Every finding on record at Desert Care Enterprises, LLC

Observed in Record Review. In 1 of 14 records, the agency did not present the patient or appropriate caregiver timely written notification that their Medicare-covered services were ending via the Medicare Notice of Non-Coverage requirement. Example: In RRNHV#7, the agency did not present the patient and caregiver with the NOMNC information. This was confirmed by the DCPS.

Observed in Tracer Visit. In 2 out of 14 records, assessment and reassessment of wounds were not performed per policy. Examples: In RRHV#1, a Stage 1 wound was identified in week 3 of admission. However, wound measurements have not been completed upon identification or during reassessment visits per policy. In RRNHV#9, coccyx wound measurements were not completed per policy. This was confirmed by the DCPS.

Observed in Record Review. In 1 of 4 applicable recertification records, the plan of care was not updated at recert. Example: In RRNHV#7, the left buttock, left lateral leg, and back wounds were resolved during benefit period #5. However, the interventions and goals remained on the POC for benefit period #6. This was confirmed by the DCPS.

Observed in Tracer Visit. In 1 out of 14 records reviewed, multiple PRN medications were prescribed to treat the same symptom without clear guidance on when each medication should be administered. Specifically, in RRHV#1, Tylenol and Hydrocodone were ordered prn for pain without guidance on when each should be administered. This was confirmed by the DCPS.

Observed in HR File Review. The organization was unable to provide documentation of defined competencies for the Volunteer Coordinator role. This was confirmed by the DCPS. Observed in HR File Review. In 1 out of 9 HR records reviewed, competencies were not assessed or documented as part of staff orientation. Example: In the HR#4 (Volunteer Coordinator) file, no competencies had been documented since the date of transition into the role. This finding was confirmed by the DCPS.

Observed in Record Review. In 2 out of 3 live discharge records, the hospice did not provide the patient’s attending physician with a copy of the hospice discharge summary and, if requested, a copy of the patient’s clinical record. Examples: In RRDC#1 and RRDC#2, there was no evidence that a discharge summary had been sent to the Attending Physician after discharge from hospice. This was confirmed by the DCPS.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to ensure that the primary care giver receive education and training provided by the hospice to their responsibilities for the care and services identified in the plan of care. For example: on review of RR#5 the patient was diabetic and receiving insulin and blood glucose monitoring. There was no documentation noted in the clinical record that the patient and/or primary care giver received education and training on diabetes management at the end of life and how to properly administer insulin, and safely monitor blood glucose. There was also no documentation noted to ensure that the patient/caregiver was able to demonstrate proficiency in providing the care. Similar lack of education and training on diabetes management can also be seen in RR#9. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, The organization failed to ensure that the individualized written plan of care was based on the patient's goals, and the goals were specific, measurable, attainable, realistic, and time bound. For example: on review of HV#1 the goal established for musculoskeletal was noted to not be specific and measurable as it read Patient is stand by assist with walking while using front wheel walker. In HV#2 the goal for cardiovascular was not measurable as it stated Prevent discomfort due to increasing edema and for falls a goal was Encourage patient to use bed side commode at night. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 6 of 11 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness to include measurable outcomes anticipated for implementing and coordinating the plan of care. For example: On review of HV#3, documentation in the record noted the patient had issues with combative behavior, agitation and hallucinations yet these issues were not reflected in the care plans. In RR#4 the patient was having issues with pain control yet the changes in the patient status were not reflected in the care plan. In RR#5 the patient was diabetic and required blood glucose monitoring, yet these issues were not noted on the care plans. In RR#8 the patient was ordered PT/INR monitoring, and multiple coumadin changes, along with bleeding precautions yet the care plans did not reflect these issues. In RR#10 the patient had a foley catheter but no care plan for urinary issues. This patient also had comfort medications initiated near the end of life, yet the issues were not reflected in the plan of care. In RR#11 the patient was receiving spiritual counseling yet there was no spiritual care plan. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization failed to ensure that the patient record contain information that reflected that patient's care, treatment, and services. For example: on review of RR#5 the documentation for the RN recertification visit was incomplete at time of survey 28 days after the visit took place. In RR#4 the documentation for an RN patient visit with changes in the patient's pain medication was incomplete at the time of survey 13 days beyond the visit date. Organization policy requires documentation to be submitted within 7 business days of the visit. Example 2: on review of RR#8 the patient was ordered multiple PT/INR's that were conducted and documented in the record, however the SN documentation failed to specify how the monitoring was conducted, such as finger stick versus blood draw, the site, how the site was cleaned, and how bleeding was ceased. These observations were reviewed with the Administrator/DPCS.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization failed to ensure the clinical record contain correct clinical information. For example: upon review of HV#1 documentation noted the patient to be a 7C on the FAST scale, however documentation in the clinical record and noted on home observation the patient was able to converse verbally and ambulated independently with the use of a walker. Similar documentation of a Fast score of a 7c could be seen in RR#11, yet the clinical documentation noted that the patient was verbal. In RR#7 the care plan for gastrointestinal noted Free of infection on G-tube site and Patient will have skin integrity maintained around G-tube site, however there was no indication in the clinical documentation that the patient had a G-tube. This observation was reviewed with the Administrator/DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to ensure that the hospice plan of care specifically identify which provider is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. For example: on review of RR#5 there was an order for insulin that specified check blood sugar before meals and hold insulin if blood sugar is less than 250 and call hospice however the plan of care failed to identify who was responsible for the blood glucose monitoring. In RR#9 the patient was also diabetic with a goal addressing blood glucose monitoring, yet the care plan failed to identify who was responsible for the blood glucose monitoring. This observation was reviewed with the Administrator/DPCS.