Every finding on record at Cb Homecare Hospice Corporation

Observed in Record Review. In 8 of 8 resident records reviewed, The HCO did not ensure patient care plan goals were individualized, measurable, and include appropriate time frames. Examples include the following: Will be free from s/s of hypo/hyperglycemia as no tremors, diaphoresis and no change of level of consciousness daily within 90 days, Symptoms of respiratory exacerbation like SOB, cough, low O2 sat, will control / resolve within 24 hours after nursing intervention/medication within 90 days, Exacerbation of symptoms of heart disease like chest pain, dyspnea/SOB , elevated BP, syncope, will minimize/resolve within 2-3 hours after nursing intervention/medication in 1-2 weeks throughout certification period, Pt will verbalize able to sleep at least 6-8 hours of uninterrupted sleep at night after medication/ intervention in 1-2 weeks throughout certification period, Patient respiratory status will be managed by current medication/treatment, as evidenced by O2 sat of above 90% and respiratory of 16-24 in 1-2 weeks and throughout certification period. Patient’s anxiety will be managed effectively by current medication as evidenced by reduction of anxiety/ calm within 1 hour after nursing intervention/medication in 1-2 weeks and throughout certification period. These goals do not contain specific information, including time frames and diagnosis specificity that can be accurately measured, to assist staff in determining whether the patient is progressing towards goal achievement. These findings were reviewed, discussed, and validated with the organization’s Administrator/DPCS.

Observed in Record Review. In 3 of 6 patient records reviewed, The HCO’s hospice aide failed to follow the visit frequency as ordered. For example, the surveyor noted On HV #1/RR #1 aide visits were ordered for three times a week; there were three weeks where visits were made two times. On HV #3/RR #3, there were two weeks where aide visits were made two times, when the visit frequency was ordered for three times a week. On RR #6 the visit frequency was ordered for two times a week; the aide visited one time a week for two of the weeks. There were no orders present in the patient record covering the frequency changes. Standards require patient services be provided according to the patient’s individual plan of care. These findings were reviewed, discussed, and verified with the Administrator/DPCS.

Observed in Data Session. The HCO Leadership did not ensure their Bereavement Services and Volunteer Services were included in its QAPI program. On review of QAPI data, the surveyor noted these two programs were not represented on the agendas, in data analysis, or service evaluation reports. Standards require an organization’s QAPI program include all provided services. These findings were reviewed, discussed, and validated with the organization’s Administrator/DPCS and Assistant Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, The HCO staff failed to use standard infection prevention and control precautions at times required by the organization's policies. For example, on HV #1/RR #1, the surveyor observed the hospice aide completing hand hygiene, turning off the water with bare hands and using toilet paper from the patient’s bathroom to dry hands. Additionally, when preparing to provide personal care, the aide placed the nursing bag on paper towels, on the floor, next to a soiled beside commode. The organization’s policies require standard precautions to be used, including hand hygiene, and proper bag technique, to prevent and control infection when conducting direct patient care. These findings were discussed and confirmed with the Administrator/DPCS.

Observed in Record Review. In 5 of 6 patient records reviewed, The HCO’s registered nurse did not ensure the hospice aide care plan provide specific directions for ADL/personal care. For example, the surveyor noted the aide care plans for HV #1/RR #1, HV #2/RR #2, HV #3/RR #3 and RR #6 did not contain instructions related to oxygen/use, HV #1/RR #1 and HV #2/RR #2 did not contain directions for patient transfer, and RR #8 contained no instructions for feeding patient. Standards requires the registered nurse to prepare written patient care instructions for the hospice aide. These findings was reviewed, discussed, and verified with the Administrator/DPCS.

Observed in Patient Home. The HCO’s hospice aide failed to follow the patient’s care plan for personal care/hygiene. For example, the surveyor observed on HV #1/RR #1 the aide washed the patient’s hair during on the visit, without it being listed on the aide assignment sheet. Standards require the hospice aide to follow the written instructions for personal care as prepared by the registered nurse. These findings were reviewed, discussed and verified with the Administrator/DPCS.

Observed in Record Review. In 3 of 6 patient records reviewed, The HCO’s registered nurse did not complete hospice aide supervisory visits every 14 days. For example, the surveyor noted on HV #1/RR #1, HV #3/RR #3, RR #8, the surveyor noticed there was approximately 30-day periods of time between documentation of hospice aide supervisory visits. To ensure aide services meet the patient’s needs, standards require registered nurse conduct supervisory visits at a time frame of every 14 days. These findings were reviewed, discussed, and verified with the Administrator/DPCS.