Every finding on record at Charter Hospice of Houston, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs, other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. THIS IS A CONTINUING PRIOR REQUIRED ACTION. This standard was not met as evidenced by clinical record review and interview. 5 of 5 (100%) applicable records for patients receiving oxygen therapy reviewed revealed there was no documented evidence of oxygen on the patient's medication profile Record #49997: The comprehensive assessment dated 11/08/2021 new orders stated, "Oxygen at 2-4l / min per nasal cannula prn." An oxygen concentrator was delivered to the patient's home to be used prn. The drug profile was reviewed on 11/22/2021 at IDG. There was no documented evidence of oxygen updated to the drug profile up to the review date on 11/29/2021. Record #44357: The comprehensive assessment dated 11/01/2021 new orders stated, "Oxygen at 2-4l / min per nasal cannula prn." An oxygen concentrator was delivered to the patient's home to be used prn. The drug profile was reviewed on 11/08/2021 and 11/22/2021 at IDG. There was no documented evidence of oxygen updated to the drug profile up to the review date on 11/29/2021. Record #27588: The comprehensive assessment dated 11/10/2021 new orders stated, "Oxygen at 2-4l / min per nasal cannula prn." An oxygen concentrator was delivered to the patient's home to be used prn. The drug profile was reviewed on 11/22/2021 at IDG. There was no documented evidence of oxygen updated to the drug profile up to the review date on 11/29/2021. Record #65283: The comprehensive assessment dated 11/06/2021 new orders stated, "Oxygen at 2-4l / min per nasal cannula prn." An oxygen concentrator was delivered to the patient's home to be used prn. The drug profile was reviewed on 11/08/2021 and 11/22/2021 at IDG. There was no documented evidence of oxygen updated to the drug profile up to the review date on 11/29/2021. Record #55900: The comprehensive assessment dated 11/06/2021 new orders stated, "Oxygen at 2-4l / min per nasal cannula prn." An oxygen concentrator was delivered to the patient's home to be used prn. The drug profile was reviewed on 11/11/2021 and 11/18/2021 at IDG. There was no documented evidence of oxygen updated to the drug profile up to the review date on 11/29/2021. The Director of Patient Care Services (DPCS) was interviewed on 11/29/2021." The DPCS confirmed this finding and instructed the RN to update the medication profiles to include the prn orders for oxygen on 11/29/2021.

It is required that hospice aides are assigned to a specific patient by a Registered Nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. 1 of 5 (20%) applicable records of patients receiving aide services indicated that the RN did not provide specific instructions on the aide plan of care. Thus allowing the aide to make decisions that are out of their scope of practice. Record #27588: The patient was admitted on 10/10/2021. The aide plan of care initiated by the RN on 10/10/2021 instructed the aide to change the patient's linen 1 time a week and prn. The Director of Patient Care Services (DPCS) was interviewed on 11/29/2021 and stated," The RN was not specific on the aide plan of care. "The DPCS confirmed this finding and stated, "The RNs will be educated on being specific on the aide plan of care."

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. THIS IS A CONTINUING PRIOR REQUIRED ACTION. This standard was not met as evidenced by a review of clinical records and interview. 1 of 5 (20%) applicable records of patients that received hospice aide services, evidence revealed that services were not completed in accordance with the orders for the tasks assigned by the RN on the aide plan of care. Record #55900: The patient was admitted to services on 11/06/2021. The aide plan of care initiated by the RN on 11/08/2021 instructed the Aide to shampoo the patient's hair 1 time a week on Mondays. The Aide documented on 11/08/2021 and 11/10/2021 that shampoo was done on both days of the same week. The Director of Patient Care Services (DPCS) was interviewed on 11/29/2021 and stated," The Aide did not follow the plan of care." The DPCS confirmed this finding and stated, "The aides will be educated on following the patient's plan of care."

It is required that hospice aides must report changes in the patient's medical, nursing, rehabilitative, and/or social needs to a Registered Nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient's needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by a review of clinical records and interview. 1 of 5 (20%) applicable records of patients that received Hospice Aide services, evidence revealed that the Aide did not report changes to the RN regarding performing additional tasks on the Aide plan of care. Record #55900: The patient was admitted to services on 11/06/2021. The Aide plan of care initiated by the RN on 11/08/2021 instructed the Aide to shampoo the patient's hair one time a week on Mondays. The Aide documented on 11/08/2021 and 11/10/2021 that shampoo was done on both days of the same week. There was no documented evidence that the RN was notified that the Aide completed a task twice during the same week. The Director of Patient Care Services (DPCS) was interviewed on 11/29/2021 and stated," The Aide did not report to the RN of tasks not completed as instructed on the plan of care."