Every finding on record at Daviess Community Hospital

Observed in Record Review. In 5 of 10 records reviewed, surveyor noted that plan of care goals were not individualized with measurable goals and appropriate timeframes for goal attainment. For example in RRHV#1 RRHV#2 and RRHV#3 the goal for anxiety stated signs and symptoms of anxiety will be minimized. In RRHV#5 the goal for anxiety stated signs and symptoms of anxiety will be minimized and the goal for altered cardiac status stated symptoms of impaired cardiac function will be minimized. In RRHV#6 the goal for anxiety stated signs and symptoms of anxiety will be minimized and the goal for depression stated symptoms of depression will be minimized. This was reviewed with the Nurse Manager.

Observed in Patient Home. In 1 of 3 home visits, the nurse failed to provide care according to the patient's individualized plan of care. For example, in HV#2, during the course of the nurse attempting to reposition the patient the patient stated to the nurse it usually takes two people to turn me, the nurse stated to the patient I should be able to turn you; the nurse then attempted to reposition patient, then decided to stop attempting to reposition the patient due to difficulty of repositioning. The nurse then asked the organization's Nurse Manager who was present at visit for assistance with repositioning patient. Upon subsequent record review, patient's plan of care stated that patient was a two-person assist for mobility. This was reviewed with the Nurse Manager.

Observed in Patient Home. In 1 of 3 home visits, per organization's policy, the clinician failed to adhere to CDC guidelines for handwashing for infection control and prevention. For example, in HV#1 the Aide did not wash hands prior to donning gloves and providing care to patient. The Aide also did not remove gloves after providing incontinence care to patient, using the same gloves to clean patient's face with a washcloth causing a risk of urine and fecal matter to be transmitted from gloves to washcloth then to patient's face and/or eyes. This was reviewed with the Nurse Manager.

Observed in Record Review. In 1 of 3 home visits conducted, the initial bereavement risk assessment was not completed. In HOSRR #3, the Surveyor noted the initial bereavement risk assessment was not completed. There was not documentation explaining why. This was discussed with Clinical Manager.

Observed in Record Review. In 13 of 13 patient records reviewed, during record review of HOVS#1-3, BRR#1-2 and HOSRR# 1-8. The Hospice Surveyor noted that the plans of care based on patients' goals did not include time frames required to meet those goal and no measurable out comes were included in the plans of care for any of the identified goals. For example : in HOSV #1 patient will free of injury, HOSRR# 2 patient ADL needs are met to an optimal level, BRR# 1 PCG will express feeling of grief/loss. The goals were not measurable or time framed. This was confirmed with Clinical Manager.

Observed in Record Review. In 2 of 3 patient records reviewed, the surveyor noted that more than one medication had been ordered for pain, it was noted that there had not been instructions or directions for the patient regarding which pain medication to take when. For example, in HOSRR #7 and HOSRR# 6 the medication profile had Norco documented has take 1-2 tab every 4hrs PRN.Their were no qualifier to indicated when the patient should take the 1 tab of Norco or the 2 tab of Norco. This finding was validated with Clinical Manager.

Observed in Record Review. In 1 of 1 patient records reviewed, it had been found that orders had not been followed. During review of HOSRR # 3 it had had been found that the patient had an order for a port catheter to be flushes every 30 days. The surveyor noted that the port catheter had not been flushed as per the order on the plan of care. There was no evidence found that the organization had alerted the physician. This was validated by the Clinical Manager.

Observed in Record Review. In 13 of 13 patient records reviewed, it was noted that the plan of care was not updated and did not note the patient's progress towards goals. For example. In HOSRR#1-13, and HOSV#1-3, the plan of care was developed at the start of care and there was no indication that any goals had been met or revised. For example (HOSV#3) the surveyor noted that the plan of care was not updated since the patient was admitted 6 months ago. The care plan included goals and interventions to manage the patient anxiety and pain. The goals were sign and symptoms of anxiety minimized and Pain managed to tolerable level that remained on the care plan since admission This was confirmed by the Clinical Manager.

Observed in Record Review. In 3 of 3 home visits conducted, the hospice aide did not provide services in accordance with the aide plan of care. In HV#1-3, the nurse surveyor noted that the aide documented that she monitored the patient COVID19 s/s in her weekly task sheet. But the monitoring of COVID19 s/s task was not on the aide plan of care. This was confirmed by the Clinical Manager.