Every finding on record at Caring Like Family Hospice

Observed in Record Review. In 1 of 6 records, the hospice did not conduct and document a patient-specific comprehensive assessment that identifies the patient’s need for hospice care and services. Examples: In RRNHV#2, the initial psychosocial and initial bereavement assessments were not completed per policy by the MSW. This was confirmed with the DON.

Observed in Tracer Visit. In 3 out of 3 records the hospice did not develop an individualized plan of care with measurable goals and time frames. Examples: RRHV#1 examples included the following: 1 -Be able to cope with changes 2- Medication given crushed; 3- HOB will be in 45 degrees 24.7; 4- Feeding will be slow and in small amounts. 5. Pain will remain 0-2/10 pain level with Tylenol routine and sling. RRHV#2 examples: 1- PCG will verbalize understanding that ANOREXIA symptoms is a part of the disease process and the SUPERVISION OF ALL MEALS WITH CUEING WILL BE EFFECTIVE AND the PATIENT WILL NOT SHOW DECREASED MAC. 2-O2 PRN will be utilized by ASLF staff PRN SOB/DYSPNEA to achieve and maintain patient comfort. RRHV#3: 1-PAID CGs will verbalize/demonstrate understanding of medication REGIMEN /and side effects, aspiration precautions and fall precautions 2-Paid PCG will provide adequate food and fluids as the patient tolerates, DUE TO ANXIETY DISORDER AND EX ALZHEIMER'SThis was confirmed by the DON.

Observed in Tracer Visit. In 7 out of 7 records, range orders for oxygen did not have defined parameters and indications for adjusting and/or changing the settings. Examples: In RRHV#1, RRHV2, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3 and RRNHV#4 , the PRN oxygen orders were for a range of 2-5 LPM without defined parameters or indications for adjusting. This was confirmed with the DON.

Observed in Record Review. In 3 of 7 records, the hospice orders did not clearly define the frequency of the services to be provided to meet the needs of the patient and family. Examples:In RRNHV#1 the MSW POC order for benefit period 4 was entered as follows: MSW: 1 As Needed - as needed PSYCHOSOCIAL visits or calls. Frequency changed to PRN PSYCHOSOCIAL C\concerns or new issues. Will follow up randomly to check on how family and CGs are doing. In RRNHV#1 the SC POC order for benefit period #4 was entered as follows: SC: 1 Recert - Change of condition.In RRNHV#3, the MSW POC order for benefit period1 was entered as follows: MSW: 1 As needed and Recert - continuing monthly follow-up calls and offer visits. In RRNHV#3, the SC order for benefit 1 was entered as follows: SC: Recert - change of condition. In RRNHV#4 the MSW order for benefit 9 was as follows: MSW: 1 per Month - Recertifications, and PRN's new psychosocial needs. The SC orders for benefit 9 were as follows: SC: Recert - change of condition. This was confirmed with the DON.

Observed in Record Review. In 3 out of 3 records, the organization did not provide the patient with services according to the patient's individualized plan of care. Examples: In RRHV#1, there is a missed SW visit during month 1 of benefit period 8. In RRHV#2, there is a missed SW and SC visit during Month 1 of benefit period 8. In RRHV#3, there is a missed SC and SW visit during Month 1 of benefit period 2. This was confirmed by the DON.

Observed in Record Review. In 1 of 2 discharge records, the hospice did not provide the patient’s attending physician with a copy of the hospice discharge summary. Examples: A Discharge Summary was not sent to the Attending physician for RRDC#1. This was confirmed by the DON.

Observed in Individual Tracer. the organization had not ensured that there was evidence of effective hand hygine. For example, during HV2 the RN had not rubbed hands together long enough to fully dry hands and instead waved her hands in the air to dry prior to re-gloving. Another example during the same visit the Nurse was observed to don gloves during the first glove change and instead of applying hand sanitizer before donning the gloves. However, she had followed by using the sanitizer on top of the new gloves. This was confimed by the staff member accompanying on the visit.

Observed in Record Review. In 1 of 4 patient records reviewed, the organization had not documented in the record the availability of a discharge summary to the Attending Physician. For example, during RR7 (discharge record) the Surveyor identified the patient had been transferred to another hospice but there was no evidence of the discharge/transfer summary being offered to the Attending Physician as per CMS condition of participation 418.104 L682: Clinical Records. This was confirmed by the Administrator/ DCPS.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not ensured that infection prevention and control activities were used in the foley care of a patient. For example, during HV1 the Certified Home Health Aide practiced behaviors to avoid sources that contribute to infection risk in the environment. In this case the Aide allowed the foley collection bag to lay on the floor and continue to stay on the floor after the visit was concluded. Per review of yearly staff competency, this employee was checked off as understanding the practice of attach the drainage bag to the side of the bed or wheelchair using a clip and rubberband. She was also checked on her performance appraisals as follows infection control. This was confirmed by the Staff member accompanying this visit and the Administrator/DCPS