Every finding on record at Caring Hospice of South Jersey

Based on the review of the emergency preparedness plan, staff interview, and review of facility documents, it was determined the facility failed to develop and implement a process to inform state and local officials about patients in need of evacuation during an emergency. --- Findings include: The facility's Emergency Preparedness Plan was reviewed on 9/4/2024. The Emergency Preparedness Plan did not identify a process to inform state and local officials concerning patients in need of evacuation during an emergency. During an interview conducted on 9/6/2024 at 12:35 PM with Staff (S)1, Manager, it was confirmed that State and Local officials were not informed and stated, "No they are not informed, we don't inform them, they don't have any prior awareness before an emergency evacuation happens." A review of the facility policy titled, "Emergency/Disaster Management" last revised 4/21/23, states, "...Procedures:..2... b. Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation."

Based on patient interviews, staff interviews, and a review of facility documents, it was determined the facility failed to ensure arrangements with other facilities are in place to provide continuation of services in the event of evacuation or cessation of operations. --- Findings include:On 9/4/2024, a review of the facility's Emergency Preparedness Plan revealed the facility did not have a policy in place to address arrangements with other facilities and providers to receive patients in the event of limitations or cessation of operations. On 9/4, 9/5 and 9/6, S1 and S2 were requested to provide copies of transfer agreements, documented arrangements with other facilities and providers, but were unable to provide documentation of any arrangements with other facilities. On 9/5/24, upon review of Patient (P) 3 and P4's medical records, the "Patient Specific Emergency Plan" evacuation site was listed as "TBD" [To be determined]. P3 and P4 were homebound patients. On 9/5/24, a home visit was conducted to observe P3's care. An interview with P3's daughter was conducted at 2:00 PM. When questioned about emergency evacuation plans, P3's daughter stated, "The facility never told us where we are supposed to evacuate [P3] to." On 9/6/2024 at 12:37 PM, during an interview with Staff (S) 1, Manager, it was stated that in the event of an emergency, all home patients would be "sent to the local hospital." When questioned if local hospitals were informed of the facility's plan, S1 stated, "we would call the hospitals at the time of the emergency." A review of the facility policy titled, "Emergency/Disaster Management" revised 4/21/23, states, "... Procedures: ... 6. Information related to emergency preparedness is included in the materials provided to patients and their caregivers when they are admitted..."

Based on observations, staff interviews, and a review of facility policies and documents, it was determined that the facility failed to maintain and document an effective infection control program as evidenced by: 1.) failure to ensure that facility policies were followed to prevent the transmission of infections and communicable diseases during the care of two of three patients (Patient (P) 2 and P3) (L0679); 2.) failure to develop and implement a coordinated program for infection control and prevention at the facility (L0580). --- Cross Reference: 418.60 (a) Infection Control: Prevention 418.60 (b) Infection Control: Control

