Every finding on record at Centennial Group LLC

Observed in Tracer Activities. The hospice surveyor observed where the Mitigation activities derived from the HVA were not defined by the organization. This was reviewed and validated with the Administrator.

Observed in Record Review. In 6 of 14 patient records reviewed, the organization failed to respect, protect, and promote the patient's rights. In HOSRRHV #1, HOSRRHV #2, HOSRRHV #3, HOSRRNHV #3, HOSRRNHV #4, and HOSRRNHV #7 the patients were not given a copy of the patient's rights and there was no documentation that the patient's rights had been reviewed with the family and or their caregivers. This was reviewed and validated with the Administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, where the patients were discharged, the hospice surveyor observed in HOSRRDC #2 that the patient revoked hospice and the revocation statement could not be found. This was reviewed and validated with the Administrator.

Observed in Record Review. In 7 of 14 patient records reviewed, the organization failed to respect the patient's right to participate in decisions about their care, treatment or services. The hospice surveyor observed that in HOSRRHV #1, HOSRRHV #2, HOSRRHV #3, HOSRRNHV #2, HOSRRNHV #3, and HOSRRBRV #1, and HOSRRBRV #2 the patient did not sign the admission consent and election of benefit and the family members who signed for the patient were not the power of attorney. This was reviewed and validated with the Administrator.

Observed in Record Review. In 11 of 14 patient records reviewed, the organization failed to respect the patient's right to participate in decisions about their care, treatment, or services. In HOSRRHV #1, HOSRRHV #2, HOSRRHV #3, HOSRRNHV #1, HOSRRNHV #2, HOSRRNHV #3, HOSRRNHV #4, HOSRRNHV #5, HOSRRNHV #6, and HOSRRDC #1m and HOSRRBRV #2 the notice of non-covered items was requested at admission; however, the HCO did not provide it. In HOSRRBRV #1 the patient was not offered the notice of non-coverage. This was reviewed and validated with the Administrator.

Observed in Record Review. In 6 of 14 patient records reviewed, the organization failed to allow the patient the right to choose their medical care provider. In HOSRRHV #1, HOSRRHV #2, HOSRRNHV #3, HOSRRNHV #6,, the selection of the hospice provider was left blank at admission. In HOSRRDC #1 the patient selected her primary care provider as her Hospice Provider and the Hospice Medical Director signed all her orders, treatments, and plan of care. In HOSRRBRV #1 the patient was not provided a freedom of choice for provider. This was reviewed and validated with the Administrator.

Observed in Record Review. In 11 of 14 patient records reviewed, the organization failed to plan the patient's care. The MSW and Chaplain care plan goals are not individualized and they did not have timeframes. In HOSRRHV #1, HOSRRHV #2, HOSRRHV #3, HOSRRNHV #1, HOSRRNHV #3, HOSRRNHV #6, HOSRRNHV #7 and HOSRRDC #1 the MSW care plan goals are all identical and state the MSW will continue with relationship building to express feelings, concerns and emotions. None of these goals have a timeframe and they are not specific as to the concerns and emotions that are being addressed. In HOSRRHV #3 the chaplain care plan goal states he will facilitate an optimal spiritual environment to begin the bereavement process. It is not specific as to what the optimal spiritual environment is. In HOSRRNHV #3, HOSRRNHV #4, HOSRRNHV #5, HOSRRNHV #6, HOSRRNHV #7 and HOSRRDC #1, and HOSRRBRV #2 the chaplain goal has no time frame and the goal states, “healing road to peace”. Not specific on what issues are being addressed. In HOSRRNHV #4 and HOSRRNHV #5, and HOSRRBRV #2 the MSW goal states, she will develop a positive and trusting relationship with the patient to express feelings, concerns and emotions. No time frame and the goal is not specific as to what concerns the patient may have. This was reviewed and validated with the Administrator.

