aide), her competencies were competed using verbal confirmation. Finding was validated by the Administrator and the Director of Patient Care Services.

Observed in Record Review. In 2 of 9 patient records reviewed, for active patient's with a Hospice Aide, it was noted by the nurse surveyor that the hospice aide care plans did not contain all the necessary or current information. For RRHV#3, the patient had a drain and a dressing, however there was not anything on the Hospice Aide care plan regarding the Hospice Aide’s responsibility or what she should report regarding the drain/wound. for RRNHV#3, the patient had a dressing to his shin and heal however, there was not anything on the Hospice Aide care plan regarding the Hospice Aide’s responsibility or what she should report regarding the dressings. Additionally, the patient had a foley catheter and there were no instructions regarding the care or what to report. Findings were discussed with the RN Administrator and the Director of Patient Care Services.

Observed in Tracer Activities. It was noted by the nurse surveyor that the organization was not able to demonstrate cost savings achieved through the use of volunteers since despite recruitment efforts, they do not have any volunteers. Finding was verified by the Administrator and the Volunteer Coordinator.

Observed in Tracer Activities. It was noted by the nurse surveyor that volunteers did not provide at least 5% of the total patient care hours of all paid hospice employees and contract staff for the last ten months. From April of 2024 to the end of January 2025, the percentage of volunteer to paid hours is 0.00% There currently are no active patient care volunteers or office volunteers. Recruitment efforts have been unsuccessful. Finding was verified by the Administrator, DPCS, and the Volunteer Coordinator.

Observed in Tracer Activities. There was no evidence that the governing body and leadership had established requirements to support patient care and treatment and services as evidence by Condition Level deficiencies §418.56 and §418.102. Findings were discussed with Leadership.

Observed in Tracer Activities. It was noted by the nurse surveyor that there was no backup medical director under contract or directly employed by the organization. Finding was validated by the Medical Director and the Administrator.

Observed in Patient Home. In 2 of 3 home visits conducted, it was noted by the surveyor that the medication profile was inaccurate. During RRHV#2, it was noted that the patient’s bottle of medication stated it was Metoprolol Tartrate 25mg 1/1 tablet twice a day, yet the medication profile in the medical record had Metoprolol Succinate 25mg 1/1 tablet at night. During RRHV#3, the patient’s significant other stated the patient liked to use “OTC Gummies for pain” to enhance her pain medication. This was not noted on the mediation profile. Findings were reviewed with the DPCS who was present on the home visits.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#2 the backup E-tank was secured in a stand behind some items in the patient's closet. Findings were verified by the Director of Patient Care Services. Tank was immediately removed from the closet and put in a secure location in the patient room.

Upon patient record review, 2 of 5 records (Patient #1, #2) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 1, 2: Medical record contains election of benefits form with no evidence of election of attending physician. The section for listing attending physician was left blank.

Upon patient record review, 2 of 5 records (Patient #4, #5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 4 & 5: The medical record with evidence of diabetes diagnosis though no evidence of a plan of care to include interventions and goals for diabetes.

Upon patient record review, 3 of 5 records (Patient #2, #4, #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 2: The medical record contained physician orders for Calmoseptine and A&D ointment with dose identified apply to affected area, and route states skin and buttocks. Corrected on site. Patient 4: The plan of care has evidence of DME of lancets, strips, alcohol wipes, and glucometer. There was no evidence of physician order for finger stick blood sugars to be performed. Patient 5: The plan of care has evidence of DME lancets, strips, alcohol wipes, and glucometer and Repaglimide 1mg, 1 tab 3x daily for Finger stick blood sugar >150. The plan of care has no evidence of physician order to check Finger stick blood sugars.

Upon patient client record review, 5 of 5 records (Patient #1,#2,#3,#4,#5) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 1,2, 3, 4, 5: Medical record contains and election of benefits form with no of date on election indicated. The section intended for date left blank. The election of benefits form was signed on the date of start of care. Patient 1, 2: Medical record contains election of benefits form with no evidence of election of attending physician. The section for listing attending physician was left blank.

Upon patient client record review, 1 of 5 records (Patient #2) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 2: The Plan of Care medication list contains subsequent page that has written 3000mg daily with no evidence of medication attached to it. The medical record contains nursing documentation for the visit date 1/19/22 has evidence of the signature date being 1/12/22. There is evidence of patient having visits both days of 1/12/22 and 1/19/22.