Based on observations, staff interviews, and a review of facility documents, it was determined that the facility failed to ensure that facility policies were followed to prevent the transmission of infections and communicable diseases during the care of two of three patients (Patient (P) 2 and P3). --- On 9/5/24 at 2:08 PM, S6, a RN, was observed providing care for P3. At 2:10 PM, S6 placed a barrier pad on P3's floor and placed his/her nursing bag on the barrier pad. S6 then placed a barrier pad in this inside of his/her nursing bag. At 2:12 PM, S6 began collecting vital signs on P3. S6 used a plastic, retractable tape measure to assess P3's arm circumference. After collecting vital signs, S6 placed dirty vital sign equipment inside his/her nursing bag. At 2:30 PM, S6 completed P3's assessment and picked up his/her nursing bag and ended the visit. P3 then walked to his/her car, opened the trunk, laid a barrier pad down, and placed his/her nursing bag on the driveway. S6 then proceeded to pull the dirty equipment out from the nursing bag to wipe down with Clorox Hydrogen Peroxide disinfectant wipes. S6 cleaned the plastic, reusable tape measure and then immediately allowed it to retract without allowing any dry time. The equipment was then placed on the barrier pad in S6's car. An interview was conducted with S1, Manager, on 9/6/24 at 12:31 PM, regarding proper placement of the nursing bag. S1 stated, "the nursing bag should be placed on a clean, hard surface. It is not allowed on the ground." Findings include: On 9/4/24 at 12:33 PM, Staff (S) 7, a Registered Nurse (RN), was observed providing care for P2. At 12:39 PM, S7 placed a barrier pad on P2s bed and placed the nursing bag on the barrier pad. S7 placed his/her tablet on P2s bed without using a barrier pad. At 12:40 PM, S7 began collecting vital signs on P2. S7 used a plastic, retractable tape measure to assess P2s arm circumference. After collecting vital signs, S7 placed dirty vital signs equipment back on the barrier pad with the nursing bag. At 12:45 PM, S7 finished collecting P2s vital signs and began cleaning the equipment with a Chlorox Hydrogen Peroxide disinfectant wipe. After using the disinfectant wipes on the vital sign equipment (stethoscope, pulse oximeter, sphygmomanometer, and blood pressure cuff), S7 placed the equipment immediately back into the nursing without allowing any dry time. S7 failed to disinfect the retractable tape measure and the tablet before leaving P2s room. At 12:49 PM, the visit with P2 was completed and the surveyor asked S7 to wait in the lobby of the facility while an interview was conducted with a staff member at the assisted living facility. At 12:55 PM, an interview with S7 was conducted. When questioned about the policy for cleaning tablets, S7 stated ";You just missed it. I just cleaned the tablet with a disinfectant wipe while you were interviewing the facility staff member." When questioned about the dry time for the disinfectant wipes, S7 stated ";I have to be honest, I dont know." S7 was unable to provide a package of the disinfectant wipes to determine the dry time. On 9/5/24 at 1:48 PM, S1, the Manager / Nursing Supervisor, provided surveyors with a package of Chlorox Hydrogen Peroxide disinfectant wipes used by nurses at the facility for review. Directions on the package stated, ";1 minute contact (dry) time." On 9/5/24 at 2:08 PM, S6, a RN, was observed providing care for P3. At 2:10 PM, S6 placed a barrier pad on P3's floor and placed his/her nursing bag on the barrier pad. S6 then placed a barrier pad in this inside of his/her nursing bag. At 2:12 PM, S6 began collecting vital signs on P3. S6 used a plastic, retractable tape measure to assess P3's arm circumference. After collecting vital signs, S6 placed dirty vital sign equipment inside his/her nursing bag. At 2:30 PM, S6 completed P3's assessment and picked up his/her nursing bag and ended the visit. P3 then walked to his/her car, opened the trunk, laid a barrier pad down, and placed his/her nursing bag on the driveway. S6 then proceeded to pull the dirty equipment out from the nursing bag to wipe down with Clorox Hydrogen Peroxide disinfectant wipes. S6 cleaned the plastic, reusable tape measure and then immediately allowed it to retract without allowing any dry time. The equipment was then placed on the barrier pad in S6's car. On 9/6/24 at 12:31 PM, an interview was conducted with S1 When questioned about the policy for placement of the nursing bag during a home visit, S1 stated, "the nursing bag should be placed on a clean, hard surface. It is not allowed on the ground." When questioned about the policies for cleaning equipment, S1 stated that ";equipment should be cleaned as soon as it is done being used. All equipment should be cleaned before it leaves the patients home and before it goes back into the nursing bag. After using disinfectant wipes, the nurses should let equipment dry for 30 seconds to one minute before placing it back in the bag." Facility policy titled, ";Cleaning and Disinfecting Equipment", states ";The agency will orient all personnel to their Infection Control Policies and Procedures on an annual basis and as deemed necessary... Reusable instruments can be disinfected in the home for procedures requiring clean technique." 8:42C - 10.2(b)