Observed in Record Review. In 1 of 14 patient records reviewed, the hospice surveyor observed in HOSRRNHV #1 that the patient had a foley catheter and the provider entered an order stating, foley catheter replacement 16 fr. 30 ml, it is not clear if the 30 ml is for the balloon and what type of solution to use and the order does not state how often the catheter should be changed. HOSRRNHV #4 the patient had a foley catheter and the provider submitted an order that stated change foley catheter every visit if it is patent and change foley catheter once a month and as needed if it is dislodged, clogged and not patent. no size of catheter, amount or type of fluid to fill the balloon documented int the order. A second order 2 months later for this patient states replacement of foley catheter 16fr 10 cc balloon no specifics of what goes in the balloon or how often to change the catheter. This was reviewed and validated with the Administrator. Observed in Regulatory Review. In 5 of 14 patient records reviewed, the organization failed to plan the patient's care. The Hospice surveyor observed in HOSRRHV #1 that the patient was on Clopidogrel 75 mg every day as an anticoagulant. The RN did not include a care plan on bleeding precautions. In HOSRRNHV #3 the patient was on Clopidogrel 75 mg every day and ASA 81 mg as anticoagulants. The RN did not include a care plan on bleeding precautions. In HOSRRNHV #7 the patient was on Eliquis 50 mg every day and the RN did not include a care plan on bleeding precautions. In HOSRRBRV #1 the patient was on Warfarin and the RN did not include a bleeding precautions care plan. This patient was also on oxygen and had a foley catheter in place with no care plan entered. In HOSRRBRV #2 the patient was on Clopidogrel 75 mg daily and there was no care plan on bleeding precautions. This was reviewed and validated with the Administrator. Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to plan the patient's care. The hospice surveyor observed in HOSRRBRV #1 where the patient had an indwelling foley catheter but there were no interventions specific to the catheter. This was reviewed and validated with the Administrator. Observed in Record Review. In 2 of 14 patient records reviewed, the hospice surveyor observed where duplicate medications were ordered and the instructions for use were not clear. In HOSRRHV #1 the patient had Lorazepam 0.5 mg one tablet three times a day as needed for anxiety. The patient also had an order for Hydroxyzine 25 mg one tablet every 6 hours as needed for anxiety. It is not clear when the caregiver should give one over the other for anxiety. In HOSRRHV #3 the patient had an order for docusate sodium/senna 50 mg daily and as needed for constipation and Bisacodyl 10 mg suppository as needed for constipation. It is not clear when to take one over the other. This was reviewed and validated with the Administrator.

Observed in Record Review. In 2 of 14 patient records reviewed, the hospice surveyor observed in HOSRRHV #1 where the patient had an order for Oxygen at 2 Liters via nasal cannula and this could be titrated up to 5 liters for shortness or breath. The oxygen order is unclear as there are not instructions for the caregiver on when to titrate up the oxygen. In HOSRRBRV #1 the patient had an order to check INR, there was no documentation of when this should be done and how often as the patient was on Warfarin. This was reviewed and validated with the Administrator.

Observed in Record Review. In 2 of 14 resident records reviewed, the organization failed to plan the patient's care. The hospice surveyor observed in HOSRRDC #1 that a bereavement assessment was not completed on the patient's son or the caregiver. In HOSRRDC #2 a bereavement assessment was not completed on the patient's sister. This was reviewed and validated by the Administrator.

Observed in Record Review. In 6 of 14 patient records reviewed, the organization failed to plan the patient's care. In HOSRRHV #1 the patient was on an anticoagulant and also had a PEG tube in place and the HHA assignment did not address the bleeding precaution and also did not address what the aide should do with the PEG tube dressing. when bathing the patient. Additionally this patient was on continuous oxygen and the care plan did not address whether the oxygen could be removed for the bath. In HOSRRNHV #2 the patient had two wounds with dressings to her dorsal right foot and sacrum and there no instructions for the aide as to what to do with the dressings when bathing the patient. This patient was also on an anticoagulant and a fall risk and there was no bleeding or fall precautions entered into the aide assignment. In HOSRRNHV #5 there are no instructions in the aide assignment for what to do with the nephrostomy tubes or dressings to her sacrum and left foot when giving the patient a bath. In HOSRRNHV #7 the patient was on an anticoagulant and the aide assignment did not include bleeding precautions. In HOSRRBRV #1 the patient was on continuous oxygen and there were no instructions for the aide if she could take off the oxygen when bathing the patient. In HOSRRBRV #2 the patient was on Clopidogrel an anticoagulant daily and there were no bleeding precautions entered. Additionally, this patient was on continuous oxygen and there were no instructions what to do with the oxygen when the aide was bathing the patient. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. There was no evidence that the governing body and leadership had established requirements to support patient's rights. In addition a condition level deficiency was identified at 418.52.

