Every finding on record at Creative Hospice Care, Inc - Newnan

Observed in Tracer Activities. During review of the Volunteer Training Program, it was noted that education on their role during an emergency was not included in the initial training for volunteers. Upon further discussion with Corporate Leadership, it was discovered that the Volunteer Coordinator was not using the most recent updated Volunteer Training Program that had been developed by the corporate office over a year ago.

Observed in Record Review. In 3 of 14 patient records reviewed, it was noted by the nurse surveyor that the initial bereavement risk assessment had not been completed as required for RRNHV#3, RRNHV#7, and RRBR#2. Findings were verified by the Branch Director.

Observed in Record Review. In 10 of 10 patient records reviewed, for active hospice patients the nurse surveyor noted that the goals were not consistently measurable. For example, “Pulse oximetry reading is obtained and appropriate intervention is initiated,” and “Pain will be managed at a level acceptable to patient by end of certification period”. Additionally, goals were mostly the same from patient to patient with minimal individualization. There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety, most time frames for completion were at the end of certification period or had no time frames for completion at all. Findings were discussed with the Branch Director and other Leadership present.

Observed in Patient Home. In 3 of 3 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per policy “Hand Hygiene IC15” During RRHV#1 the hospice aide washed her hands in the patient’s sink with soap and water prior to providing care. She then donned gloves and proceeded to set up the shower, then assisted the patient to undress, helped her into the shower, and provided care, all with the same gloves on. During RRHV#2 the skilled nurse did not hand sanitize between touching the patient and objects in the patient’s room. She then hand sanitized and put gloves on and assisted the patient to the bedside commode. The nurse changed gloves, hand sanitizing appropriately, prior to doing wound care. She then cleaned the new wound site on patient’s right hip and applied a dressing, then removed the old dressing on the patient’s sacrum, cleansed that wound and applied a new dressing all with the same gloves on. During RRHV#3 the chaplain hand sanitized prior to entering the facility and prior to sitting down with the patient. She then documented on her tablet, held the patient’s hands while praying, documented again, all with out hand sanitizing. Findings were verified by the Branch Director who was present on the home visits.

Observed in Record Review. In 3 of 10 patient records reviewed, for active patients, 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. For RRHV#1, the patient care plan had that the patient was to be given a tub bath and had not been updated to reflect that the patient was being given a shower. For RRHV#2, the hospice aide care plan did not address what the hospice aide’s responsibility was regarding the patient’s wound on her coccyx. Additionally, the patient was on oxygen and there were no instructions to indicate if the patient’s oxygen could be removed for her bath. For RRNHV#1, the care plan did indicate how often each assigned task was to be performed. Also of note, none of the records reviewed gave any instructions of when the nurse was to be notified. Findings were verified by the Branch Director.

Observed in Patient Home. In 1 of 3 home visits conducted, It was noted by the nurse surveyor that for RRHV#1 the hospice aide did not provide care according to the hospice aide plan of care. The hospice aide plan of care had that the patient was to get a tub bath, however the hospice aide assisted the patient to take a shower as it was safer for the patient and she could not get in and out of the tub. Finding was validated by the Branch Director who was present on the home visit.

Observed in Tracer Activities. It was noted by the nurse surveyor that volunteers did not provide at least 5% of the total patient care hours of all paid hospice employees and contract staff for the last year and for the first two months of this year. There are currently two active volunteers. Finding was verified by the Volunteer Coordinator and the Branch Director.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the surveyor during the medication review by the nurse that the medication profile did not accurately reflect what the patient was taking or using. For RRHV#2, the patient was using Vicks Vapor rub on her chest, and the nurse was using Dakin's Solution to clean the wound, but neither on the medication profile in the medical record. Additionally, Zinc Oxide ointment, wound cleanser, and Betadine had been ordered weeks ago for wound care, but they had not been added to the medication profile in the electronic medical record. The medication profile had also not been updated to reflect and increase in the oxygen flow rate from 2 liters to 4 liters per minute BNC. Finding was validated by the Branch Director who was present during the visit.

Observed in Patient Home. In 2 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#1, and RRHV#2, the patients did not have an individualized disaster plan in their home folders. Additionally, when asked about being taught about what to do in an emergency situation if evacuation was necessary, the caregiver for RRHV#1 could not remember it ever being discussed. Finding was verified by the Branch Director who was present during the home visits.