Based on staff interviews and a review of facility documents, it was determined that the facility failed to develop and implement a coordinated program for infection control and prevention at the facility. --- Findings include: On 9/4/24 at 9:50 AM, an entrance conference was conducted with Staff (S) 1, the Nursing Supervisor; S2, the Chief Operating Officer; and S3, the Regional QAPI Coordinator. When questioned about the infection control program, S2 stated that there was a regional infection control professional (ICP) but was unsure who the day-to-day ICP would be in the facility. S2 stated that the day-to-day ICP would probably be S1. On 9/6/24 at 11:30 AM, a review of S1s personnel file was conducted. S1s personnel file did not contain any additional training, education, or certification for infection control. S1s job description did not contain any information about being the day-to-day infection control lead. S1s resume did not list any experience related to infection control. On 9/6/24 at 11:53 AM, during an interview, S2 confirmed that S1 did not have any additional training in infection control beyond the annual infection control training provided to all the staff at the facility. On 9/6/24 at 12:20 PM, an interview was conducted with S1. S1 confirmed that he/she does not have any training in infection control other than the basic training provided to staff. S1 stated that he/she conducts the training for staff on bag technique and hand hygiene and supervises the annual competencies for staff infection control practices at the facility. 8:42C – 10.1(b) On 9/4/24 at 9:50 AM, during the entrance conference, S1, S2, and S3 were questioned about the infection control committee members. S2 and S3 stated that the infection control committee members would be the same as the IDG (interdisciplinary group) members and that the infection control committee would be a part of QAPI (Quality Assurance and Performance Improvement). On 9/4/24 at 12:00 PM, during the review of the facility's Infection Control Plan and QAPI documents, there was no documented evidence of an infection control meeting minutes in either document. Upon request, S1 and S2 were unable to provide documentation of meeting minutes for an infection control committee. On 9/6/24 at 12:20 PM, upon interview, S1 confirmed that there was no infection control committee for the facility because ";it is a small office." 8:42C – 10.2(a)

Based on medical record review, staff interview, and review of facility documents, it was determined that the facility failed to ensure the medical records were completed within 48 hours in four of 14 medical records reviewed (Patient (P) 2, 3, 4, 8, and 10). --- On 9/5/24 at 3:30 PM, P10s medical record was reviewed. The review of P10s medical record revealed three nursing assessments that were documented greater than 48 hours after the clinician visit. On 7/26/24 at 3:30 PM, P10 was seen in-home by a hospice nurse. The documentation of this nursing assessment was signed on 8/4/24 at 9:07 PM. On 8/21/24 at 10:06 AM, P10 was seen in- home by a hospice nurse. On 9/5/24 at 3:45 PM, the nursing assessment for 8/21/24 was listed as ";pending" and the documentation only included P10s temperature. The documentation of this nursing assessment was completed and signed on 9/6/24 at 10:55 AM. On 8/30/24 at 4:34 PM, P10 was seen in- home by a hospice nurse. On 9/5/24 at 3:45 PM, the nursing assessment for 8/30/24 was listed as ";pending" and the documentation was blank. The documentation of this nursing assessment was completed and signed on 9/6/24 at 11:21 AM. On 9/6/24 at 12:51 PM, Staff (S) 1, Patient Care Manager, explained that clinicians are expected to write and upload notes 48 hours after patient visit. S1 confirmed that when a clinician signs the documentation, it is considered complete. S1 verified that the date and timestamp listed at the bottom of documentation is when a clinician signs the document as complete. Facility policy titled, ";Clinical Record Guidelines for EMR [Electronic Medical Record]" states, ";...Procedures: ... 3. Entries must be accurate, relevant, timely and complete. 4. Notes must be completed, reviewed, and synchronized to the clinical record as soon as possible after the visit. This will occur within forty-eight hours after the visit, but no less often than weekly..." On 9/5/24, P3's medical record was reviewed. The review of P3's medical record revealed two nursing assessments that were documented greater than 48 hours after the clinician visit. On 8/15/24 at 12:17 PM, P3 was seen in-home by a hospice nurse. The documentation of this nursing assessment was signed 9/3/24 at 9:09 PM. On 8/21/24 at 12:41 PM, P3 was seen in-home by a hospice nurse. The documentation of this nursing assessment was signed 9/3/24 at 9:30 PM. On 9/5/24, P4's medical record was reviewed. The review of P4's medical record revealed two nursing assessments that were documented greater than 48 hours after the clinician visit. On 8/13/24 at 3:05 PM, P4 was seen in-home by a hospice nurse. The documentation of this nursing assessment was signed on 8/26/24 at 11:14 AM. On 8/15/24 at 2:01 PM, P4 was seen in-home by a hospice nurse. The documentation of this nursing assessment was signed on 8/26/24 at 12:07 PM. On 9/6/24, P8's medical record was reviewed. The review of P8's medical record revealed two nursing assessments that were documented greater than 48 hours after the clinician visit. On 8/12/24 at 10:51 AM, P8 was seen by a hospice nurse. The documentation of this nursing assessment was signed on 9/4/24 at 10:19 AM. On 8/21/24 at 10:21 AM, P8 was seen by a hospice nurse. The documentation of this nursing assessment was signed on 9/5/24 at 11:15 AM.

