Every finding on record at Constellation Hospice Oh LLC

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical record reviewed revealed that the agency did not ensure that each patient's individualized plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 2: The patient’s election of the hospice benefit was dated 08/29/2024 with a primary and secondary diagnosis of Heart Failure, Atrial Fib, Edema, HTN, Venous Insufficiency, and Dementia. The Plan of Care (POC) dated 08/29/2024 to 11/26/2024 included the medication Eliquis (anticoagulant) 5mg twice daily. The patient has a diagnosis of Dementia and was a high fall risk on the care plan AEB: The MAHC-10 (fall risk assessment) performed 08/29/2024 score was (8) eight (anything greater than a (4) four is at risk). The POC did not include bleeding precautions. In an interview on 12/04/2024, the Administrator/Registered Nurse (RN) stated that the bleeding precaution was missed as the focus was on the overall care plan.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions and hand hygiene. This standard was not met as evidenced by document review and observation. In 1 of 3 (33%) home visit observations, the agency did not ensure that accepted standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions and hand hygiene, were followed. Document 1: The agency's policy read in part, " When the visit is completed, reusable equipment will be cleaned using alcohol, soap, and water, or other appropriate solution, hands will be washed, and equipment and supplies will be returned to the bag. Hands will be decontaminated before returning clean equipment to bag." (Bag Technique) (November 2023). Home Visit 3: A home visit (Home Visit 3) with the Registered Nurse (RN) (Personnel Record 3) on 12/04/2024, the RN was observed using the thermometer and blood pressure cuff. The RN cleaned each piece of equipment with an alcohol pad and did not perform hand sanitation before placing the equipment back in the bag. In an interview on 12/05/2024, the Registered Nurse (RN) (Personnel Record 3) admitted to being nervous during the observation and not performing hand hygiene before placing clean equipment back in the nursing bag.

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. In 1 of 14 (7%) clinical record reviews revealed that the agency did not ensure written patient care instructions for a hospice aide were prepared by a RN who was responsible for the supervision of the hospice aide. Clinical Record 2: The patient’s election of the hospice benefit was dated 08/29/2024 with a primary and secondary diagnosis of Heart Failure, Atrial Fib, Edema, HTN, Venous Insufficiency, and Dementia. The Plan of Care (POC) dated 08/29/2024 to 11/26/2024 included the medication Eliquis (anticoagulant) 5mg twice daily. The patient has a diagnosis of Dementia and was a high fall risk AEB: The MAHC-10 (fall risk assessment) performed 08/29/2024 score was (8) eight (anything greater than a (4) four is at risk). The aide care plan included instructions to shave the patient's chin but did not include bleeding precautions. In an interview on 12/04/2024, the Administrator/Registered Nurse (RN) stated that the bleeding precaution was missed as the focus was on the overall care plan.