Observed in Tracer Activities. In 1 of 9 HR files reviewed, the Hospice surveyor observed that the Bereavement Coordinator did not have initial competency. This was reviewed and validated with the Administrator.

Observed in Record Review. In 4 of 14 patient records reviewed, there were multiple nursing notes that were started but were not completed. In HOSRRNHV #1 the recertification had not been completed. As of the survey date it was outstanding 13 days. In HOSRRNHV #2 a visit note was not completed as of 8 days from the time of he visit. In HOSRRNHV #5 it has been 32 days since the visit and the visit note had not been completed. In HOSRRNHV #6 the recertification note 10 days prior to survey had not been completed. Per the administrator the organizational requirement is to have notes completed within 48 hours of the visit. This was reviewed and validated by the Administrator.

Observed in Record Review. In 2 of 14 patient records reviewed, dressing changes not fully described in the record. In HOSRRNHV#2 there were two visits in September and 2 visits in October where the RN documented wound care provided the RN did not specify what wound care was done on left heel or the dorsal right foot. In HOSRRNHV #5 the patient had both sacral and left heel wounds and the RN documented wound care provided as ordered in 4 visit notes in October. This was reviewed and validated with the Administrator.

Observed in Record Review. In 1 of 2 resident records reviewed, where a patient was a live discharge the organization failed to provide a summary of care to the receiving organization when patient was transferred. In HOSRRDC #1 the patient was transferred to another Hospice and the organization failed to send a discharge summary to the receiving organization. They failed to follow their policy Transfer Information 2.070.1. This was reviewed and validated with the Administrator.

Observed in Record Review. In 1 of 1 patient records reviewed, the Deemed HOS agency did not provide the physician with the discharge summary after a discharge to the community. In HOSRRDC #2 the patient revoked from hospice and the organization failed to send a discharge summary to the community provider per their Discharge and Transfer Policy, 2-037.1. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. In 1 of 10 HR files reviewed, a criminal background check was not conducted per HCO policy. The HR #2 Alternate Medical Director did not have a criminal background check done at hire. The Administrator states that the Nevada State Organization was hacked and they are not able to process but the Administrator did not seek another avenue to complete a background check prior to allowing the physician to see patients. This was reviewed and validated with the Administrator.

Observed in Patient Home. In 3 of 3 home visits conducted, the hospice did not provide the patient with written information about its policies on advance directives. A review of the material given to patients at HV#1, HV#2, and HV#3 it was found that neither the policy on advance directives nor the state of Nevada information on filing an advance directive were provided to patients. This was reviewed with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 11 of 11 patient records reviewed, the hospice failed to conduct comprehensive re-assessments that identified patients’ needs for care and services, and in accordance with the organization's Ongoing Comprehensive Assessment policy 2-031. In every record reviewed, assessments by registered nurses did not address all required elements outlined in the policy. This was reviewed with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 11 of 11 patient records reviewed, where the interdisciplinary group had met more than twice, the organization did not update comprehensive assessments based on changes that had occurred since the initial assessment. The surveyor found that notes did not document on-going patient decline, progress toward goals, and plans for the next two weeks. This was reviewed with the Administrator/Director of Patient Care Services. Observed in Record Review. In 11 of 11 patient records reviewed, the interdisciplinary group did not update the comprehensive assessment every 15 days or less. This could not be done because the elements required of a comprehensive assessment were not gathered by an RN prior to the meeting. This was reviewed with the Administrator/Director of Patient Care Services.

Observed in Competency Session. In the personnel record of HR BC/SC it was noted that the individual supervising the provision of bereavement services was not a qualified professional with experience or education in grief or loss counseling. Additionally, this individual did not possess a bachelor’s degree or equivalent theological degree from a college or university; and did not have previous experience with families/caregivers and patients through death and dying issues as required by the job description. This was reviewed with the Administrator/Director of Patient Care Services.

Observed in Competency Session. In the personnel record of HR CHHA it was noted that competency was not assessed through observation in the field or with a pseudo-patient. Rather it was done verbally. This was reviewed with the Administrator/Director of Patient Care Services.