Every finding on record at Dedicated Hospice Care, Inc.

Observed in Record Review. In 3 of 13 patient records reviewed, During RR#2 it was noted the patient had diabetes type 2 on insulin that was listed on the medication profile. The initial RN evaluation lacked a baseline assessment of the patient's diabetic status. During RR#3 it was noted the patient had diabetes type 2 on metformin that was on the medication profile with blood sugar parameters to notify the physician. The initial RN evaluation lacked a baseline assessment of the patient's diabetic status. During RR#5 it was noted lack of a diabetic assessment performed during the initial RN evaluation. The patient was prescribed metformin and orders to report blood sugar reading not within stated parameters. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 13 patient records reviewed, During RR#5 it was noted during an IDG meeting the beginning of May 2023 on the RN summary, the patient's blood sugars were increasing and the physician ordered Metformin 500 mg PO twice a day. Caregiver to continue to provide fasting blood sugars checks twice daily and will monitor for medication effectiveness. Interventions and goals were not added to the POC for the change in the patient's diabetic status. This was discussed with the organization leadership.

Observed in Record Review. In 4 of 13 patient records reviewed, During RR#4 it was noted dressing change orders for pressure ulcer care and treatment to a gangrenous foot did not indicate who was to perform the wound care. During RR#6 it was noted dressing change orders for pressure ulcers on the patient's coccyx did not indicate who was to perform the wound care. During RR#7, it was noted a pressure ulcer care order that did not indicate who was to perform the dressing changes. During RR#8 it was noted on the RN summary during an IDG in May 2023, the patient had a skin tear on the left hand with an order to cleanse with NS, pat dry, apply triple ATB ointment, cover with dry dressing daily x 30 days and reassess. This was not added to POC to establish goals, other interventions related to the wound and who would perform the wound care. This was discussed with the organization leadership. Observed in Record Review. In 2 of 13 patient records reviewed, During RR#3 and #7 it was noted the medication profile lacked the flushing protocol for medications that were to be administered via G-tube. This was discussed with the organization leadership

Observed in Record Review. In 10 of 13 patient records reviewed, During review of HV#1-3, RR#1-5, 8 and 10 it was noted lack of medical supplies related to patient incontinence issues that were necessary to meet the patient needs were not listed on the POC. In addition RR#4 POC lacked dressing supplies used for pressure ulcer care. During RR#8 it was noted lack of wound care supplies added to the POC in May 2023. During RR#10 it was noted wound care supplies were not added to the POC in May 2023. This was discussed with the organization leadership.

Observed in Patient Home. In 1 of 3 home visits conducted, During HV#3 it was noted the SN after performing vital signs using a BP cuff, stethoscope, and thermometer, placed the equipment into the nursing bag without disinfection of equipment. The organization policy #9-014 Beg Technique stated #5 when the visit is complete, reusable equipment will be cleaned using alcohol and/or soap and water as appropriate, hands will be washed and equipment and supplies will be returned to the bag. This was discussed with the organization leadership.

Observed in Record Review. In 10 of 13 patient records reviewed, During HV#1-3 and RR#1-3, 5, 6, 7 and #10, it was noted the section on advanced directive information, if the patient had an advanced directive, was blank on the consent forms. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 13 patient records reviewed, During RR#3 it was noted the patient medical record lacked accurate documentation. The patient was NPO and received medications and nutrition via a G-tube. The following interventions related to the ordered comfort kit were as follows: Educate PCG on non pharmacological interventions for managing nausea/vomiting (avoid foods and smells that trigger nausea, offer dry food like crackers or toast or bland, simple foods like broth, rice, bananas, or Jell-O, Position the patient upright while eating and for 1 to 2 hours post-meal. This was discussed with the organization leadership.

Observed in Emergency Management Session. During review of the organization admission patient/family information, it was noted lack of an individualized plan and procedures to follow if care, treatment, or services are disrupted by a natural disaster or an emergency. The form in the packet labeled Emergency Plan is comprised of a fill in list of telephone numbers for the patient/family to call. This was discussed with the organization leadership.

Observed in Document Review. During review of the organization contract with a skilled nursing facility (SNF) it was noted lack of a provision that stated the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 2 patient records reviewed, During HV#1 record review it was noted the frequency of visits for the spiritual counselor (SC) was once a month and as needed for spiritual needs/support. The order lacked the number of as needed visits proposed for the certification period. This was discussed with the Director of Nursing.

Observed in Record Review. In 1 of 2 patient records reviewed, who received hospice aide services. During RR#1 it was noted the hospice aide assignment form completed the end of May 2021 contained an order for oxygen therapy 2L/min continuously. There is an IDG order the day before the hospice aide assignment was documented as complete that increased the oxygen therapy from 2L/min continuously to 5L/min continuously. The hospice aide assignment was not updated to reflect the change in the oxygen order. This was discussed with the Director of Nursing.