Every finding on record at Comprehensive Hospice Care, LLC

Upon patient record review 9 of 11 (Patient #1,2,4,5,6,8,9,10,11) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patients #1,2,4,5,6,8,9,10,11, Patient refused MSW and SC initial evaluation, there was no evidence of a spiritual or psychosocial assessment completed.

Upon patient record review, 8 of 11 (Patient #1,2,3,4,6,7,9,10) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1, Naloxone 0.4mg/ml PRN no reason for PRN Patient #2, hydrocodone/acetaminophen 5/325 PRN, no reason for PRN Patient #3, Atropine every 4 hours as needed, no reason for PRN Patient #4, Albuterol PRN every 6 hours, no reason for PRN Patient #6,Ibuprofen 800mg 1 time prn, no reason for PRN Patient #7, Tramadol 50mg 1 tab PRN, no reason for PRN Patient #9, Lidocaine patch 4% 2x/day PRN, no reason for PRN, Percocet 10-325mg PRN, no reason for PRN. Patient #10, Levsin 0.125mg as needed, no reason for PRN, Norco 10-325 1 tab PRN, no reason for PRN.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1, Aide used blood pressure cuff to check blood pressure then returned cuff back to original place on clean area without cleaning cuff first. Patient #2, RN set up wound care dressing that are kept in specific box, RN went in and out of wound care box without sanitizing hands in between. RN removed one glove and went into her nursing bag without sanitizing hands prior to entering nursing bag then placed used glove back on her hand. RN removed a dressing from nursing bag and placed on patient bed, then opened dressing and placed on clean work area then placed dressing packaging on top of the clean dressing. RN removed soiled dressing, tossed dressing into garbage can without containing soiled in bag and did not change dirty gloves prior to picking up clean dressing.

Upon patient record review, 10 of 11 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patients #1,2,3,4,5,6,7,8,9,10. All aide care plans documented vitals every visit without parameters to report to RN. Patient #1, Aide care plan documented to give both shower and bed bath without documentation on how the aide would pick which one.

Upon patient record review 1 of 11 (Patient #3) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #3, Care Plan states to shave every visit, documented not done, no documentation RN was notified.

Upon patient record review 1 of 11 (Patient #7) did not have evidence in the patient record that the hospice aides report: • Changes in the patient's medical, nursing, rehabilitative, and social needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities • Hospice aides must also complete appropriate records in compliance with the hospice's policies and procedures Patient #7, Aide documented skin redness under neck and underarm applied skin cream, no documentation RN was notified or RN directed aide to apply skin cream.

Upon patient record review, 11 of 11 (Patient #1,2,3,4,5,6,7,8,9,10,11) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1,2,3,4,5,6,7,8,9,10,11. All IDT notes missing MSW and SC signatures.

Upon patient record review, 3 of 11 (Patient #9,10,11) did not have evidence that the discharge summary includes all required information. Patient #9,10,11, Discharge summary did not include: current plan of care, latest MD orders, summary of patients stay, including treatments, symptoms and pain management.