Every finding on record at Direct Hospice Inc

Upon patient record review, 2 of 14 (Patient #7,10) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #7,10, No evidence of order for oxygen therapy documented on medication profile. DME list identified oxygen concentrator and both RN assessments documented patient has shortness of breath relieved with use of oxygen 2L/NC. COS

Upon patient record review 1 of 14 (Patient #5) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #5, No evidence of RN supervisory visit was completed every 14 days. RN supervisory visits completed 10/27/25 then 11/11/25 which is 15 days.

Based on observation, interview, and record review, the Hospice Agency (HA) failed to ensure the patient was provided an option about choosing primary care physician for their medical care for two of four sampled patients (Patient 3 and Patient 4). This deficient practice had a potential to result in patients not given opportunity to choose their own primary physician to provide medical care for the patients. --- A review of Patient 3's (P3) Patient Information indicated a start of care (SOC) date of 07/23/2023, with a diagnosis of cerebrovascular disease unspecified (a group of conditions that affect blood flow and the blood vessels in the brain). A review of P3's Plan of Care (POC) for the certification period of 7/23/23 to 10/21/23, included an order for skilled nurse (SN) to visit once per week for changes in condition to promote comfort and symptom management, Registered Nurse (RN) once a month for supervisory visits, SN to monitor vital signs, Coronavirus Disease (COVID 19, a highly contagious infectious disease caused by severe acute respiratory syndrome) symptoms, and to manage symptoms of pain. During a phone interview with P3's family member on 8/24/23 at 2:20 p.m., stated a person from the agency offered them the services of the hospice agency. P3's family member stated that P3 suffered a cardiac arrest, had hip replacement and was hospitalized before going on hospice care. P3's family member stated that her primary physician retired already and P3 had not seen a doctor ever since she was discharged from the hospital on 7/21/23. P3's family member stated he just spoke to a nurse from the agency and she ordered the medications from the hospital. P3's family member stated, ";I would want a doctor come and see P3" P3 family member stated, P3 visited by a nurse who spends 30-45 mins just checking her vitals and medications. P3's family member stated that this person ";Neil" goes to different board and cares and facilities asking old people to go to these services. P3's family member stated "This person kept on calling our landlords asking for our names and numbers and I have never seen or met this person. This person lied to the landlord and lied to the people here." A review of Patient 4's (P4) clinical record indicated a start of care (SOC) date of 07/20/2023, with a diagnosis of atherosclerotic heart disease (is the buildup of fats, cholesterol and other substances in and on the artery walls, cause buildup of plaque, limiting blood flow to the heart). A review of P4's POC for the certification period of 7/18/23 to 10/15/23, included an order for skilled nurse (SN) to visit once per week for changes in condition to promote comfort and symptom management, Registered Nurse (RN) once a month for supervisory visits, SN to monitor vital signs, COVID 19 symptoms, and to manage symptoms of pain. During the home visit and an interview with P4 on 8/24/23 at 10:55 a.m., P4's family member stated she was referred by a close friend of P4 who knew a person named "Neil. When asked who this person ";Neil" was, P4 stated "he was a person who knew her friend and told her that she can benefit from a these kinds of services" and gave them information for the hospice agency. The hospice agency came and she was admitted. Pt 4 stated that ";Neil" is not a doctor or worked at a clinic but a person who works in an apartment building where her friend lives. P4 would not provide information about the person). During an interview with the owner/Administrator (owner/Admin) on 8/25/23 at 10:00 a.m., Owner/Admin denied any knowledge nor work relations with person named "Neil". Owner/Admin stated the patients should had provided an option to choose their own primary physician. Owner/Admin stated she received information from the patients but should have coordinated with their primary care physician first before documenting on the patient's medical record. A review of the HA's policy titled " Comprehensive Assessment" dated 11/2/22 indicated that during the comprehensive assessment, all baseline data and other relevant information will be documented, through interview and observation, in the patients clinical record. The patients past and present medical and psychosocial history including pertinent diagnosis and any co-morbid conditions, name and address of the patients attending physician, name of the hospital and other agencies or persons involved in the past and present care of the patient.