Based on a review of medical records, staff interview, and review of facility documents, it was determined that the facility failed to document in the patient's medical record that a written copy of policies and procedures for the management and disposal of controlled drugs was provided to two of two patients (Patient (P) 3 and 4) receiving care at their home. --- Findings include: On 9/5/24, a medical record review was conducted for P3 and P4. The medical records for P3 and P4 lacked documentation that the hospice provided a copy of the hospice's policies and procedures for the safe management and disposal of controlled drugs to the patient or the patient's representative. An interview was conducted with Staff (S) 1, Manager, on 9/6/24 at 12:45 PM. S1 stated that comfort packs (medicine kits that may contain controlled substances such as Morphine and Ativan) are given to every homebound patient. Education on the comfort packs is provided to patients and "should be written in the nursing documentation notes." Upon request, S1 was unable to provide evidence of this documentation for P3 and P4. A review of facility policy titled, "Medications - Use and Disposal of Controlled Substances", last reviewed 3/30/18, states, "... Procedures: 1. At the time when controlled substances are first ordered, the hospice nurse: ... c. documents in the patient's clinical record that written policies and procedures for managing controlled drugs were provided and discussed."

Based on staff interview, medical record review and document review, it was determined that the facility failed to ensure patients receive care as ordered. Findings include: Reference: Facility policy titled, "Missed Visit Note" states, "...3. In the event a visit is not completed according to the patient's plan of care, and is unable to be assigned to another clinician and/or replacement refused, a missed visit form will be completed. Notification will be made to the patient/family, physician and facility (if applicable). 4. Documentation of the missed visit will be included in the patient record." 1. Upon medical record review on 12/16/2021, the following was indicated: a. Patient #4's Plan of Care states, "...MSW [Master of Social Work]: 1x month for 3 months [one time a month for three months], starting 11/19/21..." (i) There was a missed visit for the month of December. (ii) The MSW Patient Missed Visit note states, "Reason for missed visit...other: COVID precautions." (iii) There was no evidence that the physician was notified of the missed visit. b. The Care Plan states, "HHA [Home Health Aide] 7 x week for 8 weeks [seven times per week for eight weeks], starting 11/21/21." (i) There was a missed HHA visit on 12/10/21. (ii) There was no missed visit note. (iii) There was no evidence that the physician was notified of the missed visit. 2. The above findings were confirmed by Staff #2. N.J.A.C. 8:42C-5.1(b)7

Based on staff interview, document review and medical record review, it was determined that the facility failed to ensure that a comprehensive assessment is completed in accordance with facility policy. Findings include: Reference: Facility policy titled "Levels of Care - Inpatient Respite Care" states, "...8. The IDG [interdisciplinary group] continues to provide services to the patient/caregiver during the period of respite and re-evaluates and updates the comprehensive assessment and the plan of care at the time of discharge from inpatient respite care." 1. Review of Medical Record #1 on 12/17/2021 revealed the following: a. Patient #1 was in respite care on 10/18/2021 through 10/23/2021. (i) Patient #1 returned home from respite on 10/23/2021; the comprehensive assessment was not completed until two (2) days later. b. Upon interview, Staff #1 stated that a comprehensive assessment should have been performed on 10/23/2021.

