Every finding on record at Desert Harmony Hospice of Tucson

Observed in Patient Home. In 4 of 4 home visits conducted, the hospice had not provided the patient/family with written information about its policies on advance directives, including a description of any state law concerning advance directives. In review of the home folder for RRHV #1 the surveyor noted that the organization had included the policy 1006 on Advance Directives which the CEO/Executive Director stated was outdated and had been updated. The home folder did not include the organization's current policy on Advance Directives PC. A35 and there was no evidence that the organization had provided information on Arizona state law on Advance Directives. This was also observed for RRHV #2, RRHV #3 and RRHV #4. This was validated with the CEO/Executive Director.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization had not provided services according to the patient's plan of care. In review of the medical record for RRHV #3 the frequency for skilled nursing visits was twice weekly however for the 4th week of care a skilled nursing visit was only made once. Additionally, the frequency for spiritual care was one time a month however there was no evidence that a spiritual care visit occurred during the second month of service. This was validated with the CEO/Executive Director.

Observed in Patient Home. In 2 of 4 home visits conducted, staff failed to perform hand hygiene consistent with the organization's policy PC. 125 Infection Control - Hand Hygiene. For RRHV #1 the social worker failed to perform hand hygiene after contact with the patient's immediate environment (bed), after contact with the primary caregivers and after leaving the home. For RRHV #4 the RN failed to perform hand hygiene after handling the patient's medications and again failed to perform hand hygiene after handling the patient's nebulizer equipment. This was validated with the Director of Social Work and also the Director of Nursing. Observed in Patient Home. In 1 of 4 home visits conducted, disinfectant manufacturer instructions for use were not followed. For RRHV #2 the RN did not follow contact time (wet time) as specified by the manufacturer’s instruction for use of the Sani-Wipes which requires a 1 minute wet time. The RN wiped the equipment used during the visit including temporal thermometer, blood pressure equipment, pulse oximeter, stethoscope and bandage scissors and replaced each item back into the clinical bag after wiping with the Sami-Wipe. This was validated by the Director of Nursing. Observed in Patient Home. In 1 of 4 home visits conducted, the organization had not followed their policy Nursing Bag Requirements which states that the nursing bag is placed on a barrier when the Nurse enters the patient home. The RN failed to use a barrier for the skilled nursing visit for RRHV #4 and placed equipment including the blood pressure cuff, thermometer, oximeter and phone directly on the patient's dining room table and did not use a barrier as required. This was validated by the Director of Nursing.

Observed in HR File Review. In 2 of 2 HR files reviewed, for volunteers, the organization had not assessed staff competence and documented as part of orientation. In review of the personnel files for HR #9 who joined the volunteer program four years ago and for HR #10 who became a volunteer six weeks ago there was no documented evidence that volunteer competencies had been assessed. This was validated by the Volunteer Coordinator.

Observed in Patient Home. In 1 of 2 home visits conducted, with nursing staff, the patient's record did not contain an accurate list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care, treatment, or services. For RRHV #4 who had been admitted to the hospice program four weeks ago, the medication profile in the clinical record and the medication list provided to the patient was not accurate. For example, the medication profile included Jardiance 10mg daily and Levothyroxine 25MCG daily and the primary caregiver reported that those medications had been stopped two weeks ago however despite nursing visits twice weekly the medication list in the patient home and medication profile in the medical record had not been updated. This was validated by the Director of Nursing.

Observed in Patient Home. In 1 of 1 home visits conducted, to a skilled nursing facility, the organization failed to provide the Skilled Nursing Facility with the physician certification of terminal illness. In review of the facility record for RRHV #2 who resided in a skilled nursing facility and in discussion with facility staff there was no evidence that the hospice had provided the physician certification of terminal illness to the skilled nursing facility. This was verified by the Director of Nursing.

Observed in Document Review. In 1 of 3 contracts reviewed, the written agreement with an outside agency providing contracted services for the hospice did not include all required elements. In review of the current contract for durable medical equipment there was no evidence that the contract included a stipulation that the outside agency will complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This was validated by the Director of Operations.

Observed in Record Review. In 3 of 3 patient records reviewed, Review of medical records identified that the goals for problems identified were not measurable. Examples include: Goal for wrist swelling was not measurable, e.g. will achieve optimal skin integrity, for pain, achieve and maintain optimal physical comfort, for oxygen safety, maintain safety of patient, environment and equipment, for fall risk falls prevented or reduced whenever possible throughout length of stay, for poor appetite and weight loss, optimal nutrition and hydration. These goals are templates in the electronic medical record. This was verified with leaders.