Every finding on record at Dignity Hospice Care Inc

Observed in Emergency Management Session. The organization has a written delegation of authority plan that did not provide the individual(s) with the legal authorization to act on behalf of the organization for specified purposes and to carry out specific duties. The organization had created a succession tree for delegation of authority in the absence of a key leader, however the organization had not specified particular functions that an individual was authorized to perform, nor any restrictions or limitations associated with that authority.

Observed in Document Review. the organization had not informed the patient of the patient's rights both orally and in writing. The organization's consent form and admission documents did not include any information regarding the patient's responsibility or lack of responsibility for payment. This was discussed with the Alternate DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not conducted and documented a patient-specific assessment and reassessment. During RRHV#2, the patient was Spanish speaking, yet the SN did not speak Spanish; the care providers in the home did not speak Spanish as confirmed with the RN during the home visit. The patient was not able to answer most questions regarding pain level other than yes or no, questions about bowel movements, etc. due to the language barrier. Upon questioning, the RN indicated she uses the family on the phone when needed, however there was no one available during the visit to assist with translation services. This was discussed with the Administrator.

Observed in Record Review. In 1 of 5 patient records reviewed, the record was not accurate. In the chart for RRHV#2, the initial nursing assessment indicated that no translator was needed and the patient was English speaking. This was not accurate as confirmed with the Alternate DPCS.

Observed in Record Review. In 4 of 4 patient records reviewed, the written plan of care was not based on the patient's goals and the time frames, settings, and services required to meet those goals. In all records reviewed in which Spiritual Care was included, the Spiritual Care goal was not a goal, rather an intervention. Chaplain will continue to offer monthly emotional and spiritual support. This was discussed with the Alternate DPCS.

Observed in Record Review. In 5 of 5 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. All plans of care reviewed included prn visits for nursing, however did not include what indication would necessitate a prn visit. This was discussed with the Alternate DPCS.

Observed in Record Review. In 2 of 5 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: Medications and treatment necessary to meet the patient’s needs. In the charts for RRHV#1 and RRHV#2, the patients were assessed to be at high risk for pressure ulcer development, yet the plans of care did not include any interventions related to risk reduction. This was discussed with the Alternate DPCS.

Observed in Document Review. In 2 of 3 contracts reviewed, the written agreement with an outside agency providing contracted services for the hospice did not include the following: A stipulation that services will be delivered in accordance with the patient’s plan of care. This stipulation was missing in the DME and Pharmacy contracts. This was discussed with the Administrator.

Observed in Document Review. In 2 of 3 contracts reviewed, the written agreement with an outside agency providing contracted services for the hospice did not include the following: 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 stipulation was missing in the DME and Pharmacy contracts. This was discussed with the Administrator.