Based on staff interview, review of one (1) of four (4) medical records (#13), and review of facility policies and procedures, it was determined that the facility failed to ensure that patient care services are provided in accordance with the plan of care. Findings include: Reference #1: Facility policy titled, "Plan of Care" states, "... Procedures: 1. The patient's plan of care specifies the care and services necessary to meet the needs of the patient ..." Reference #2: Facility policy titled, "Plan of Care - Content" states, "... Procedures: ... 2. The plan of care includes, ... b. a detailed statement of the scope and frequency of services necessary to meet the specific patient ... needs ..." 1. On 12/20/2021, upon medical record review, the following was indicated: a. Patient #13 was admitted to the hospice on 9/28/2021, and received HHA [Home Health Aide] services on the following dates: - 10/20/2021 through 10/23/2021 - 10/25/2021 through 10/29/2021 - 11/1/2021 through 11/5/2021 - 11/8/2021 through 11/12/2021 - 11/15/2021 through 11/19/2021 - 11/21/2021 through 11/26/2021 (i) The "IDG [interdisciplinary group] Meeting Review/Plan of Care" on the following dates: 10/20/2021 and 11/3/2021, did not contain a detailed statement of the scope and frequency of services in the "Frequencies" section for HHA services. (ii) The "IDG Meeting Review/Plan of Care" dated 11/17/2021, contained a detailed statement of the scope and frequency of services in the "Frequencies" section for HHA services, however, it stated, "HHA: 5 x week for 3 weeks [five times a week for three weeks] starting 11/28/2021 (week 2) Start date: 11/28/2021 ..." (iii) Staff #1 was unable to provide documented evidence of a physician order for the HHA services provided on the above dates. A verbal order for HHA services was received by Staff #13 on 11/11/2021 however, it stated "... HHHA [Hospice Home Health Aide]: 5 x week for 3 weeks starting 11/28/21 ..." b. The HHA services provided on the above specified dates were not in accordance with the patients plan of care and the facility's policy and procedure. 2. The above findings were confirmed by Staff #1 on 12/20/2021 at 2:15 PM. N.J.A.C. 8:42C-6.3(a)6

Based on observation, staff interview, and review of facility documents, it was determined the facility failed to ensure hand hygiene is performed to prevent the transmission of infections and disease. Findings include: Reference: Facility policy titled, "Infection Control-Hand Hygiene; Policy Number: PC.125", states, " ... Policy: Caring Hospice Services follows hand hygiene guidelines recommended by the Centers for Disease Control and the World Health Organization and establishes goals to improve compliance with hand hygiene guidelines. Procedures: 1. Hospice staff must wash hands: a. before and after touching a patient; ... . e. after any activity involving physical contact with a patient's immediate environment; ... . 3. Hospice clinicians are provided with hand washing supplies, including anti-bacterial soap and/or alcohol-based hand cleanser as part of their routine supply inventory. ... ." 1. On 12/15/2021 at 1:20 PM, during a hospice home visit by Staff #10 (Home Health Aide), the following was observed: a. Staff #10 entered the home of Patient #2 and failed to perform hand hygiene before the start of the home visit. (i) Staff #10 stated that the purpose of the visit was to provide respite for the patient's "Live in Aide." He/She will sit and offer companionship to the patient while the "Live in Aide" takes his/her break. (ii) During the visit, Staff #10 was in contact with items within the home, such as making adjustment to the blinds to make lighting in the home comfortable for the patient. b. At the conclusion of the visit, Staff #10 failed to perform hand hygiene. 2. Outside the home, Staff #10 was questioned about the Agency's hand hygiene policy and procedure. Upon interview, Staff #10 stated that hand hygiene should occur before and after each visit at a minimum. He/She then proceeded to go into his/her Home Care Bag and pulled out a small bottle of hand sanitizer. He/She attempted to apply sanitizer to his/her hands, but the bottle was empty, and he/she did not have a replacement available. 3. The above was confirmed by Staff #1. N.J.A.C. 8:42C-10.3(a)5

Based on review of contracted services, it was determined that the facility failed to ensure that Speech Language Pathology Services, Physical Therapy Services and Occupational Therapy Services are provided.. Findings include 1. On 12/17/2021, upon interview Staff #1 stated that the facility provides PT (Physical Therapy) and OT (Occupational Therapy) if needed. a. On 12/20/2021, Staff #1 was unable to provide an executed contract. 2. On 12/20/2021, Staff #2 confirmed the above finding.

