Every finding on record at Creative Hospice Care, Inc

Observed in Record Review. In 1 of 7 patient records reviewed, for active patients, it was noted by the nurse surveyor that the comprehensive assessment was not completed within five calendar days of the election of the hospice benefit. For RRNHV#3, the social worker documented her assessment one day late. There was no documentation in the electronic medical record to indicate why her visit was completed late. Finding was verified with the Branch Director, Administrator, and the Regional Clinical Specialist.

Observed in Record Review. In 3 of 7 patient records reviewed, for active patients, it was noted by the nurse surveyor that the initial bereavement risk assessment had not been completed as part of the comprehensive assessment. For RRHV#3, it was completed three months late. For RRNHV#2, it was completed three days late. For RRNHV#3, it was completed five days late. Findings were verified by the Branch Director, Administrator, and the Regional Clinical Specialist.

Observed in Record Review. In 7 of 7 patient records reviewed, for active hospice patients the nurse surveyor noted that the goals were not consistently measurable. For example, “Patient/caregiver understands effects of terminal illness on nutrition and hydration,” and “Pain will be controlled at a level acceptable to patient”. Additionally, goals were mostly the same from patient to patient with minimal individualization. Findings were discussed with the Branch Director, Administrator, and the Regional Clinical Specialist.

Observed in Record Review. In 3 of 4 patient records reviewed, for active patients with oxygen,, it was noted by the nurse surveyor that the orders were not clear or complete. For RRHV#1, the oxygen order was for Oxygen 2 liters as needed for shortness of breath, however, there was no route of delivery for the oxygen noted in the order. For RRNHV#1, the oxygen order was for Oxygen 2 – 4 liters by nasal canula continuously. For RRNHV#2, the oxygen order was for Oxygen 1 – 4 liters by nasal canula prn SOB. Findings were verified with the Branch Director, Administrator, and the Regional Clinical Specialist.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noticed by the nurse surveyor that the nurse did not follow the organization’s bag/barrier policy. During RRHV#2, the nurse put her nursing bag on a barrier and took her clean equipment out of the bag and placed it on the barrier directly next to the bag. As she used each piece of equipment (blood pressure cuff, stethoscope, thermometer, measuring tape, and pulse oximeter) she returned the dirty equipment to the barrier, placing it on top of/directly next to the clean equipment still on the clean barrier. Finding was verified by the Branch Manager who was present on the home visit.

Observed in Record Review. In 1 of 3 patient records reviewed, for active patients with the hospice aide, It was noted by the nurse surveyor that the hospice aide care plan did not include all of the information for the hospice aide to effectively provide care. RRNHV#1, the patient was on oxygen prn and there were no instructions to indicate if the patient’s oxygen could be removed for her bed bath. Additionally, there were no instructions as to when to notify the nurse. There were also incorrect instructions as the patient had a foley catheter and the care plan instructed to empty the urinal. Findings were verified with the Branch Director, Administrator, and the Regional Clinical Specialist.

Observed in Tracer Activities. It was noted by the nurse surveyor that the Volunteer Coordinator did not document retention activities that she did with/for her volunteer. Finding was discussed with the Branch Director, Administrator, and the Regional Clinical Specialist.

Based on record review, staff interview, observations, and review of facility policy, the agency failed to obtain orders that were individualized to address the scope and frequency of services to meet specific patients needs of four patients (P) (P#2, P#5, P#9, and P#11) of four records reviewed. --- Findings include: Review of the facility policy titled, ";Wound Assessment", effective date 4/2021, revealed the following: Measurements F. Wounds shall be measured at least weekly upon assessment. H. Wounds will be photographed upon initial identification with any significant change (decline or progress) in wound status and/or at least monthly. Wound Care K. The agency will obtain physician wound care orders for all identified wounds. During a home visit with P#2 on 1/9/2024 at approximately 12:30 p.m., Registered Nurse (RN) DD failed to follow the agency's Wound Assessment policy to measure at least weekly and obtain photographs of wounds monthly, During the visit, RN DD revealed that she would assess the wound on the next visit as the caregiver had already provided the wound care. Review of records for P#2 revealed no pictures of wounds obtained monthly and upon initial wound identification. Review of records for P#5 revealed no pictures of wounds obtained monthly and upon initial wound identification. Review of records for P#9 revealed no pictures of wounds obtained monthly and upon initial wound identification. Review of records for P#11 revealed no pictures of wounds obtained monthly and upon initial wound identification. During an interview with the Administrator on 1/10/2024 at 10:30 a.m., the Administrator acknowledged that the agency failed to document location of wound sites and obtain frequency orders for wound care. She acknowledged that the agency failed to follow the Wound Assessment policy as to document the wound site location, measure at least weekly and obtain pictures upon initial identification and at least monthly for P#2, P#5, P#9 and P#11.