Based on observation, interview and record review, the hospice agency (HA) failed to ensure volunteer service program was maintained and was offered and provided for 2 out of 4 sampled patients (Patient 3 and 4). This deficient practice prevented the patients from receiving benefit from the volunteer program. --- A review of Patient 3's(P3) clinical record indicated a start of care (SOC) date of 07/23/2023, with a diagnosis of cerebrovascular disease unspecified (a group of conditions that affect blood flow and the blood vessels in the brain). A review of P3's Plan of Care (POC) for the certification period of 7/23/23 to 10/21/23, included an order for skilled nurse (SN) to visit once per week for changes in condition to promote comfort and symptom management. Registered Nurse (RN) once a month for supervisory visits. The POC further indicated for SN to monitor vital signs, Covid symptoms, and to manage symptoms of pain. During a phone interview with P3's son conducted on 8/24/23 at 2:20 p.m., P3's son stated they were never offered a volunteer and had not known of that service. A review of Patient 4's (P4) clinical record indicated a start of care (SOC) date of 07/20/2023, with a diagnoses of atherosclerotic heart disease (the buildup of fats, cholesterol and other substances in and on the artery walls, causes coronary arteries to narrow, limiting blood flow to the heart). A review of P4's POC for the certification period of 7/18/23 to 10/15/23, included an order for skilled nurse (SN) to visit once per week for changes in condition to promote comfort and symptom management. Registered Nurse (RN) once a month for supervisory visits. The POC further indicated for SN to monitor vital signs, Covid symptoms, and to manage symptoms of pain. During an interview with P4 and family member on the same date, stated that they were not offered volunteer services from the start of service. During an interview with the owner/administrator(owner/admin) of the HA on 8/25/23 at 10:00 a.m., owner/admin stated the volunteers are utilized for clerical stuff and helps with filling charts. A review of the HA's policy titled "Duties and Responsibilities of a Hospice Volunteer" from the Hospice Volunteer Program resource Manual, indicated that review of job descriptions of a various volunteer opportunities are companionship, respite, supportive tasks, spiritual support, bereavement and administrative assistance. The Home Care Volunteer is responsible for providing non-medical support services as needed to the home care patient and family on a volunteer service.

Based on observation, interview, and record review the facility failed to maintain an accurate medication profile for two of 4 sampled patients (PT3 and PT4). This deficient practice had the potential to increase the risk of medication errors. --- A review of Patient 3's clinical record indicated a start of care (SOC) date of 07-20-2023, with a diagnoses of Atrial fibrillation (an irregular and often very rapid heart rhythm). A review of Patient 3's Plan of Care (POC) dated 8-24-23, included an order for LVN to visit once per week, CHHA visits of twice per week, and supervisory visits conducted every 2 weeks by RN. The POC further indicated for SN to monitor vital signs, Covid symptoms, and to manage symptoms of pain. On 8-24-23 at 12:35pm. a home visit with registered Nurse (RN1) was conducted at Patient 3s board and care. During the medication reconciliation and observation of an incorrect med label was made, Lorazepam 1mg tablet by mouth every 4-6 hours as needed. A review of Patient 3s Medication Profile, dated 7-20-23, indicated Patient 3 had a physician's order for Lorazepam 2mg/ml concentrate solution every 4-6 hours as needed. During an interview on 8-24-23 at 1:40pm RN1 stated the medication label for Lorazepam 1mg tablet by mouth did not reflect what was on the medication profile Lorazepam 2mg/ml concentrate solution. During an interview on 8-24-23 at 3:50pm with the Director of Nursing (DON) she stated the medication profile for PT3 did not match what was found on the medication label in the home for one medication. DON further stated that a medication reconciliation should be done with each visit to ensure the patient is receiving exactly what the MD is ordering. During a review of the agencys policy entitled ";Medication Profile" it indicated patients receiving medications will have a current, accurate medication profile in the clinical record. A review of Patient 4's clinical record indicated a start of care (SOC) date of 07-20-2023, with a diagnoses of atherosclerotic heart disease (is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. he usual cause is the buildup of plaque. This causes coronary arteries to narrow, limiting blood flow to the heart.Coronary artery disease can range from no symptoms, to chest pain, to a heart attack. Treatments include lifestyle changes, medications, angioplasty, and surgery). A review of Patient 4's Plan of Care (POC) for the certification period of 7018-23 to 10-15-23, included an order for skilled nurse (SN) to visit once per week for changes in condition to promote comfort and symptom management. Registered Nurse (RN) once a month for supervisory visits. The POC further indicated for SN to monitor vital signs, Covid symptoms, and to manage symptoms of pain. On 8-24-23 at 10:55a.m., a joint home visit with Registered Nurse 2 (RN2) was conducted at Patient 4s residence. During the medication reconciliation the following discrepancies were noted: Aspirin 81 mg daily was in the home but not listed on the current medlist. Ibuprofen 600 mg 1 tablet every 6 hours as needed for pain. Daughter stated the patient is not taking anymore. On concurrent interview and record review with RN2 at the same date and time , RN2 stated she reviews medications every home visit. During an interview on 8-24-23 at 3:50pm with the Director of Nursing (DON) she stated the medication profile for P4 did not match what was found on the medication found in the home. DON further stated that a medication reconciliation should be done with each visit to ensure the patient is receiving exactly what the MD is ordering. DON further stated that the medication review should be per bottle compared with the medication list. During a review of the agencys policy entitled ";Medication Profile" it indicated patients receiving medications will have a current, accurate medication profile in the clinical record.