A. Based on staff interview, review of one (1) of 4 (four) medical records (#13) and a review of facility policy and procedure, it was determined that the facility failed to ensure written patient care instructions are provided to all hospice aides. Findings include: Reference: Facility policy titled, "Hospice Aide Assignments & (and) Duties" states, "Policy: Hospice aides are assigned by a hospice RN (Registered Nurse) and follow written patient care instructions in providing care to assigned patients. 1. The hospice RN responsible for supervising the hospice aide prepares written patient care instructions that are patient-specific and nor generic based on patient assessment. ..." 1. On 12/20/2021, review of Medical Record #13 revealed the following: a. Patient #13, was admitted to the hospice on 9/28/2021, and received hospice aide services on the following dates: - 10/19/2021 through 10/23/2021 - 10/25/2021 through 10/29/2021 - 11/1/2021 through 11/5/2021 - 11/8/2021 through 11/10/2021 b. The medical record did not contain written patient care instructions that are patient-specific, prepared by the RN, for the above referenced dates in which aide services were rendered to the patient. 2. The above finding was confirmed by Staff #1 on 12/20/2021 at 1:30 PM. N.J.A.C. 8:42C-7.5(a)1 B. Based on staff interview and review of two (2) of four (4) medical records (#10 and #13), it was determined that the facility failed to provide written patient care instructions for the hospice aide regarding fall precautions and the use of assistive devices. Findings include: 1. Patient #10 was admitted to the hospice service on 6/22/2021. a. The "Hospice Plan of Care" dated 10/20/2021, indicated in the "Musculoskeletal/Activities" section stated "... Recent fall with head injury prior to hospice, unwitnessed fall 7/12 no injury noted, floor mats/bed alarm now in place" (i) Review of the "Hospice Aide Assignment" dated 10/19/2021, did not include the floor mats/bed alarm. Staff #1, upon interview, indicated that the floor mats/bed alarm should be documented in the "Precautions/Safety" section of the assignment. 2. Patient #13 was admitted to the hospice service on 9/28/2021. a. The "Musculoskeletal/Activities" section "IDG Meeting Review/Plan of Care" dated 11/3/2021, stated, "... Provide assistive devices (specify) : wheelchair Start Effective Date: 09/28/2021 ..." (i) Review of the "Hospice Aide Assignment" dated 11/11/2021, did not include a wheelchair as an assistive device in the "Pertinent Information" section of the assignment. 3. The above findings were confirmed on 12/20/2021 at 1:00 PM by Staff #1. N.J.A.C. 8:42C-7.5(a)1

