Every finding on record at Clearwater Hospice

Based on observation, interview, and document review, the agency failed to ensure the agency had interventions/ orders to manage a Foley catheter for 1 of 1 patient(s) (P1) reviewed with a catheter. --- Findings include: P1's plan of care (POC) dated 2/28/23 through 5/28/23, identified a start of care (SOC) date of 11/30/22. Diagnoses included edema, pulmonary edema, diabetes, congestive heart failure, and vascular dementia, Functional limitations indicated P1 was incontinent of bowel and bladder. Skilled nurse visits (SNV) were ordered one to three times per week and as needed (prn) for various assessments, support and teaching. Home health aide visits were ordered three times per week for thirteen weeks to assist with bathing, dressing, grooming, transfers, peri care, skin care, foot care and catheter care. P1's skilled visit note dated 3/13/23, indicated registered nurse (RN)-A completed a home visit with various assessments conducted. The SNV note indicated RN-A performed a Foley catheter change, inserting a new 16 French 10 cubic centimeter (cc) balloon, using sterile technique. P1's medical record lacked diagnosis, physician orders, and nursing interventions regarding P1's indwelling Foley catheter. During a home visit on 4/3/23, at 1:30 p.m. P1 was observed sitting in his recliner. A foley catheter leg bag was attached to his lower left leg and had a small amount of yellow urine in the bag. P1 denied any recent concern with his catheter and stated the girls at the assisted living assisted him with catheter care. When interviewed on 4/3/23, at 1:00 p.m. RN-A stated P1 had an indwelling catheter placed during his last hospitalization in of December 2022. P1's catheter was to be changed by the hospice nurse on a monthly basis and daily catheter care was done by the assisted living staff where P1 resided. P1's catheter, catheter care and monthly sterile catheter changes were not addressed on P1's POC and should have been. The agency's undated Care Plans policy identified the care plan would address the identified needs of the client and the planned interventions to meet those needs and specific, measurable goals. The care plan would include the type of services, supplies and equipment required and all medications and treatments. The agency's Implementation of Medication Prescriptions and Treatment and Therapy Orders, dated January 2014, indicated prescriptions for medications and orders for treatments or therapy must be implemented as quickly as possible. The RN would update the client records and service plan as necessary to reflect a new order. Orders would be added to the client record in the appropriate place and update the service plan, care plan, medication record or other documents as necessary. The agency's undated Physician Orders, indicated all medications, treatments and services provided to clients must be ordered by a physician.