Every finding on record at Centra Management Services LLC

Observed in Tracer Activities. In 2 of 2 volunteer records reviewed, there was no documentation indicating that the volunteers had received training in emergency management that was consistent with their role and responsibility in an emergency. This finding was discussed with the volunteer coordinator at the time of discovery.

Observed in Individual Tracer. In 1 of 4 Individual Tracers, it was noted that the organization did not ensure that the comprehensive assessment update included all requirements. For example, during home visit activities for RRHV#1, it was noted that the clinician did not assess the skin integrity at the back or buttocks area of the patient’s body. This observation was reviewed with agency leadership.

Observed in Record Review. In 2 of 14 patient records, it was noted that the plan of care did not include all required information. For example, a review of the medical record for RRHV#1 revealed that the patient had a history of a ground level fall with head trauma 20 days prior to the start of care date. The Morse falls risk assessment indicated the patient was at high risk for falls. The plan of care did not include a goal statement to evaluate the response to care, treatment and services related to fall prevention interventions. Example #2: A review of the medical record for RRNHV#1, revealed that the clinician documented the presence of a stage 2 wound at the Left Shin. The plan of care did not include a goal statement to evaluate the response to care, treatment, and services related to Left Shin wound. Example #3: A review of the medical record for RRNHV#3, revealed that the patient’s terminal illness diagnosis was Alzheimer’s Dementia disease. The plan of care did not include a goal statement to evaluate the response to care, treatment, and services related to Alzheimer’s Dementia disease. This observation was reviewed with agency Leadership.

Observed in Record Review. In 2 of 14 patient records, it was noted that the plan of care did not include interventions based on the problems identified in the comprehensive assessment. For example, a review of the medical record for RRHV#1 revealed that the patient had a history of a ground level fall with head trauma 20 days prior to the start of care date. The Morse falls risk assessment indicated the patient was at high risk for falls. The plan of care did not include interventions to maintain patient safety, and strategies to prevent injury. Example #2: A review of the medical record for RRNHV#1, revealed that the clinician documented the presence of a stage 2 wound at the Left Shin. The plan of care did not include interventions related to the care, and treatment of the Left Shin wound. Example #3: A review of the medical record for RRNHV#3, revealed that the patient’s terminal illness diagnosis was Alzheimer’s Dementia disease. The plan of care did not include interventions related to the care, treatment, and services of the patient’s terminal illness diagnosis. This observation was reviewed with agency Leadership.

Observed in Individual Tracer. In 1 of 4 Individual Tracers, it was noted that the organization did not implement its infection prevention and control activities to minimize, reduce or eliminate the risk of infection. For example, during the home visit activity for RRHV#1, it was noted that when the clinician moved from assessing the patient’s feet with irritated skin and healing blistered areas the clinician moved to assessing the patient’s right eye without removing gloves and performing hand hygiene. This observation was reviewed with agency leadership. Observed in Individual Tracer. In 1 of 4 Individual Tracers, it was noted that the organization did not ensure its planned infection prevention and control activities to eliminate the risk of infection were implemented. For example, during home visit activity for RRHV#1, it was noted that after equipment cleaning was completed the clinician did not place the equipment on a clean barrier. In addition, the organization’s bag technique policy indicated that a 70% alcohol spray should be used for equipment cleaning. The clinician used Sani-Cloth germicidal disposable wipes for equipment cleaning. This observation was reviewed with agency leadership.

Observed in HR File Review. In 1 of 1 hospice aide competency files reviewed, an annual on-site performance evaluation at the patient's home or site of care had not been conducted. The aide participated in a skills fair at the office, but a site of care evaluation was not done. This finding was discussed with the leaders of the organization at the time of the survey.

Observed in Record Review. In 3 of 4 patient records, for patients receiving Hospice Aide services it was noted that the supervisory visit did not address all requirements: For example, a review of the medical record for RRHV#3, RRHV#4, and RRNHV#3 revealed that the following information was not addressed in the supervisory visit: (a) Creating successful interpersonal relationships with the patient and family, (b) Demonstrating competence with assigned tasks, (c) Complying with infection control policies and procedures, and (d) Reporting changes in the patient’s condition. This observation was reviewed with agency leadershipl

Observed in Record Review. In 1 of 2 patient records reviewed, for patients discharged or transferred from the organization, it was noted that the discharge/transfer summary did not include all required information. For example, a review of the discharge/transfer summary for RRDC#2, did not include a summary of the patient's stay, including treatments, symptoms, and pain management; the patient's current plan of care; the patent's latest physician orders; and any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving provider. This observation was reviewed with agency leadership.