Based on medical record review, staff interview and review of a facility document, it was determined that the facility failed to ensure that care is provided to meet the needs of the patient while in respite. Findings include: Reference: Facility policy titled, "Levels of Care - Inpatient Respite Care" states, "...1. Short term inpatient respite care is provided in Medicare-certified facilities that have enough nursing personnel available on all shifts to ensure that adequate safety measures are in place for the patients and that the routine, special, and emergency needs of all patients are met at all times. ..." 1. Upon medical record review on 12/17/2021, the following was revealed: a. Patient #1 received inpatient respite care from 10/18/2021 through 10/23/2021. Staff #19 (a contracted staff) was assigned to care for Patient #1 during respite. b. The Hospice Eligibility Guidelines Review, dated 8/3/21, states, "...Comments: ...being recertified with senile degeneration of brain; comorbidity- seizure disorder,...Patient is non verbal makes unintelligible sounds...Patient was ambulating/wandering in perpetual motions twenty-two (22) hours a day until [he/she] fell down...this recert, the Patient walked into an open closet door and fell to the floor; requires 24/7 supervision. Patient with increased difficulty swallowing... ." c. The IDG (Interdisciplinary Group) Meeting Review/Plan of Care, dated 10/20/21, states, "...Meeting Notes- Patient in respite for five day stay requires 24/7 supervision..." d. A document titled "_____(Name of Patient) Respite Stay 10/18/21 - 10/23/21" states, "...Monday 10/18 ...Received call from CHS [Caring Hospice of South], (Name of SW [Social Worker]) stating,"facility is refusing to allow patient to stay unless we provide 1:1 [one-to-one] coverage from 7 AM-11 PM, due to patient being a wanderer. ..." e. A Medical Social Services Clinical Note, dated 10/21/21, states, "...SW met with (Name of Staff) in nursing and also spoke with DON [Director of Nursing] who shared that they were not satisfied with the care that agency was providing. SNF [Skilled Nursing Facility] stated that ___ [Staff #19] did not walk patient and that patient has been in the room and in bed. They also informed SW that ___ [Staff #19] did not get patient bathed this morning and they felt [he/she] was not changing patient diapers as often as needed. SW explained that ___ [Staff #19] contacted SW earlier in the morning stating that SNF was not assisting [him/her]. ... ___ [Staff #19] stated that patient is a two (2) person assist and stated that patient was not ambulatory when [he/she] arrived Tuesday, and that [he/she] did not feel safe walking patient due to weakness..." 2. There was a lack of coordination of care.

Based on staff interview and document review, it was determined that the facility failed to ensure that all contracted staff are provided orientation regarding the hospice philosophy. Findings include: Reference: Facility policy titled, "Orientation Program" states, "...PROCEDURES...6. Contracted personnel receive orientation to Caring Hospice's polices regarding confidentiality, the hospice philosophy on care and the contract personnel's specific job duties, as appropriate and delineated in the written agreement." 1. Staff #1 stated that Caring Hospice utilized Staff #19 (Licensed Practical Nurse) from ___ (name of contracted company) to provide care for Patient #1. 2. On 12/17/2021, Staff #1 was unable to provide evidence that Staff #19 was trained on the hospice philosophy. N.J.A.C 8:42C-3.1(e)ii

Based on staff interview and review of facility policy and procedure, it was determined that the facility failed to ensure that all contracted staff are oriented to their specific job duties. Findings include: Reference: Facility policy titled, "Contract Management" states, "...3. All contracted staff will complete orientation to the hospice policies and procedures and their role as part of the patient's plan of care. 4. The following information will be provided prior to doing business with the entity: ...Orientation to hospice services ... ." 1. Upon interview, Staff #1 was unable to provide evidence that Staff #19 (a contracted LPN [licensed practical nurse]) was oriented to his/her job duties. N.J.A.C 8:42C-3.1(e)ii

Based on review of facility documents and staff interviews, it was determined that the facility failed to ensure all employees are provided with in-service training and education. Findings include: Reference: Facility policy titled, "Contract Management" states, "...3. All contracted staff will complete orientation to the hospice polices and procedures and their role as part of the patient's plan of care. ..." 1. On 12/15/2021, Staff #1 stated that Staff #19 is an agency nurse, who provided care for Patient #1 on 10/19/2021, 10/20/2021 and 10/21/2021. 2. Upon interview, Staff #1 stated that Staff #19 did not receive orientation to the hospice polices and procedures and specific role.

Based on medical record review, staff interview and review of facility documents, it was determined that the facility failed to include a summary of the care provided in the medical record. Findings include: Reference: Facility policy titled, "Levels of Care-Inpatient Respite Care" states, "...PROCEDURES: ...9. A summary of the care provided to the patient during the respite stay is filed in the patient's clinical record. ... ." 1. A Physician Order dated 10/25/21 states, "Respite stay 10/18-10/23." a. Upon interview, Staff #1 stated that the Medical Record of Patient #1 does not include the clinical notes of the care provided during respite. 2. The above was confirmed by Staff #1.