Every finding on record at Caring Hospice Services of Massachusetts LLC

Observed in Regulatory Review. In 1 of 12 patient records reviewed, the organization failed to assess the patient condition according to defined time frames. During record review for RRHV#3, the Hospice Nurse Surveyor observed the initial spiritual assessment was not completed until day 6 ,as the documented narrative note from 7/21 stated This is a note regarding the late date for the Spiritual and Pre-Bereavement Assessment of 7-6-23 for patient. Patient was admitted during the week when I was on vacation and not available to do assessments; on my next regularly scheduled day as a per diem SC, the assessments were completed. . This was discussed and reviewed with the Director.

Observed in Record Review. In 1 of 12 patient records reviewed, the organization failed to assess the patient condition according to defined time frames. During record review for RRHV#3, the Hospice Nurse Surveyor observed the initial bereavement assessment was not completed until day 6 as documented in a narrative note on 7/21 from the employee which stated This is a note regarding the late date for the Spiritual and Pre-Bereavement Assessment of 7-6-23 for patient. Patient was admitted during the week when I was on vacation and not available to do assessments; on my next regularly scheduled day as a per diem SC, the assessments were completed. . This was discussed and reviewed with the Director.

Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to plan the patient's care. During record review for all records, the Hospice Nurse Surveyor observed goal timeframes were not updated. For example in RRHV#1, the most recent CP- SW goal of preparing EM plan to be achieved by 6/7 not updated as of 7/25. Patient/ CG to discuss bereavement needs to be achieved by 6/8- not updated as of 7/25. In RRNHV#2, there were no measurable target dates for listed goals. And in RRNHV#3, target dates were not listed or left unfinished such as will designate healthcare proxy by __________. This was discussed and reviewed with the Director.

Observed in Record Review. In 7 of 8 patient records reviewed, the organization failed to provide care, treatment, or services according to the Aide Plan of Care. During record review for RRHV#1,RRHV#2, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#5, Hospice Nurse Surveyor observed the aide did not follow the Plan of Care written by the RN. For example in RRHV#1, a bed bath was ordered 1x weekly. No bath was documented on the week of 6/26 and 7/3. And two baths were provided the week of 6/4. There was also a bath provided by facility on 7/12 but no documentation that the IDG was made aware. Also the patient had monthly weights to be documented per the Aide Plan of Care but there were no weights documented. For RRHV#2, bed bath's were to be provided 1x weekly but for weeks 6/19, 6/21, 6/26 and 7/20 the aide documented RCA under bed bath. After discussion with the Director, it was noted this means Resident Care Assistant meaning the facility provided the bath. There was no documentation to the IDG that the aide care plan was not followed. For RRNHV#5, the Aide Care Plan stated chair bath with no frequency and the chair bath was not documented. The care plan was changed to reflect frequency during survey. There was no documentation to the IDG that the aide care plan was not followed. This was discussed and reviewed with the Director.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. During home visits for RRHV#1 and RRHV#2, the Hospice Nurse Surveyor observed the organization policy on bag technique was not followed. During RRHV#1 the RN wiped the table down with Clorox wipes ( not following manufacturer guidelines for disinfection with wet time of 4 minutes). She then placed a disposable barrier onto the wet surface. Used it to place her nursing bag on. At the end of the visit she folded the disposable barrier up and placed it inside her nursing bag stating I hate to wasted so I use it for more than one patient. The organizational policy states that the bag will be placed on a clean, dry surface and that all reusable items will be cleaned before putting back into bag. For RRHV#2, the aide left her hand sanitizer in her bag so when she needed to use it she went in and out several times, leaving the hand sanitizer inside the bag each time. This is not in line with the organizational policy which states hand hygiene will be completed before entering the bag. This was discussed and reviewed with the Director.