Observed in HR File Review. In 2 of 2 Contracted staff HR files reviewed, During HR# 10 and HR# 11's personnel records review, it was noted the organization had not ensured there was documented evidence of orientation for the Medical Director and alternate Medical Director. This was reviewed and discussed with Leadership and validated.

Observed in Patient Home. In 1 of 2 home visits conducted with medication reconcilliation, During HV# 2's home observation it was noted the organization had not ensured a complete medication review was conducted on admission and subsequent nursing visits per organization policy, Medication Profile. For example: HV# 2 was a resident of an assisted living facility (ALF) that administered HV# 2's medications and had been receiving hospice services for approximately 36 days prior to the home visit. During the RN medication review it was noted the ALF medication administration record had multiple medications that were not on the hospice medication profile. For example: Morphine Sulfate, Nystatin cream, hydrocortisone cream, and atropine. In addition, review of HV# 2's medications revealed the Morphine Sulfate had been expired for approximately 3 months. This was reviewed and discussed by the RN and the Director of Clinical Services and validated.

Observed in Record Review. In 3 of 3 active patient records reviewed, During HV# 1, HV# 2, and HV# 3's patient records review, it was noted the organization had not ensured that plan of care included individualized measurable goals/outcomes. For example: For example: review of HV# 1's plan of care revealed the goal that HV# 1 would achieve and maintain optimal physical comfort, with no indication what the optimal physical comfort was for HV# 1. Review of HV# 2 and HV# 3's patient records revealed the same goal of Patient's dysphagia will be managed to a comfortable level based on disease process. However, HV# 2's terminal diagnoses was Alzheimer's and HV# 3's terminal diagnosis was Parkinson's and there was no indication what a comfort level would be for HV# 2 or HV# 3. This was reviewed and discussed with the Director of Clinical Services and validated.

Observed in Record Review. In 1 of 5 patient records reviewed, During HV# 2's patient record review, it was noted the organization had not ensured the plan of care included interventions to manage symptoms. For example: review of the patient's record revealed an order for Foley catheter and change monthly with no additional information, such as what size or and how much fluid in the retention balloon. This was reviewed and discussed with the Director of Clinical Serivces and validated.

Observed in Record Review. In 4 of 5 patient records reviewed, During HV# 1, HV# 2, HV# 3, and RR# 2's patient records review, it was noted the organization had not ensured the plan of care included a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs. For example: review of the patients' records revealed PRN [as needed] orders for either skilled nurse, medical social worker, home health aide, or chaplain with no indication for the need of the visit. This was reviewed and discussed with the Director of Clinical Services and validated.

Observed in Record Review. In 2 of 2 active patient records reviewed with Home Health Aide services, During HV# 1 and HV# 2's patient records review, it was noted the organization had not ensured the home health aide (HHA) written patient care instructions were complete. For example: review of HV# 1's patient record revealed HV# 1 was on continuous oxygen and the care plan did not address whether the oxygen could be removed for the shower. Review of HV# 2's patient record revealed HV# 2 had an indwelling urinary catheter and the care plan did not include direction for perineal care to include catheter care. This was reviewed and discussed with the Director of Clinical Services and validated.

Observed in Record Review. In 1 of 5 patient records reviewed, During HV# 3's patient record review it was noted the organization had not ensured the Medical Director reviewed the clinical information or signed the initial certificate of terminal illness (CTI). For example: review of the patient record revealed HV# 3's start of care was approximately 53 days prior to the surveyor review of the record. Review of the initial CTI revealed a verbal order by the Administrator dated the day of the start of care and a verbal order by the admission registered nurse two days later. Further review of the CTI revealed no documentation or signature from the Medical Director. This was discussed with the Medical Director and reviewed and discussed with the Director of Clinical Services and validated.

Observed in Patient Home. In 1 of 3 home visits conducted, During HV# 2's home observation, it was noted the organization had not ensured the patient's record contained information that reflected the care treatment and services. For example: HV# 2 was observed without oxygen during the home observation. Review of HV# 2's plan of care revealed patient was on continuous oxygen at 4L per nasal cannula. This was observed, reviewed and discussed with the Director of Clinical Services and validated.

Observed in Record Review. In 3 of 5 patient records reviewed, During HV# 1, HV# 2, and RR# 2's patient record review, it was noted the organization had not ensured the patient records included all of the physician/practitioner orders. For example: review of RR# 2's patient record revealed no documentation of a physician/practitioner referral order for a hospice evaluation for the organization. Further review of RR# 2's record revealed a physician/practitioner referral order for a hospice evaluation to a different hospice organization. Review of HV# 2's patient record revealed no documentation of a physician/practitioner referral order for a hospice evaluation. Review of HV# 1's patient record revealed no documentation of a physician/practitioner referral order for a hospice evaluation. This was reviewed and discussed with the Director of Clinical Services and validated.