Based on observation, interview, and record review, the hospice agency (HA) failed to observe, implement, and maintain infection control measures for one of 4 sampled patients (Patient 4). The HA's failure to follow and implement infection control, when RN 2, laid her bag with care equipment on the floor while performing a home visit on 1 of 4 sampled patients (Patient 4). The HA's failure to conduct in-service training for all field staff for infection control. These deficient practices had the potential in contamination of the Patient 4's care equipment and could spread infection. --- A review of Patient 4's clinical record indicated a start of care (SOC) date of 07/18/23, with a diagnoses of atherosclerotic heart disease (is the buildup of fats, cholesterol and other substances in and on the artery walls, causes coronary arteries to narrow, limiting blood flow to the heart. A review of Patient 4's Plan of Care (POC) for the certification period of 7/18/23 to 10/15/23, included an order for skilled nurse (SN) to visit once per week for changes in condition to promote comfort and symptom management. Registered Nurse (RN) once a month for supervisory visits. The POC further indicated for SN to monitor vital signs, Covid symptoms, and to manage symptoms of pain. On 8/24/23 at 10:55 a.m., a joint home visit with Registered Nurse 2 (RN2) was conducted at Patient 4s residence. On concurrent observation, RN2 placed her bag on the floor without a protective barrier. When asked if it was her nursing bag or personal bag , RN stated "; both". RN2 did not disinfect her equipment after use and placed it directly in her bag. RN2 further stated that she should have followed proper bag technique to prevent the spread of infections. A request was made to the owner of the HA for all staff in-services on 8/24/23.The HA's lesson plan listed that the agency should have conducted their Infection Control in-service last November 2022. On concurrent review of the HA's employee file list indicated the HA had a total of eleven office and field staff employed. There was no documentation that the agency conducted their infection control in-service for all 11 staff. On 8/24/23 at 3:30 p.m., during an interview with the Director of Nursing (DON) stated that the field staff should have kept their belongings in a proper nursing bag. DON stated that field staff should have wiped their bags and staff should keep their bags separate. A review of the HA's policy titled " Infection Control Plan" dated 2023-2024 indicated the Director of Nursing (DON) is responsible for the implementation of the infection control plan and activities. The care , treatment or services provides the organization's risk for the care, treatment, and services it provides will prevent infections with hand hygiene. A review of the hospices agency's policy and procedure titled "Bag Technique" revised November 2021, stipulates, " Paper towels/newspapers used as protective barrier for bag placement in the patients home will be discarded . 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. Hands will be decontaminated prior to returning clean equipment to bag." A review of the HA's policy titled " Job Description: Registered Nurse" indicated that the registered nurse assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and maintains participation in continuing education and in-service classes.