Every finding on record at Divine Care Hospice LLC

Observed in Emergency Management Session. The Surveyor noted the organization’s hazard vulnerability analysis did not include emerging infections. This was confirmed with the Administrator

Observed in Emergency Management Session. The organization reviews and makes necessary updates based on after-action reports or opportunities for improvement as evidenced by opportunities for improvement was not completed and this was observed and validated by the Administrator

Observed in Record Review. In 1 of 6 patient records reviewed, The organization failed to maintain complete and accurate patient records as evidenced in RRHV#2 Five nursing notes did not have oxygen level documented , 6th nursing note stated 2 litres of oxygen and patient was ordered 4 litres via N/C and patient was ordered IV antibiotics via PICC line at SOC for 10 days, there was only one note at SOC and no further documentation this was observed and validated by the Administrator

Observed in Record Review. In 6 of 6 patient records reviewed, The organization written plan of care failed to be based on the patient’s goals and the time frames, settings, and services required to meet those goals, while some goals were measurable and had time frames, not all goals had realistic time frames as identified in RRHV#1 patient had lower ext edema/dyspnea and goals were that patient will be free from complications as related to cardiovascular system by end of cert period. RRDC#1: Pain is rated 5 and using pain AD guarding behavior, intervention teach change in position and observe verbal cues /pain behavior, goals goal for pain is 0 and for CG to verbalize understanding on assistance with muscle and generalized relaxation, e.g back rubs, no time frame. RRDC#3 In POC, patient is anxious, interventions to teach comfort and symptom control and outcome symptoms of anxiety are decreased, pain is 5 and interventions to teach comfort measures and medication regime to control pain, monitor pain control, outcomes : symptoms managed, compliance with medication regimen and pain is 0. RRHV#2: Dyspnea identified in interventions oxygen and teach comfort and symptom control, goals that O2 sat will be maintained above 90%. RRHV#3: Patient is incontinent of urine and goal is to maintain clear yellow urine and output of at least 30mls/hour within 24 hours, this was observed and validated by the Administrator

Observed in Record Review. In 4 of 6 patient records reviewed, The organization failed to provide the patient with care, treatment, or services according to the patient's individualized plan of care s evidenced in RRHV#1: Patient was diabetic, prescribed metformin but no orders for management of diabetes in POC. RRHV#2: patient started taking promethazine 12.5 mgs q 8 hourly/PRN for nausea and ondansetron was discontinued 3 weeks ago and no orders in the chart, in RRDC#1 : No orders for PEG tube care identified in initial assessment but not on POC and in RRHV#2: Patient was on IV antibiotic and treatment was not in IDG POC, per policy IV.6.PICC and Extended peripheral catheters, and in RRHV#3: Initial Plan of Care did not identify if patient was a DNR or Full code, this was observed and validated by the Administrator Observed in Record Review. In 4 of 6 patient records reviewed, The organization failed to include all services needed for the palliation and management of the terminal illness and related conditions in the POC as evidenced in RRHV#1:Tylenol 325 mgs 1-2 tabs daily PRN and docusate sodium 1 tab daily/PRN with no indication. RRDC#1:Oxygen 2 litre via N/C not identified whether continuous or PRN and Tylenol 325 mgs q 8 hours for pain PRN with no indication. RRDC#2: Tylenol ES 300mgs 2 tabs po q 8 hours PRN, Fleets enema ordered per rectum q 24 hours/PRN and O2 @ 2 - 4 L via N/C PRN with no indications. RRDC#3: O2 ordered 2 litre PRN and Tylenol 325 mgs 2 tabs q 8 hourly PRN without indication. this was observed and validated by the Administrator

Observed in Tracer Activities. In review of the bereavement program with the bereavement coordinator , the surveyor observe that the organization did not have a organized bereavement program. The program did not include a bereavement care plan, post death bereavement risk assessment or evaluation of services, this was observed and validated by the Bereavement Coordinator and the Administrator

Observed in Record Review. In 4 of 6 patient records reviewed, The Certificate of Terminal Illness failed to include the patient’s life expectancy considers the following factors: Current subjective and objective medical Information about the medical management of the patient’s conditions unrelated to the terminal condition as evidenced : RRHV#1: contains diagnosis, but no progression of disease, states incontinent of bowel and bladder and dependent on CG on majority of ADL's. RRHV#2: CTI does not identify decline, states primary diagnosis and secondary, other description includes increased SOB, oxygen dependent, pt is bedbound, paraplegic, has colostomy, urostomy. Patient has chronic generalized pain controlled with medication ordered. RRHV#3: CTI did not have progression of illness, states diagnosis, pain and SOB controlled by prescribed medication. and in RRDC#6: CTI lacks progression of disease, CG reports incontinence of bowel and bladder, unable to communicate, confused and dependent on CG.This was observed and validated by the DON

Observed in Patient Home. In 2 of 3 home visits conducted, The patient record failed to contain information that reflects the patient's care, treatment, or services, including any medications administered and dose as evidenced inRRHV#2- Benadryl 25 mgs ordered TID and patient taking every night and PRN for itching during the day, Albuterol II puffs ordered q 4 hourly and patient taking PRN. RRHV#3: Inaccurate medication order Fluticasone 1 puff PRN instead of 1 puff once daily and clonazepam 1mg ordered PRN for anxiety but not on Medication profile, this was observed and validated by the Administrator

Observed in Patient Home. In 2 of 3 home visits conducted, The organization failed to provide patient education and training for not providing education for safe oxygen cylinder storage as evidenced in HV#2 and HV#3,back up oxygen tanks stored upright but not in well ventilated area, they surrounding by equipment and clothes, this was observed and validated by the Administrator